scholarly journals Population-level management of Type 1 diabetes via continuous glucose monitoring and algorithm-enabled patient prioritization: Precision health meets population health

2021 ◽  
Author(s):  
Johannes O Ferstad ◽  
Jacqueline Jil Vallon ◽  
Daniel Jun ◽  
Angela Gu ◽  
Anastasiya Vitko ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Monitoring ◽  
Population Level ◽  
Continuous Glucose Monitor ◽  
Team Members ◽  
Clinical Criteria ◽  
Number Of Patients ◽  
Patient Prioritization ◽  
Time In Range

Objective: To develop and scale algorithm-enabled patient prioritization to improve population-level management of type 1 diabetes (T1D) in a pediatric clinic with fixed resources, using telemedicine and remote monitoring of patients via continuous glucose monitor (CGM) data review. Research Design and Methods: We adapted consensus glucose targets for T1D patients using CGM to identify interpretable clinical criteria to prioritize patients for weekly provider review. The criteria were constructed to manage the number of patients reviewed weekly and identify patients who most needed provider contact. We developed an interactive dashboard to display CGM data relevant for the patients prioritized for review. Results: The introduction of the new criteria and interactive dashboard was associated with a 60% reduction in the mean time spent by diabetes team members who remotely and asynchronously reviewed patient data and contacted patients, from 3.2 +/- 0.20 to 1.3 +/- 0.24 minutes per patient per week. Given fixed resources for review, this corresponded to an estimated 147% increase in weekly clinic capacity. Patients who qualified for and received remote review (n=58) have associated 8.8 percentage points (pp) (95% CI = 0.6-16.9pp) greater time-in-range (70-180 mg/dL) glucoses compared to 25 control patients who did not qualify at twelve months after T1D onset. Conclusions: An algorithm-enabled prioritization of T1D patients with CGM for asynchronous remote review reduced provider time spent per patient and was associated with improved time-in-range.

Increased Time-in-Range with Sotagliflozin as Adjunct Therapy to Insulin in Adults with Type 1 Diabetes as Demonstrated by 24-Week Continuous Glucose Monitoring (inTandem1, inTandem2)

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1179-P ◽  
Author(s):  
THOMAS DANNE ◽  
BERTRAND CARIOU ◽  
JOHN B. BUSE ◽  
SATISH K. GARG ◽  
JULIO ROSENSTOCK ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Adjunct Therapy ◽  
Time In Range

scholarly journals Alarm Settings of Continuous Glucose Monitoring Systems and Associations to Glucose Outcomes in Type 1 Diabetes

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Yu Kuei Lin ◽  
Danielle Groat ◽  
Owen Chan ◽  
Man Hung ◽  
Anu Sharma ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Monitoring ◽  
Continuous Glucose Monitor ◽  
Cross Sectional ◽  
Therapeutic Goals ◽  
Glucose Levels ◽  
Alarm Threshold ◽  
Negative Impacts ◽  
Average Glucose

Abstract Context Little evidence exists regarding the positive and negative impacts of continuous glucose monitor system (CGM) alarm settings for diabetes control in patients with type 1 diabetes (T1D). Objective Evaluate the associations between CGM alarm settings and glucose outcomes. Design and Setting A cross-sectional observational study in a single academic institution. Patients and Main Outcome Measures CGM alarm settings and 2-week CGM glucose information were collected from 95 T1D patients with > 3 months of CGM use and ≥ 86% active usage time. The associations between CGM alarm settings and glucose outcomes were analyzed. Results Higher glucose thresholds for hypoglycemia alarms (ie, ≥ 73 mg/dL vs < 73 mg/dL) were related to 51% and 65% less time with glucose < 70 and < 54 mg/dL, respectively (P = 0.005; P = 0.016), higher average glucose levels (P = 0.002) and less time-in-range (P = 0.005), but not more hypoglycemia alarms. The optimal alarm threshold for < 1% of time in hypoglycemia was 75 mg/dL. Lower glucose thresholds for hyperglycemia alarms (ie, ≤ 205 mg/dL vs > 205 mg/dL) were related to lower average glucose levels and 42% and 61% less time with glucose > 250 and > 320 mg/dL (P = 0.020, P = 0.016, P = 0.007, respectively), without more hypoglycemia. Lower alarm thresholds were also associated with more alarms (P < 0.0001). The optimal alarm threshold for < 5% of time in hyperglycemia and hemoglobin A1c ≤ 7% was 170 mg/dL. Conclusions Different CGM glucose thresholds for hypo/hyperglycemia alarms are associated with various hypo/hyperglycemic outcomes. Configurations to the hypo/hyperglycemia alarm thresholds could be considered as an intervention to achieve therapeutic goals.

