Comparing Real-Time Self-Tracking and Device-Recorded Exercise Data in Subjects with Type 1 Diabetes

Background Insulin therapy, medical nutrition therapy, and physical activity are required for the treatment of type 1 diabetes (T1D). There is a lack of studies in real-life environments that characterize patient-reported data from logs, activity trackers, and medical devices (e.g., glucose sensors) in the context of exercise. Objective The objective of this study was to compare data from continuous glucose monitor (CGM), wristband heart rate monitor (WHRM), and self-tracking with a smartphone application (app), iDECIDE, with regards to exercise behaviors and rate of change in glucose levels. Methods Participants with T1D on insulin pump therapy tracked exercise for 1 month with the smartphone app while WHRM and CGM recorded data in real time. Exercise behaviors tracked with the app were compared against WHRM. The rate of change in glucose levels, as recorded by CGM, resulting from exercise was compared between exercise events documented with the app and recorded by the WHRM. Results Twelve participants generated 277 exercise events. Tracking with the app aligned well with WHRM with respect to frequency, 3.0 (2.1) and 2.5 (1.8) days per week, respectively (p = 0.60). Duration had very high agreement, the mean duration from the app was 65.6 (55.2) and 64.8 (54.9) minutes from WHRM (p = 0.45). Intensity had a low concordance between the data sources (Cohen's kappa = 0.2). The mean rate of change of glucose during exercise was –0.27 mg/(dL*min) and was not significantly different between data sources or intensity (p = 0.21). Conclusion We collated and analyzed data from three heterogeneous sources from free-living participants. Patients' perceived intensity of exercise can serve as a surrogate for exercise tracked by a WHRM when considering the glycemic impact of exercise on self-care regimens.

Download Full-text

Feasibility study of real-time online text-based CBT to support self-management for people with type 1 diabetes: the Diabetes On-line Therapy (DOT) Study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001934 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001934

Author(s):

Anne M Doherty ◽

Anne Herrmann-Werner ◽

Arann Rowe ◽

Jennie Brown ◽

Scott Weich ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Real Time ◽

Instant Messaging ◽

Controlled Trial ◽

Self Management ◽

Diabetes Distress ◽

The Mean ◽

Distress Scale

IntroductionThis study examines the feasibility of conducting diabetes-focused cognitive–behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes.Research design and methodsWe used a pre–post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS).ResultsWe screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference −6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved.ConclusionsIt would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.

Download Full-text

Active Subjects with Autoimmune Type 1 Diabetes have Better Metabolic Profiles than Sedentary Controls

Cell Transplantation ◽

10.3727/096368916x693022 ◽

2017 ◽

Vol 26 (1) ◽

pp. 23-32 ◽

Cited By ~ 10

Author(s):

M. Adamo ◽

R. Codella ◽

F. Casiraghi ◽

A. Ferrulli ◽

C. Macrì ◽

...

Keyword(s):

Physical Activity ◽

Type 1 Diabetes ◽

Insulin Pump ◽

Glycosylated Hemoglobin ◽

High Volume ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Glucose Levels ◽

Nonobese Diabetic Mice

Previous studies in humans with type 1 diabetes mellitus (T1D) and in nonobese diabetic mice have investigated the beneficial immunomodulatory potential of aerobic physical activity. Performing high volume of aerobic exercise may favorably regulate autoimmunity in diabetes. We tested whether increased physical activity is a self-sufficient positive factor in T1D subjects. During a 3-month observational period, active (six males; 40.5 ± 6.1 years; BMI: 24.5 ± 2.1) and sedentary (four males, three females; 35.9 ± 8.9 years; BMI: 25.7 ± 3.8) T1D individuals on insulin pump therapy were studied for metabolic, inflammatory, and autoimmune parameters. At baseline and at the end of a 3-month period, glycosylated hemoglobin (HbA1c), autoantibodies (anti-GAD, anti-ZnT8, anti-IA2, and ICA) and proinflammatory cytokines (IL-6 and TNF-α) were evaluated. During the third month of the period, physically active T1D patients showed a significant reduction in the average glucose levels (-9%, p = 0.025, by CGM) compared to the first month values, and even their hyperglycemic episodes (>180 mg/dl) diminished significantly (-24.2%, p = 0.032 vs. first month). Moreover, active T1D subjects exhibited an improved body composition with respect to sedentary controls. No significant changes were detected as to the autoimmune and inflammatory profiles. This study confirms the beneficial role of physical exercise associated with insulin pump therapy in order to improve metabolic control in individuals with T1D. These preliminary positive observations need to be challenged in a prolonged interventional follow-up.

