Real‐world Evidence on Clinical Outcomes of People with Type 1 Diabetes Using Open‐Source and Commercial Automated Insulin Dosing Systems: A Systematic Review.

Background: The benefits of Continuous Glucose Monitoring (CGM) on glycemic management have been demonstrated in numerous studies; however, widespread uptake remians limited. The aim of this study was to provide real-world evidence of patient attributes and clinical outcomes associated with CGM use across clinics in the U.S. based T1D Exchange Quality Improvement (T1DX-QI) Collaborative. Method: We examined electronic Health Record data from eight endocrinology clinics participating in the T1DX-QI Collaborative during the years 2017-2019. Results: Among 11,469 type 1 diabetes patients, 48% were CGM users. CGM use varied by race/ethnicity with Non-Hispanic Whites having higher rates of CGM use (50%) compared to Non-Hispanic Blacks (18%) or Hispanics (38%). Patients with private insurance were more likely to use CGM (57.2%) than those with public insurance (33.3%) including Medicaid or Medicare. CGM users had lower median HbA1c (7.7%) compared to nonusers (8.4%). Rates of diabetic ketoacidosis (DKA) and severe hypoglycemia were significantly higher in nonusers compared to CGM users. Conclusion: In this real-world study of patients in the T1DX-QI Collaborative, CGM users had better glycemic control and lower rates of DKA and severe hypoglycemia (SH) events, compared to nonusers; however, there were significant sociodemographic disparities in CGM use. Quality improvement and advocacy measures to promote widespread and equitable CGM uptake have the potential to improve clinical outcomes.

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Clinical outcomes to exercise training in type 1 diabetes: A systematic review and meta-analysis

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2017.11.036 ◽

2018 ◽

Vol 139 ◽

pp. 380-391 ◽

Cited By ~ 23

Author(s):

C. Ostman ◽

D. Jewiss ◽

N. King ◽

N.A. Smart

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Exercise Training ◽

Clinical Outcomes ◽

Meta Analysis

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Shaping Workflows in Digital and Remote Diabetes Care During the COVID-19 Pandemic: A Service Design Approach. (Preprint)

10.2196/preprints.24374 ◽

2020 ◽

Author(s):

Katarina Braune ◽

Karina Boss ◽

Jessica Schmidt-Herzel ◽

Katarzyna Anna Gajewska ◽

Axel Thieffry ◽

...

Keyword(s):

Quality Of Life ◽

Type 1 Diabetes ◽

Open Source ◽

Clinical Outcomes ◽

Service Design ◽

Data Access ◽

Multiple Stakeholders ◽

Remote Consultations

BACKGROUND The COVID-19 pandemic poses new challenges to healthcare providers to deliver continuous care. Although diabetes technology is increasingly established today, data rarely gets assessed, and telemedicine has not been sufficiently integrated into clinical workflows. OBJECTIVE This project sought to remotely support children with type 1 diabetes and their caregivers to enhance clinical outcomes and quality-of-life, engage multiple stakeholders through a participatory approach, evaluate the feasibility of using an interoperable open-source platform in a university hospital setting, and analyze success factors and barriers in transitioning from conventional to digital care. METHODS Service design methods were used to adapt clinical workflows. Remote consultations were performed monthly and on-demand. Device data were uploaded from patients’ homes to an open-source platform. Clinical and patient-reported outcomes were assessed before, during and after the lockdown period in Germany due to COVID-19. RESULTS A total of 28 children with type 1 diabetes and their caregivers enrolled and completed 6 months of remote visits. Of them, 16 participants opted to perform at least one of their regular visits online. After 3 months, Time-in-Range and Time-in-Hyperglycemia significantly improved whilst Time-in-Hypoglycemia did not increase. These improvements were maintained during the COVID-19 related lockdown between month 3 and 6 of the study. Psychosocial health improved after 6 months. CONCLUSIONS Remote consultations and data access can improve clinical outcomes and quality-of-life in children with type 1 diabetes even during challenging circumstances. Service design helped to deliver a comprehensive and holistic solution taking multiple stakeholders into consideration. These findings can inform further integration and use of digital tools into clinical care during the pandemic and beyond. CLINICALTRIAL Clinical Trial registration number: DRKS00016170, IRB: Charité ethics approval number: EA2/125/18

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Route to improving Type 1 diabetes mellitus glycaemic outcomes: real-world evidence taken from the National Diabetes Audit

Diabetic Medicine ◽

10.1111/dme.13541 ◽

2017 ◽

Vol 35 (1) ◽

pp. 63-71 ◽

Cited By ~ 19

Author(s):

A. H. Heald ◽

M. Livingston ◽

A. Fryer ◽

G. Y. C. Moreno ◽

N. Malipatil ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Real World ◽

Real World Evidence

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Real-World Use of Do-It-Yourself Artificial Pancreas Systems in Children and Adolescents With Type 1 Diabetes: Online Survey and Analysis of Self-Reported Clinical Outcomes

JMIR mhealth and uhealth ◽

10.2196/14087 ◽

2019 ◽

Vol 7 (7) ◽

pp. e14087 ◽

Cited By ~ 24

Author(s):

Katarina Braune ◽

Shane O'Donnell ◽

Bryan Cleal ◽

Dana Lewis ◽

Adrian Tappe ◽

...

Keyword(s):

Type 1 Diabetes ◽

Children And Adolescents ◽

Clinical Outcomes ◽

Median Duration ◽

Real World ◽

Online Survey ◽

Hemoglobin A1c ◽

Artificial Pancreas ◽

Do It Yourself

Background Patient-driven initiatives have made uptake of Do-it-Yourself Artificial Pancreas Systems (DIYAPS) increasingly popular among people with diabetes of all ages. Observational studies have shown improvements in glycemic control and quality of life among adults with diabetes. However, there is a lack of research examining outcomes of children and adolescents with DIYAPS in everyday life and their social context. Objective This survey assesses the self-reported clinical outcomes of a pediatric population using DIYAPS in the real world. Methods An online survey was distributed to caregivers to assess the hemoglobin A1c levels and time in range (TIR) before and after DIYAPS initiation and problems during DIYAPS use. Results A total of 209 caregivers of children from 21 countries responded to the survey. Of the children, 47.4% were female, with a median age of 10 years, and 99.4% had type 1 diabetes, with a median duration of 4.3 years (SD 3.9). The median duration of DIYAPS use was 7.5 (SD 10.0) months. Clinical outcomes improved significantly, including the hemoglobin A1c levels (from 6.91% [SD 0.88%] to 6.27% [SD 0.67]; P<.001) and TIR (from 64.2% [SD 15.94] to 80.68% [SD 9.26]; P<.001). Conclusions Improved glycemic outcomes were found across all pediatric age groups, including adolescents and very young children. These findings are in line with clinical trial results from commercially developed closed-loop systems.

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