scholarly journals Diabetes technologies for children and adolescents with type 1 diabetes are highly dependent on coverage and reimbursement: results from a worldwide survey

2021 ◽  
Vol 9 (2) ◽  
pp. e002537
Author(s):  
Tiago Jeronimo Dos Santos ◽  
Chetankumar Dave ◽  
Sarah MacLeish ◽  
Jamie R Wood
Keyword(s):  
Decision Making ◽  
Type 1 Diabetes ◽  
Religious Affiliation ◽  
Glucose Monitoring ◽  
Insulin Pumps ◽  
Electronic Survey ◽  
Parental Educational Level ◽  
Design And Methods ◽  
Pediatric Type 1 Diabetes

IntroductionTo study healthcare professionals’ (HCP) perceptions on decision making to start insulin pumps and continuous glucose monitoring (CGM) systems in pediatric type 1 diabetes.Research design and methodsAn electronic survey supported by the International Society for Pediatric and Adolescent Diabetes (ISPAD) was disseminated through a weblink structured as follows: (1) HCP’s sociodemographic and work profile; (2) perceptions about indications and contraindications for insulin pumps and (3) for CGM systems; and (4) decision making on six case scenarios.Results247 responses from 49 countries were analyzed. Seventy per cent of respondents were members of ISPAD. Most of participants were women over 40 years old, who practice as pediatric endocrinologists for more than 10 years at university/academic centers and follow more than 500 people with type 1 diabetes. Although insulin pumps and CGMs are widely available and highly recommended among respondents, their uptake is influenced by access to healthcare coverage/insurance. Personal preference and cost of therapy were identified as the main reasons for turning down diabetes technologies. Parental educational level, language comprehension and income were the most relevant socioeconomic factors that would influence HCPs to recommend diabetes technologies, while gender, religious affiliation and race/ethnicity or citizenship were the least relevant.ConclusionsResponders seem to be markedly supportive of starting people on diabetes technologies. However, coverage/insurance for devices holds the biggest impact on the extent of their recommendations.

A Decade of Disparities in Diabetes Technology Use and HbA1c in Pediatric Type 1 Diabetes: A Trans-Atlantic Comparison

2020 ◽  
Author(s):  
Ananta Addala ◽  
Marie Auzanneau ◽  
Kellee Miller ◽  
Werner Maier ◽  
Nicole Foster ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Technology Use ◽  
Hemoglobin A1c ◽  
Diabetes Technology ◽  
Design And Methods ◽  
Relationship Of ◽  
The Relationship ◽  
Pediatric Type 1 Diabetes

<b>Objective:</b> As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA1c disparities. <p> </p> <p><b>Research Design and Methods: </b>Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, US, n=16,457) and Diabetes Prospective Follow-up (DPV, Germany, n=39,836) registries were categorized into lowest (Q1) to highest (Q5) SES quintiles. Multiple regression analyses compared the relationship of SES quintiles with diabetes technology use and HbA1c from 2010-2012 and 2016-2018. </p> <p> </p> <p><b>Results: </b>HbA1c was higher in participants with lower SES (in 2010-2012 & 2016-2018, respectively: 8.0% & 7.8% in Q1 and 7.6% & 7.5% in Q5 for DPV; and 9.0% & 9.3% in Q1 and 7.8% & 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (p<0.001). After adjusting for technology use, results for DPV did not change whereas the increase in T1DX was no longer significant.</p> <p> </p> <p><b>Conclusions: </b>Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX and this difference for HbA1c broadened in the last decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry. </p>

scholarly journals Screening and Treatment Outcomes in Adults and Children with Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study

2020 ◽  
Author(s):  
Farid H. Mahmud ◽  
Antoine B.M. Clarke ◽  
Kariym C. Joachim ◽  
Esther Assor ◽  
Charlotte McDonald ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Celiac Disease ◽  
Glucose Monitoring ◽  
Gluten Free ◽  
Asymptomatic Patients ◽  
Adults And Children ◽  
Diet Study ◽  
Glycemic Outcomes ◽  
Design And Methods

<b>Objective</b>: To describe Celiac Disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in type 1 diabetes patients asymptomatic for CD. <p><b>Research Design and Methods</b>: Asymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA1c and continuous glucose monitoring (CGM) over 12 months. </p> <p><b>Results</b>: Adults had higher CD-seropositivity rates than children (6.8%, 95%CI 4.9% to 8.2%, N=1298 vs. 4.7%; 95%CI 3.4% to 5.9%, N=1089, p=0.035) with lower rates of prior CD-screening (6.9% vs 44.2%, p<0.0001). 51 participants were randomized to a GFD (N=27) or GCD (N=24). No HbA1c differences were seen between groups (+0.14%, 1.5mmol/mol; 95%CI: -0.79 to 1.08; p=0.76) although greater post-prandial glucose increases (4-hr +1.5mmol/L; 95%CI: 0.4 to 2.7; p=0.014) emerged with a GFD.</p> <p><b>Conclusions</b>: CD is frequently observed in asymptomatic patients with type 1 diabetes and clinical vigilance is warranted with initiation of a GFD. </p>

Prevalence of Nocturnal Hypoglycemia in Pediatric Type 1 Diabetes: A Pilot Study Using Continuous Glucose Monitoring

2011 ◽  
Vol 159 (2) ◽  
pp. 297-302.e1 ◽  
Author(s):  
Alexandra Ahmet ◽  
Simon Dagenais ◽  
Nick J. Barrowman ◽  
Catherine J. Collins ◽  
Margaret L. Lawson
Keyword(s):  
Type 1 Diabetes ◽  
Pilot Study ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Nocturnal Hypoglycemia ◽  
Pediatric Type 1 Diabetes

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 Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children?

