Use of ambulatory glucose monitoring and analysis of ambulatory glucose profile in clinical practice for diabetes management; a position statement of the Arab Society of Paediatric Endocrinology and diabetes

As to the development of treatment for diabetes, Continuous Glucose Monitoring (CGM) has been recently prevalent rapidly. By the analysis of real-time CGM, Ambulatory Glucose Profile (AGP) has been used. It includes time in range (TIR, 70-180 mg/dL), time above range (TAR, >181mg/dL), time below range (TBR, <69 mg/dL), Glycemic Variability (GV), Glucose Management Indicator (GMI), Glycemic variability, Coefficient Of Variation (CV%) and so on. TIR value indicating approximately 70% seems to correlate closely with the HbA1c level of 6.77.0%. Marked discordance of HbA1c values has been found between laboratory HbA1c and estimated HbA1c (eA1c) using GMI from CGM.

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Using trend arrows in continuous glucose monitoring systems for insulin adjustment in clinical practice: Brazilian Diabetes Society Position Statement

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-020-00607-2 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

M. Rodacki ◽

L. E. Calliari ◽

A. C. Ramalho ◽

A. G. D. Vianna ◽

D. R. Franco ◽

...

Keyword(s):

Clinical Practice ◽

Continuous Glucose Monitoring ◽

Insulin Dose ◽

Glucose Monitoring ◽

Position Statement ◽

Monitoring Systems ◽

Insulin Pumps ◽

Patients With Diabetes ◽

Bolus Insulin ◽

Basal Bolus

AbstractThis manuscript reports the Brazilian Diabetes Society Position Statement for insulin adjustments based on trend arrows observed in continuous glucose monitoring systems. The Brazilian Diabetes Society supports the utilization of trend arrows for insulin dose adjustments in patients with diabetes on basal-bolus insulin therapy, both with multiple daily insulin doses or insulin pumps without closed-loop features. For those on insulin pumps with predictive low-glucose suspend feature, we suggest that only upward trend arrows should be used for adjustments. In this paper, tables for insulin adjustment based on sensitivity factors are provided and strategies to optimize the use of trend arrows in clinical practice are discussed.

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Utilizing the Ambulatory Glucose Profile to Standardize and Implement Continuous Glucose Monitoring in Clinical Practice

Diabetes Technology & Therapeutics ◽

10.1089/dia.2019.0034 ◽

2019 ◽

Vol 21 (S2) ◽

pp. S2-17-S2-25 ◽

Cited By ~ 12

Author(s):

Mary L. Johnson ◽

Thomas W. Martens ◽

Amy B. Criego ◽

Anders L. Carlson ◽

Gregg D. Simonson ◽

...

Keyword(s):

Clinical Practice ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Glucose Profile

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Health Technology Assessments for Flash Glucose Monitoring and How to Use Them in Everyday Clinical Practice

Journal of Diabetes Science and Technology ◽

10.1177/1932296818794668 ◽

2018 ◽

Vol 13 (3) ◽

pp. 584-591

Author(s):

Magnus Stueve ◽

Oliver Schnell

Keyword(s):

Clinical Practice ◽

Canary Islands ◽

Clinical Decision Making ◽

Diabetes Management ◽

Glucose Monitoring ◽

Clinical Decision ◽

Health Technology ◽

Insufficient Evidence ◽

Everyday Clinical Practice ◽

Flash Glucose Monitoring

Background: Various health technology assessment (HTA) agencies review new medical devices worldwide, and their recommendations can be useful in guiding clinical decision making. However, different agencies use different processes and methodologies, resulting in variation in recommendations. Objectives: The objectives were to review full HTAs for a new technology for diabetes management, flash glucose monitoring (FGM), with the aim of summarizing similarities/differences in processes, methodologies, and recommendations from the perspective of everyday clinical practice. Methods: A literature review was conducted using online HTA resources. Results: Four full HTAs were identified (Canary Islands, France, Catalunya, and Norway); one issued a conditional recommendation for patients with type 1 diabetes mellitus (T1DM) with controlled glycated hemoglobin (HbA1c) (Spain; Canary Islands), one issued a broader recommendation for patients with T1DM and T2DM (France), and two reported that there was insufficient evidence to support a recommendation (Spain [Catalunya] and Norway). The most comprehensive and stringent of the available HTAs were those in the Canary Islands and Norway, which included systematic literature reviews (SLRs), consultation with patient groups and clinicians, GRADE evidence quality assessments, and full economic models. Comprehensive HTAs either did not recommend FGM (Norway) or restricted the recommendation to a small subpopulation of the overall diabetes population (Canary Islands). Conclusion: HTAs represent a valuable additional resource for clinicians to consider alongside clinical evidence, guidelines, and consensus papers; however, interpreting recommendations requires an understanding of the processes behind these recommendations. In this review, comprehensive HTAs either recommended for a selected subpopulation based on RCT evidence or found insufficient evidence for a recommendation.

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Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

Journal of Diabetes Science and Technology ◽

10.1177/19322968211021386 ◽

2021 ◽

pp. 193229682110213

Author(s):

Stuart Chalew ◽

Alan M. Delamater ◽

Sonja Washington ◽

Jayalakshmi Bhat ◽

Diane Franz ◽

...

Keyword(s):

Type 1 Diabetes ◽

Racial Disparity ◽

Diabetes Management ◽

New Technology ◽

African American Youth ◽

Glucose Monitoring ◽

Supportive Role

Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.

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Emergency management of the paediatric patient with convulsive status epilepticus

Paediatrics & Child Health ◽

10.1093/pch/pxaa127 ◽

2021 ◽

Vol 26 (1) ◽

pp. 50-57

Author(s):

Kyle C McKenzie ◽

Cecil D Hahn ◽

Jeremy N Friedman

Keyword(s):

Clinical Practice ◽

Status Epilepticus ◽

Emergency Management ◽

Treatment Algorithm ◽

Position Statement ◽

Convulsive Status Epilepticus ◽

Pharmacological Management ◽

The Past ◽

New Treatment ◽

New Evidence

Abstract This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than 1 month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.

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An Interactive Web Application for the Statistical Analysis of Continuous Glucose Monitoring Data in Epidemiological Studies

Journal of Diabetes Science and Technology ◽

10.1177/1932296820985570 ◽

2021 ◽

pp. 193229682098557

Author(s):

Alysha M. De Livera ◽

Jonathan E. Shaw ◽

Neale Cohen ◽

Anne Reutens ◽

Agus Salim

Keyword(s):

Continuous Glucose Monitoring ◽

Web Application ◽

Diabetes Management ◽

Glucose Monitoring ◽

Epidemiological Studies ◽

Interactive Software ◽

Web Based ◽

Software Applications ◽

Visualization Of Data ◽

User Friendly

Motivation: Continuous glucose monitoring (CGM) systems are an essential part of novel technology in diabetes management and care. CGM studies have become increasingly popular among researchers, healthcare professionals, and people with diabetes due to the large amount of useful information that can be collected using CGM systems. The analysis of the data from these studies for research purposes, however, remains a challenge due to the characteristics and large volume of the data. Results: Currently, there are no publicly available interactive software applications that can perform statistical analyses and visualization of data from CGM studies. With the rapidly increasing popularity of CGM studies, such an application is becoming necessary for anyone who works with these large CGM datasets, in particular for those with little background in programming or statistics. CGMStatsAnalyser is a publicly available, user-friendly, web-based application, which can be used to interactively visualize, summarize, and statistically analyze voluminous and complex CGM datasets together with the subject characteristics with ease.

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