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Babiker A, Alammari N, Aljuraisi A, Alharbi R, Alqarni H, Masuadi E, Alfaraidi H. The Effectiveness of Insulin Pump Therapy Versus Multiple Daily Injections in Children With Type 1 Diabetes Mellitus in a Specialized Center in Riyadh. Clin Med Insights Endocrinol Diabetes 2022; 15:11795514221128495. [PMID: 36313241 PMCID: PMC9597023 DOI: 10.1177/11795514221128495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Comparison of continuous subcutaneous insulin infusion (CSII) with multiple daily injections (MDI) in achieving glycemic control in youths with type 1 diabetes mellitus (T1DM). Methods Retrospective cohort study including 2 matched groups of youths with T1DM treated by CSII or MDI in a tertiary specialized children's hospital in Saudi Arabia. Children and adolescents aged up to 18 years, diagnosed with T1DM and using CSII or MDI, from the period 2016 to 2018. Patients on MDI were newly-diagnosed patients with T1DM who had the disease for only 1 year duration; all CSII patients had at least 1 to 2 years of T1DM but who had just started on pumps in the past 3 months. We excluded patients with other autoimmune diseases, non-ambulatory patients and those admitted to hospital for non-diabetes reasons. Primary outcome was HbA1c at 1, 2, and 3 years, with weight gain as a secondary outcome. Ambulatory glycemic profile was analyzed from a subset of patients using intermittently scanned continuous glucose monitoring (isCGM). Results A total of 168 youths with T1DM (n = 129 in the MDI group, n = 39 in the CSII group) were included. The CSII group consistently had lower HbA1c levels compared to the MDI group throughout a 3-year follow up period: 8.1% versus 10.1, P-value < .001 at 1 year, 7.5% versus 10.1% at 2 years, P-value < .001, 8.9% versus 10.3% at 3 years, P-value = .033. Body mass index significantly increased in both groups at 1 year, although greater in CSII group. In a subgroup using isCGM (n = 37 on MDI and n = 29 on CSII), the CSII group had a lower average blood glucose (194 mg/dL vs 228 mg/dL, P-value = .028) and a lower estimated HbA1c level (8.4% vs 9.6%, P-value = .022). Conclusion Treatment with CSII resulted in lower HbA1c compared to MDI in our cohort, which was sustained over a 3-year period.
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Affiliation(s)
- Amir Babiker
- College of Medicine, King Saud bin
Abdul-Aziz University for Health Sciences, Ministry of National Guard Health
Affairs, Riyadh, Saudi Arabia,Pediatric Department, King Abdullah
Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National
Guard Health Affairs, Riyadh, Saudi Arabia,King Abdullah International Medical
Research Center, Ministry of National Guard Health Affairs Riyadh, Saudi
Arabia,Amir Babiker, King Abdullah Specialized
Children’s Hospital, King Abdulaziz Medical City, King Saud Bin Abdulaziz
University for Health Sciences, King Abdullah International Medical Research
Center, Ministry of National Guard Health Affairs, P.O. Box. 22490, Riyadh
11426, Saudi Arabia. Emails: ;
| | - Nawaf Alammari
- College of Medicine, King Saud bin
Abdul-Aziz University for Health Sciences, Ministry of National Guard Health
Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman Aljuraisi
- College of Medicine, King Saud bin
Abdul-Aziz University for Health Sciences, Ministry of National Guard Health
Affairs, Riyadh, Saudi Arabia
| | - Rakan Alharbi
- College of Medicine, King Saud bin
Abdul-Aziz University for Health Sciences, Ministry of National Guard Health
Affairs, Riyadh, Saudi Arabia
| | - Hamoud Alqarni
- College of Medicine, King Saud bin
Abdul-Aziz University for Health Sciences, Ministry of National Guard Health
Affairs, Riyadh, Saudi Arabia
| | - Emad Masuadi
- College of Medicine, King Saud bin
Abdul-Aziz University for Health Sciences, Ministry of National Guard Health
Affairs, Riyadh, Saudi Arabia,King Abdullah International Medical
Research Center, Ministry of National Guard Health Affairs Riyadh, Saudi
Arabia
| | - Haifa Alfaraidi
- College of Medicine, King Saud bin
Abdul-Aziz University for Health Sciences, Ministry of National Guard Health
Affairs, Riyadh, Saudi Arabia,Pediatric Department, King Abdullah
Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National
Guard Health Affairs, Riyadh, Saudi Arabia,King Abdullah International Medical
Research Center, Ministry of National Guard Health Affairs Riyadh, Saudi
Arabia
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Boscari F, Avogaro A. Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives. Rev Endocr Metab Disord 2021; 22:217-240. [PMID: 33755854 PMCID: PMC7985920 DOI: 10.1007/s11154-021-09635-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Type 1 diabetes mellitus imposes a significant burden of complications and mortality, despite important advances in treatment: subjects affected by this disease have also a worse quality of life-related to disease management. To overcome these challenges, different new approaches have been proposed, such as new insulin formulations or innovative devices. The introduction of insulin pumps allows a more physiological insulin administration with a reduction of HbA1c level and hypoglycemic risk. New continuous glucose monitoring systems with better accuracy have allowed, not only better glucose control, but also the improvement of the quality of life. Integration of these devices with control algorithms brought to the creation of the first artificial pancreas, able to independently gain metabolic control without the risk of hypo- and hyperglycemic crisis. This approach has revolutionized the management of diabetes both in terms of quality of life and glucose control. However, complete independence from exogenous insulin will be obtained only by biological approaches that foresee the replacement of functional beta cells obtained from stem cells: this will be a major challenge but the biggest hope for the subjects with type 1 diabetes. In this review, we will outline the current scenario of innovative diabetes management both from a technological and biological point of view, and we will also forecast some cutting-edge approaches to reduce the challenges that hamper the definitive cure of diabetes.
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Affiliation(s)
- Federico Boscari
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy.
| | - Angelo Avogaro
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy
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Gajewska KA, Biesma R, Bennett K, Sreenan S. Barriers and facilitators to accessing insulin pump therapy by adults with type 1 diabetes mellitus: a qualitative study. Acta Diabetol 2021; 58:93-105. [PMID: 32862261 DOI: 10.1007/s00592-020-01595-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/09/2020] [Indexed: 12/31/2022]
Abstract
AIMS Uptake of continuous subcutaneous insulin infusion (CSII) by people with diabetes (PwD) in Ireland is low and exhibits regional variation. This study explores barriers and facilitators to accessing CSII by adults with Type 1 diabetes mellitus. RESEARCH DESIGN AND METHODS A qualitative study employing focus groups with adults with Type 1 diabetes mellitus (n = 26) and semi-structured interviews with health care professionals (HCP) and other key stakeholders (n = 21) was conducted. Reflexive thematic analysis was used to analyze data, using NVivo. RESULTS Four main themes comprising barriers to or facilitators of CSII uptake were identified. These included: (1) awareness of CSII and its benefits, (2) the structure of diabetes services, (3) the capacity of the diabetes service to deliver the CSII service, and (4) the impact of individuals' attitudes and personal characteristics-both PwD, and HCP. Each of these themes was associated with a number of categories, of which 18 were identified and explored. If the structure of the health-service is insufficient and capacity is poor (e.g., under-resourced clinics), CSII uptake appears to be impacted by individuals': interest, attitude, willingness and motivation, which may intensify the regional inequality in accessing CSII. CONCLUSIONS This study identified factors that contribute to gaps in the delivery of diabetes care that policy-makers may use to improve access to CSII for adult PwD.
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Affiliation(s)
- Katarzyna A Gajewska
- Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland.