Frequency of flash glucose monitoring readings, hemoglobin A1c and time in range: a real life study in adults with type 1 diabetes

2020 ◽  
Vol 57 (11) ◽  
pp. 1395-1397 ◽  
Author(s):  
Andrea Laurenzi ◽  
Amelia Caretto ◽  
Mariluce Barrasso ◽  
Andrea Mario Bolla ◽  
Nicoletta Dozio ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Hemoglobin A1c ◽  
Real Life ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Life Study ◽  
Time In Range ◽  
Real Life Study

scholarly journals Pediatric Medicaid Patients With Type 1 Diabetes Benefit From Continuous Glucose Monitor Technology

2020 ◽  
pp. 193229682090621
Author(s):  
Sonalee J. Ravi ◽  
Alexander Coakley ◽  
Tim Vigers ◽  
Laura Pyle ◽  
Gregory P. Forlenza ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Pump ◽  
Diabetes Duration ◽  
Continuous Glucose Monitor ◽  
Percent Time ◽  
Time In Range ◽  
Continuous Glucose Monitors ◽  
Hispanic White

Background: We determined the uptake rate of continuous glucose monitors (CGMs) and examined associations of clinical and demographic characteristics with CGM use among patients with type 1 diabetes covered by Colorado Medicaid during the first two years of CGM coverage with no out-of-pocket cost. Method: We retrospectively reviewed data from 892 patients with type 1 diabetes insured by Colorado Medicaid (Colorado Health Program [CHP] and CHP+, Colorado Medicaid expansion). Demographics, insulin pump usage, CGM usage, and hemoglobin A1c (A1c) were extracted from the medical record. Data downloaded into CGM software at clinic appointments were reviewed to determine 30-day use prior to appointments. Subjects with some exposure to CGM were compared to subjects never exposed to CGM, and we examined the effect of CGM use on glycemic control. Results: Twenty percent of subjects had some exposure to CGM with a median of 22 [interquartile range 8, 29] days wear. Sixty one percent of CGM users had >85% sensor wear. Subjects using CGM were more likely to be younger ( P < .001), have shorter diabetes duration ( P < .001), and be non-Hispanic White ( P < .001) than nonusers. After adjusting for age and diabetes duration, combined pump and CGM users had a lower A1c than those using neither technology ( P = .006). Lower A1c was associated with greater CGM use ( P = .002) and increased percent time in range ( P < .001). Conclusion: Pediatric Medicaid patients successfully utilized CGM. Expansion of Medicaid coverage for CGM may help improve glycemic control and lessen disparities in clinical outcomes within this population.

scholarly journals Sensor-Augmented Insulin Pumps and Hypoglycemia Prevention in Type 1 Diabetes

2016 ◽  
Vol 11 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Isabelle Steineck ◽  
Ajenthen Ranjan ◽  
Kirsten Nørgaard ◽  
Signe Schmidt
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Insulin Pumps ◽  
Continuous Glucose Monitor ◽  
Insulin Suspension ◽  
Multiple Daily Injections

Hypoglycemia can lead to seizures, unconsciousness, or death. Insulin pump treatment reduces the frequency of severe hypoglycemia compared with multiple daily injections treatment. The addition of a continuous glucose monitor, so-called sensor-augmented pump (SAP) treatment, has the potential to further limit the duration and severity of hypoglycemia as the system can detect and in some systems act on impending and prevailing low blood glucose levels. In this narrative review we summarize the available knowledge on SAPs with and without automated insulin suspension, in relation to hypoglycemia prevention. We present evidence from randomized trials, observational studies, and meta-analyses including nonpregnant individuals with type 1 diabetes mellitus. We also outline concerns regarding SAPs with and without automated insulin suspension. There is evidence that SAP treatment reduces episodes of moderate and severe hypoglycemia compared with multiple daily injections plus self-monitoring of blood glucose. There is some evidence that SAPs both with and without automated suspension reduces the frequency of severe hypoglycemic events compared with insulin pumps without continuous glucose monitoring.

scholarly journals Use of factory calibrated real-time continuous glucose monitoring improves time in target and HbA1c in a multi-ethnic cohort of adolescents and young adults with type 1 diabetes: the MILLENNIAL Study

2020 ◽  
Author(s):  
Hood Thabit ◽  
Joshi Navis Prabhu ◽  
Womba Mubita ◽  
Catherine Fullwood ◽  
Shazli Azmi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Young People ◽  
Control Period ◽  
Glucose Monitoring ◽  
Random Order ◽  
Mean Difference ◽  
Time In Range ◽  
Hba1c Levels

<b>Objective: </b>International type 1 diabetes registries have shown that HbA1c levels are highest in young people with type 1 diabetes, however improving their glycaemic control remains a challenge. We propose that use of factory-calibrated Dexcom G6 CGM system would improve glycaemic control in this cohort. <p><b>Research Design and Methods: </b>We conducted a randomized crossover trial in young people with type 1 diabetes (16 – 24 years old), comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded CGM was worn by each participant for 10 days at the start, week-4 and week-7 of the control period. HbA1c measurements were drawn after enrolment, before and after each treatment period. The primary outcome was time in range 70–180mg/dl.</p> <p><b>Results: </b>Time in range was significantly higher during CGM compared to control [35.7±13.5% vs. 24.6±9.3%, mean difference 11.1% (95% CI 7.0 to 15.2, p<0.001)]. CGM use reduced mean sensor glucose [219.7±37.6mg/dl vs. 251.9±36.3mg/dl, mean difference -32.2mg/dl (95% CI -44.5 to -20.0, p<0.001)] and time above range [61.7±15.1% vs. 73.6±10.4%, mean difference 11.9% (95% CI -16.4 to -7.4, p<0.001)]. HbA1c level was reduced by 0.76% (95% CI -1.1 to -0.4) [-8.5mmol/mol (95% CI -12.4 to -4.6, p<0.001)]. Times spent below range (<70mg/dl and <54mg/dl) were low and comparable during both study periods. Sensor wear was 84% during the CGM period.</p> <p><b>Conclusion: </b>CGM use in young people with type 1 diabetes improves time in target and HbA1c levels compared to SMBG.<b> </b></p>

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