Download Full-text

Use of continuous glucose monitoring trend arrows in the younger population with type 1 diabetes

Diabetes and Vascular Disease Research ◽

10.1177/14791641211062155 ◽

2021 ◽

Vol 18 (6) ◽

pp. 147916412110621

Author(s):

Nancy Elbarbary ◽

Othmar Moser ◽

Saif Al yaarubi ◽

Hussain Alsaffar ◽

Adnan Al Shaikh ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young People ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Vascular Complications ◽

Rate Of Change ◽

Rapid Expansion ◽

Nocturnal Hypoglycaemia ◽

Glucose Levels

Early control of glycaemia is key to reduce vascular complications in individuals with Type 1 diabetes. Therefore, encouraging children and adolescents with T1DM to take responsibility for controlling glucose levels is an important yet a challenging task. The rapid expansion of continuous glucose monitoring (CGM) systems has allowed for more comprehensive analysis of glycaemia in T1D. Moreover, CGM devices have the ability to calculate rate of change in glucose levels and display the information as trend arrows. In turn, this can help to take evasive actions to return glucose levels to near physiological glycaemia, which can be highly motivating for young people with T1DM. In the absence of standardised, evidence-based guidance, this consensus document, generated by experts from the Arab Society of Paediatric Endocrinology and Diabetes and international advisors, summarises recent literature on the use of trend arrows in young people with T1DM. The use of trend arrows in different CGM systems is reviewed and their clinical significance is highlighted. Adjusting insulin doses according to trend arrows is discussed while also addressing special situations, such as exercise, fasting, nocturnal hypoglycaemia and menstruation. Adequate understanding of trend arrows should facilitate optimisation of glycaemic control in the T1D population.

Download Full-text

Assessment of the “Second Day” Exercise Effect on Glycemic Control, Insulin Requirements, and CHO Intake in Type 1 Diabetes Adults

Journal of Diabetes Science and Technology ◽

10.1177/1932296819879419 ◽

2019 ◽

Vol 15 (1) ◽

pp. 127-133 ◽

Cited By ~ 1

Author(s):

Michael Müller-Korbsch ◽

Lisa Frühwald ◽

Michael Heer ◽

Maria Fangmeyer-Binder ◽

David Reinhart-Mikocki ◽

...

Keyword(s):

Type 1 Diabetes ◽

Aerobic Exercise ◽

Insulin Pump ◽

Insulin Pump Therapy ◽

Target Range ◽

Pump Therapy ◽

Glucose Levels ◽

Insulin Requirements ◽

Mean Glucose

Background: Glucose control during consecutive days of aerobic exercise has not been well studied. We assessed glycemia, insulin requirements, and carbohydrate (CHO) needs during two consecutive days of prolonged cycling in type 1 diabetes (T1D) adults using sensor-augmented insulin pump therapy. Methods: Twenty adults with well-controlled T1D and six healthy adults (for comparison) were enrolled. Assessments were made during two consecutive days of cycling activities (30 miles per day). On day 1 (D1), basal rates were reduced 50% and CHO intake was guided by real-time continuous glucose monitoring (rtCGM) data to maintain a target range (70-180 mg/dL). On day 2 (D2), basal insulin infusion was stopped for the first hour of biking and resumed at a minimal rate during biking. Carbohydrate intake one hour before, during, and ten minutes after biking was recorded. Times within/below target range, glycemic variability, and mean glucose were calculated from rtCGM data. Results: Among 17 T1D participants who completed the study, mean glucose levels at the start of cycling were slightly lower on D2 vs D1: 138 ± 16 mg/dL and 122 ± 16, respectively, P = NS. Type 1 diabetes participants achieved near-normal glucose levels at the end of both cycling events; however, the reduction in glucose was most notable at one hour into the event on D2 vs D1. Carbohydrate intake was notably lower during D2 vs D1 with no difference in time <54 mg/dL (both P = NS). Conclusions: Type 1 diabetes individuals using rtCGM-augmented insulin pump therapy can safely engage in consecutive days of prolonged aerobic exercise by significantly reducing insulin dosages with no increase in CHO intake.