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kathleen Bennett
- Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland
| | - Seamus Sreenan
- 3U Diabetes, RCSI: University of Medicine and Health Sciences, Dublin, Ireland
- Department of Diabetes and Endocrinology, RCSI: University of Medicine and Health Sciences, Connolly Hospital, Dublin, Ireland
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Gajewska KA, Biesma R, Bennett K, Sreenan S. Availability of and access to continuous subcutaneous insulin infusion therapy for adults with type 1 diabetes in Ireland. Acta Diabetol 2020; 57:875-882. [PMID: 32124077 DOI: 10.1007/s00592-020-01497-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/04/2020] [Indexed: 12/18/2022]
Abstract
AIMS The uptake of continuous subcutaneous insulin infusion (CSII) is low in adults with type 1 diabetes mellitus (T1DM) in Ireland, compared to other countries where CSII is reimbursed. To explore the reasons for the low uptake, this study aims to investigate the availability of CSII in adult diabetes clinics in Ireland. METHODS A national survey of all adult diabetes clinics (public and private) in Ireland was conducted and completed anonymously by the lead physician/diabetes nurse specialist in each clinic. Descriptive statistics and comparisons between clinics offering different levels of care for CSII are presented. RESULTS Of 50 diabetes clinics invited, 47 (94%) participated in the study. Fifteen clinics (32%) offered no support for CSII, while 21 (45%) reported offering both training to commence CSII and ongoing support. Based on the survey findings, access to CSII was unavailable for 2426 (11%) of those with T1DM. The majority (n = 15,831, 71% of 22,321 T1DM population) received diabetes care from clinics offering CSII training, but only 2165 were using CSII (10% of T1DM population). Uptake of CSII was higher in clinics offering training than in those offering follow-up care for CSII only (12% vs. 5%, p < 0.001). Clinics offering all CSII services had more specialists (p = 0.005 for endocrinologists and p < 0.001 for dietitians). Reasons for not offering CSII services included staff shortages and heavy workload. CONCLUSIONS This study highlights the low uptake of CSII in Ireland and demonstrates that, even when reimbursed, other barriers to uptake of CSII can limit its use.
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Affiliation(s)
- Katarzyna Anna Gajewska
- Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland.
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, University Medical Centre, Groningen, The Netherlands
| | - Kathleen Bennett
- Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland
| | - Seamus Sreenan
- 3U Diabetes, RCSI: University of Medicine and Health Sciences, Dublin, Ireland
- Department of Diabetes and Endocrinology, RCSI: University of Medicine and Health Sciences, Connolly Hospital, Dublin, Ireland
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Gajewska KA, Bennett K, Biesma R, Sreenan S. Low uptake of continuous subcutaneous insulin infusion therapy in people with type 1 diabetes in Ireland: a retrospective cross-sectional study. BMC Endocr Disord 2020; 20:92. [PMID: 32576284 PMCID: PMC7310521 DOI: 10.1186/s12902-020-00573-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The uptake of continuous subcutaneous insulin infusion (CSII) therapy in those with type 1 diabetes varies internationally and is mainly determined by the national healthcare reimbursement systems. The aim of this study is to estimate national and regional uptake of CSII therapy in children, adolescents and adults with type 1 diabetes in Ireland. METHODS A retrospective cross-sectional study was conducted utilizing the national pharmacy claims database in 2016. Individuals using CSII were identified by dispensing of infusion sets. The uptake of CSII was calculated as the percentage of people with type 1 diabetes claiming CSII sets in 2016, both in children and adolescent (age < 18 years) and adult populations (≥ 18 years). Descriptive statistics including percentages with 95% confidence intervals (CIs) are presented, stratified by age-groups and geographical regions, and chi-square tests used for comparisons. RESULTS Of 20,081 people with type 1 diabetes, 2111 (10.5, 95% CI: 10.1-10.9%) were using CSII in 2016. Uptake was five-fold higher in children and adolescents at 34.7% (95% CI: 32.9-36.5%) than in adults at 6.8% (95% CI: 6.4-7.2%). Significant geographical heterogeneity in CSII uptake was found, from 12.6 to 53.7% in children and adolescents (p < 0.001), and 2 to 9.6% in adults (p < 0.001). CONCLUSIONS Uptake of CSII in people with type 1 diabetes is low in Ireland, particularly in those ≥18 years. Identification of barriers to uptake, particularly in this group, is required.