2020 ◽  
Author(s):  
Ivana Rabbone ◽  
Riccardo Schiaffini ◽  
Valentino Cherubini ◽  
Claudio Maffeis ◽  
Andrea Scaramuzza ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cross Sectional ◽  
Web Based ◽  
Pediatric Diabetes ◽  
Acute Complications ◽  
Design And Methods ◽  
Second Wave ◽  
Pediatric Type 1 Diabetes ◽  
New Onset

<div><b>Objective</b>: To evaluate if the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the COVID-19 pandemic in Italy.<b><br></b></div><div><b>Research Design and Methods</b>: This was a cross-sectional, web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetes ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between February 20 and April 14 in 2019 and 2020. </div><div><b>Results</b>: 53/68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared to 2019. Among those newly diagnosed patient who presented in DKA, the proportion with severe DKA was 44.3% in 2020 vs 36.1% in 2019, p = 0.03. There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed SARS-CoV-2.<b><br></b></div><div><b>Conclusions</b>: The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any “second wave” requires strategies to educate and reassure parents about timely ED attendance for non-COVID-19 symptoms.</div>

scholarly journals Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children?

2020 ◽  
Author(s):  
Ivana Rabbone ◽  
Riccardo Schiaffini ◽  
Valentino Cherubini ◽  
Claudio Maffeis ◽  
Andrea Scaramuzza ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cross Sectional ◽  
Web Based ◽  
Pediatric Diabetes ◽  
Acute Complications ◽  
Design And Methods ◽  
Second Wave ◽  
Pediatric Type 1 Diabetes ◽  
New Onset

<div><b>Objective</b>: To evaluate if the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the COVID-19 pandemic in Italy.<b><br></b></div><div><b>Research Design and Methods</b>: This was a cross-sectional, web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetes ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between February 20 and April 14 in 2019 and 2020. </div><div><b>Results</b>: 53/68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared to 2019. Among those newly diagnosed patient who presented in DKA, the proportion with severe DKA was 44.3% in 2020 vs 36.1% in 2019, p = 0.03. There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed SARS-CoV-2.<b><br></b></div><div><b>Conclusions</b>: The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any “second wave” requires strategies to educate and reassure parents about timely ED attendance for non-COVID-19 symptoms.</div>

scholarly journals Morning (Fasting) vs Afternoon Resistance Exercise in Individuals With Type 1 Diabetes: A Randomized Crossover Study

2019 ◽  
Vol 104 (11) ◽  
pp. 5217-5224 ◽  
Author(s):  
Saeed Reza Toghi-Eshghi ◽  
Jane E Yardley
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Resistance Exercise ◽  
Blood Glucose Concentration ◽  
Venous Blood ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Interstitial Glucose ◽  
Design And Methods

Abstract Objective To determine the effect of morning exercise in the fasting condition vs afternoon exercise on blood glucose responses to resistance exercise (RE). Research Design and Methods For this randomized crossover design, 12 participants with type 1 diabetes mellitus [nine females; aged 31 ± 8.9 years; diabetes duration, 19.1 ± 8.3 years; HbA1c, 7.4% ± 0.8% (57.4 ± 8.5 mmol/mol)] performed ∼40 minutes of RE (three sets of eight repetitions, seven exercises, at the individual’s predetermined eight repetition maximum) at either 7 am (fasting) or 5 pm. Sessions were performed at least 48 hours apart. Venous blood samples were collected immediately preexercise, immediately postexercise, and 60 minutes postexercise. Interstitial glucose was monitored overnight postexercise by continuous glucose monitoring (CGM). Results Data are presented as mean ± SD. Blood glucose rose during fasting morning exercise (9.5 ± 3.0 to 10.4 ± 3.0 mmol/L), whereas it declined with afternoon exercise (8.2 ± 2.5 to 7.4 ± 2.6 mmol/L; P = 0.031 for time-by-treatment interaction). Sixty minutes postexercise, blood glucose concentration was significantly higher after fasting morning exercise than after afternoon exercise (10.9 ± 3.2 vs 7.9 ± 2.9 mmol/L; P = 0.019). CGM data indicated more glucose variability (2.7 ± 1.1 vs 2.0 ± 0.7 mmol/L; P = 0.019) and more frequent hyperglycemia (12 events vs five events; P = 0.025) after morning RE than after afternoon RE. Conclusions Compared with afternoon RE, morning (fasting) RE was associated with distinctly different blood glucose responses and postexercise profiles.

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