Download Full-text

Recommendations for Using Real-Time Continuous Glucose Monitoring (rtCGM) Data for Insulin Adjustments in Type 1 Diabetes

Journal of Diabetes Science and Technology ◽

10.1177/1932296816663747 ◽

2016 ◽

Vol 11 (1) ◽

pp. 138-147 ◽

Cited By ~ 61

Author(s):

Jeremy Pettus ◽

Steven V. Edelman

Keyword(s):

Type 1 Diabetes ◽

Real Time ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Rate Of Change ◽

Clinical Experiences ◽

Clinical Benefits ◽

Effective Use ◽

Patient Use

The clinical benefits of real time continuous glucose monitoring (rtCGM) use have been well demonstrated in both CSII- and MDI-treated individuals in large clinical trials. However, recommendations for patient use of rtCGM in everyday life situations are lacking. This article provides guidance to clinicians and patients with type 1 diabetes (T1D) in effective use of rtCGM data, including glucose rate of change (ROC) arrows, for insulin dosing adjustments and other treatment decisions. The recommendations presented here are based on our own clinical experiences as endocrinologists, our personal experiences living with T1D using rtCGM, and findings from a recent survey of T1D patients who have successfully used rtCGM in their self-management. It is important that both clinicians and people with diabetes understand the utility and limitations of rtCGM. Maintaining a collaborative clinician-user relationship remains an important factor in safe, successful rtCGM use.

Download Full-text

Unexpected Management Behaviors in Adolescents With Type 1 Diabetes Using Sensor-Augmented Pump Therapy

Journal of Diabetes Science and Technology ◽

10.1177/1932296817752188 ◽

2018 ◽

Vol 12 (3) ◽

pp. 592-598 ◽

Cited By ~ 7

Author(s):

Mary Binsu Abraham ◽

Kristine Heels ◽

Jennifer A. Nicholas ◽

Carol Cole ◽

Rebecca Gebert ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Real Time ◽

Sensor Data ◽

Continuous Exposure ◽

Time Data ◽

Pump Therapy ◽

Glucose Levels ◽

Management Behaviors

Background: Continuous glucose monitoring can improve glycemic outcomes in individuals with type 1 diabetes. However, the constant exposure to real-time glucose levels can sometimes lead the individual to make some risky choices to address the glycemic excursions. Hence, the purpose of this study was to explore the aberrant management behaviors of youth with type 1 diabetes on sensor-augmented pump therapy (SAPT). Methods: Participants in a clinical trial using SAPT on Medtronic MiniMed™ 640G pump who experienced deteriorating glycemic control or unexplained hypoglycemia were identified by the health care professional. The pump and/or sensor data uploaded to CareLink™ Therapy Management Software were reviewed in these participants. Results: Uncharacteristic management behaviors were identified in five adolescent males. Continuous exposure to high glucose levels resulted in obsessive behaviors displaying a perfectionistic attitude in two participants. Multiple boluses were delivered frequently as uneaten carbohydrates in participant 1 while participant 2 resorted to delivery of extra insulin by cannula fills. In contrast, participant 3 chose to remain hyperglycemic to avoid weight gain while participant 4 trusted the system and used sensor glucose readings for calibrations, with resultant deterioration in glycemic control in both participants. On the other hand, participant 5, due to mistrust in the pump suspend function, consumed carbohydrates with downward glucose trends with rebound hyperglycemia. Conclusions: Constant exposure to real-time data can lead to unsafe management responses in adolescents with the behavior influenced by trust or mistrust in the system. Adolescents should be empowered with problem-solving strategies for safe management.

Download Full-text

Sustained Impact of Real-time Continuous Glucose Monitoring in Adults With Type 1 Diabetes on Insulin Pump Therapy: Results After the 24-Month RESCUE Study

Diabetes Care ◽

10.2337/dc20-1531 ◽

2020 ◽

Vol 43 (12) ◽

pp. 3016-3023

Author(s):

Sara Charleer ◽

Christophe De Block ◽

Frank Nobels ◽

Régis P. Radermecker ◽

Ine Lowyck ◽

...