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Affiliation(s)
- Katarzyna Anna Gajewska
- Division of Population Health Scineces, RCSI: University of Medicine and Health Sciences, Dublin, Ireland.
| | - Kathleen Bennett
- Division of Population Health Scineces, RCSI: University of Medicine and Health Sciences, Dublin, Ireland
| | - Regien Biesma
- Department of Health Sciences, Global Health, Univeristy Medical Centre Groningen, Groningen, the Netherlands
| | - Seamus Sreenan
- 3U Diabetes, RCSI: University of Medicine and Health Scineces, Dublin, Ireland
- Diabetes and Endocrinology. RCSI: University of Medicine and Health Sciences, Connolly Hospital, Dublin, Ireland
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Zuberi Z, Sauli E, Cun L, Deng J, Li WJ, He XL, Li W. Insulin-delivery methods for children and adolescents with type 1 diabetes. Ther Adv Endocrinol Metab 2020; 11:2042018820906016. [PMID: 32944212 PMCID: PMC7466897 DOI: 10.1177/2042018820906016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 01/17/2020] [Indexed: 11/15/2022] Open
Abstract
Efforts directed toward restoring normal metabolic levels by mimicking the physiological insulin secretion, thereby ensuring safety, efficacy, minimal invasiveness and conveniences, are of great significance in the management of type 1 diabetes among children and adolescents. Regardless of the various technologies being discovered in addressing invasiveness and enhancing medication adherence in the management of type 1 diabetes, yet limited success had been observed among children and adolescents. The multiple daily subcutaneous insulin injections route using vial and syringe, and occasionally insulin pens, remain the most predictable route for insulin administration among children and adolescents. However, this route has been associated with compromised patient compliance, fear of injections and unacceptability, resulting in poor glycemic control, which promote the demand for alternative routes of insulin administration. Alternative routes for delivering insulin are being investigated in children and adolescents with type 1 diabetes; these include the hybrid closed-loop 'artificial pancreas' system, oral, inhalation, intranasal routes, and others. This review article explores the current advances in insulin-delivery methods that address the needs of children and adolescents in the treatment of type 1 diabetes.
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Affiliation(s)
- Zavuga Zuberi
- Hunan Key Laboratory of Biological Nanomaterials and Devices, Hunan University of Technology, Hunan, PR China
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
| | - Elingarami Sauli
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
| | - Liu Cun
- Hunan Key Laboratory of Biological Nanomaterials and Devices, Hunan University of Technology, Hunan, PR China
| | - Jing Deng
- Hunan Key Laboratory of Biological Nanomaterials and Devices, Hunan University of Technology, Hunan, PR China
| | - Wen-Jun Li
- Zhuzhou City People’s Hospital, Affiliated Hospital of Changsha Medical College, Hunan, PR China
| | - Xu-Liang He
- Zhuzhou City People’s Hospital, Affiliated Hospital of Changsha Medical College, Hunan, PR China
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Chawla R, Makkar BM, Aggarwal S, Bajaj S, Das AK, Ghosh S, Gupta A, Gupta S, Jaggi S, Jana J, Keswadev J, Kalra S, Keswani P, Kumar V, Maheshwari A, Moses A, Nawal CL, Panda J, Panikar V, Ramchandani GD, Rao PV, Saboo B, Sahay R, Setty KR, Viswanathan V, Aravind SR, Banarjee S, Bhansali A, Chandalia HB, Das S, Gupta OP, Joshi S, Kumar A, Kumar KM, Madhu SV, Mittal A, Mohan V, Munichhoodappa C, Ramachandran A, Sahay BK, Sai J, Seshiah V, Zargar AH. RSSDI consensus recommendations on insulin therapy in the management of diabetes. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00783-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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