Keyword(s):

Type 1 Diabetes ◽

Real Time ◽

Continuous Glucose Monitoring ◽

Insulin Pump ◽

Glucose Monitoring ◽

Insulin Pump Therapy ◽

Pump Therapy

Download Full-text

Sustained impact of real-time continuous glucose monitoring in adults with type 1 diabetes on insulin pump therapy: Results after 24 months RESCUE study

10.2337/figshare.12974588 ◽

2020 ◽

Author(s):

Sara Charleer ◽

Christophe De Block ◽

Frank Nobels ◽

Régis P. Radermecker ◽

Ine Lowyck ◽

...

Keyword(s):

Type 1 Diabetes ◽

Real Time ◽

Continuous Glucose Monitoring ◽

Insulin Pump ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Acute Hypoglycemia

Objective: In recent years, a growing number of people with type 1 diabetes have access to real-time continuous glucose monitoring (rtCGM). Long-term benefits of rtCGM are unclear due to lack of large studies of long duration. We evaluated whether real-world rtCGM-use up to 24 months offered benefits, in particular to those living with impaired awareness of hypoglycemia (IAH). Research Design and Methods: This 24-month, prospective, observational, cohort study followed 441 adults with insulin pumps receiving full reimbursement for rtCGM. Forty-two percent had IAH. Primary endpoint was evolution of HbA1c, with secondary endpoints change in acute hypoglycemia complications, diabetes-related work absenteeism, and quality of life (QOL) scores. Additionally, we evaluated if people could achieve glycemic consensus targets during follow-up. Results: After 24 months, HbA1c remained significantly lower compared to baseline (7.64% [60 mmol/mol] vs 7.37% [57 mmol/mol], p<0.0001). Sustained benefits were also observed for the score on the hypoglycemia fear survey and hypoglycemia-related acute complications irrespective of hypoglycemia awareness level. People with IAH had the strongest improvement, especially for severe hypoglycemia (862 events year before vs 119 events per 100 patient-years in second year, p<0.0001). Over 24 months, more people were able to meet hypoglycemia consensus targets at the expense of slightly less people achieving hyperglycemia consensus targets. Furthermore, the number of people with HbA1c <7% (<53 mmol/mol) without severe hypoglycemia events more than doubled (11.0% vs 25.4%, p<0.0001). Conclusion: Use of rtCGM led to sustained improvements in hypoglycemia-related glucose control over 24 months. Lower fear of hypoglycemia, less acute hypoglycemia-related events and diabetes-related days off work were observed, particularly in those with IAH.

Download Full-text

Rationale and protocol for the Assessment of Impact of Real-time Continuous Glucose Monitoring on people presenting with severe Hypoglycaemia (AIR-CGM) study

BMC Endocrine Disorders ◽

10.1186/s12902-019-0439-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Parizad Avari ◽

Rozana Ramli ◽

Monika Reddy ◽

Nick Oliver ◽

Rachael Fothergill

Keyword(s):

Type 1 Diabetes ◽

Real Time ◽

Continuous Glucose Monitoring ◽

Standard Care ◽

Severe Hypoglycaemia ◽

Glucose Monitoring ◽

Significant Risk ◽

Patient Reported ◽

The Impact

Abstract Background Severe hypoglycaemia carries a significant risk of morbidity and mortality for people with type 1 diabetes. Economic costs are also high, estimated at approximately £13 million annually in England, UK. Continuous glucose monitoring (CGM) has been shown to reduce hypoglycaemia and associated fear, improve overall glycaemia and quality of life, and is cost-effective. Despite effective pathways in place with high levels of resource utilization, it has been reported there are low levels of follow-up, therapy change and specialist intervention after severe hypoglycaemia. This study is designed to assess the impact of providing real-time CGM to people with type 1 diabetes, who have had a recent episode of severe hypoglycaemia (within 72 h), compared to standard care. Methods/design Fifty-five participants with type 1 diabetes and a recent episode of severe hypoglycaemia, who are CGM naïve, will be recruited to the study. Participants will be randomised to CGM or standard care. The primary outcome is percentage time spent in hypoglycaemia (< 3.0 mmol/L, 55 mg/dL). Secondary outcomes include other measures of hypoglycaemia, time in euglycaemia, overall glucose status and patient reported qualitative measures. Discussion This study assesses the impact of providing continuous glucose monitoring at the outset in individuals at highest risk of hypoglycaemia. Changing demand means that novel approaches need to be taken to healthcare provision. This study has the potential to shape future national standards. Trial registration NCT03748433, November 2018 (UK).

Download Full-text