GlucoMine

2021 ◽  
Vol 5 (3) ◽  
pp. 1-24
Author(s):  
Abigail Bartolome ◽  
Sahaj Shah ◽  
Temiloluwa Prioleau
Keyword(s):  
User Study ◽  
Diabetes Management ◽  
Data Interpretation ◽  
Wearable Device ◽  
Personal Health ◽  
Continuous Glucose Monitor ◽  
Data Presentation ◽  
Hidden Patterns ◽  
Poor Management

The growing popularity of wearable devices for continuous sensing has made personal health data increasingly available, yet methods for data interpretation are still a work in progress. This paper investigates potential under-utilization of wearable device data in diabetes management and develops an analytic approach - GlucoMine - to uncover individualized patterns in extended periods of such data to support and improve care. In addition, we conduct a user study with clinicians to assess and compare conventional tools used for reviewing wearable device data in diabetes management with the proposed solution. Using 3-6 months of continuous glucose monitor (CGM) data from 54 patients with type 1 diabetes, we found that: 1) the recommended practice of reviewing only short periods (e.g., the most recent 2-weeks) of CGM data based on correlation analysis is not sufficient for finding hidden patterns of poor management; 2) majority of subjects (96% in this study) had clinically-recognized episodes of recurrent adverse glycemic events observable from analysis of extended periods of their CGM data; 3) majority of clinicians (89% in this study) believe there is benefit to be gained in having an algorithm for extracting patterns of adverse glycemic events from longer periods of wearable device data. Findings from our user study also provides insights, including strengths and weakness of various data presentation tools, to guide development of better solutions that improve the use of wearable device data for patient care.

Population-Level Personalized Diabetes Management Facilitated by Analyses of Continuous Glucose Monitor Data and Telehealth Visits (Preprint)

2021 ◽  
Author(s):  
David Scheinker ◽  
Angela Gu ◽  
Josh Grossman ◽  
Andrew Ward ◽  
Oseas Ayerdi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Population Level ◽  
Care Providers ◽  
Continuous Glucose Monitor ◽  
Diabetes Clinic ◽  
Time Required ◽  
Glucose Management ◽  
Automated Tool

BACKGROUND Continuous glucose monitors (CGM) are recommended as standard of care by the American Diabetes Association for individuals with type 1 diabetes on insulin. These devices generate glucose readings every 5-15 minutes and use cloud-based platforms to share data. This remotely reviewed data can be used by members of diabetes care team to provide remote care. OBJECTIVE To design an automated tool that facilitates timely, personalized, population-level guidance for glucose management through asynchronous telehealth. METHODS Using CGM data from six clinical trials and two observational datasets, we developed manufacturer-agnostic algorithms to generate generic (e.g., mean glucose (MG) > 170mg/dL) and personalized (e.g., MG increased by >10mg/dL) flags. We developed and deployed an automated tool in a pediatric type 1 diabetes clinic, measured sensitivity for identifying who may benefit from telehealth, and measured the time saved reviewing data with the use of the tool. RESULTS The eight cohorts contained 1,365 patients with 30,017 weeks of data collected by seven types of CGMs. In the cohort with the highest MG, 81.3% (26 of 32) and 3.1% (1/32) of people had a generic and personalized flag every week, respectively. In the clinic, on average, 57.2% of patients were flagged per week, corresponding to a sensitivity of 98.6% and a 42.8% reduction in the time required to review data. CONCLUSIONS The automated analysis of CGM data may help identify people requiring guidance on glucose management while reducing the workload for care providers. The rules-based approach provided fully interpretable representations of patient status relative to the latest guidelines. When deployed in a clinic, an automated tool to generate flags identified 98.6% of patients who would benefit from asynchronous telehealth contact while reducing the time required to review patient data by 42.8%. Guideline-based population health management may become more accessible through the use of automated tools.

Frequency of Diabetes-Related Complications in Type 1 and Type 2 Diabetes—Results from the International Diabetes Management Practices Study (IDMPS)

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1584-P
Author(s):  
JUAN J. GAGLIARDINO ◽  
PABLO ASCHNER ◽  
HASAN M. ILKOVA ◽  
FERNANDO J. LAVALLE-GONZALEZ ◽  
AMBADY RAMACHANDRAN ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Management Practices ◽  
Diabetes Management

Automated Insulin Delivery Systems: Today, Tomorrow and User Requirements

2021 ◽  
pp. 193229682110299
Author(s):  
Marga Giménez ◽  
Ignacio Conget ◽  
Nick Oliver
Keyword(s):  
Lived Experience ◽  
Diabetes Management ◽  
Real Life ◽  
Insulin Delivery ◽  
Qualitative Assessment ◽  
Management Tool ◽  
Diabetes Distress ◽  
Glycemic Targets

Automated insulin delivery (AID) is the most recent advance in type 1 diabetes (T1D) management. It has the potential to achieve glycemic targets without disabling hypoglycemia, to improve quality of life and reduce diabetes distress and burden associated with self-management. Several AID systems are currently licensed for use by people with T1D in Europe, United States, and the rest of the world. Despite AID becoming a reality in routine clinical practice over the last few years, the commercially hybrid AID and other systems, are still far from a fully optimized automated diabetes management tool. Implementation of AID systems requires education and support of healthcare professionals taking care of people with T1D, as well as users and their families. There is much to do to increase usability, portability, convenience and to reduce the burden associated with the use of the systems. Co-design, involvement of people with lived experience of T1D and robust qualitative assessment is critical to improving the real-world use of AID systems, especially for those who may have greater need. In addition to this, information regarding the psychosocial impact of the use of AID systems in real life is needed. The first commercially available AID systems are not the end of the development journey but are the first step in learning how to optimally automate insulin delivery in a way that is equitably accessible and effective for people living with T1D.

Glycemic control status, diabetes management patterns, and clinical characteristics of adults with type 1 diabetes in Japan: Study of Adults’ Glycemia in T1DM subanalysis

2021 ◽  
Author(s):  
Norio Abiru ◽  
Akira Shimada ◽  
Rimei Nishimura ◽  
Munehide Matsuhisa ◽  
Asuka Ozaki ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Clinical Characteristics ◽  
Diabetes Management

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

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.

Continuous Ketone Monitoring: A New Paradigm for Physiologic Monitoring

2021 ◽  
pp. 193229682110098
Author(s):  
Jennifer Y. Zhang ◽  
Trisha Shang ◽  
Suneil K. Koliwad ◽  
David C. Klonoff
Keyword(s):  
Interstitial Fluid ◽  
Good Accuracy ◽  
Physiologic Monitoring ◽  
New Paradigm ◽  
Continuous Glucose Monitor ◽  
Sensor Platform ◽  
Wired Enzyme ◽  
First Time

In this issue of JDST, Alva and colleagues present for the first time, development of a continuous ketone monitor (CKM) tested both in vitro and in humans. Their sensor measured betahydroxybutyrate (BHB) in interstitial fluid (ISF). The sensor was based on wired enzyme electrochemistry technology using BHB dehydrogenase. The sensor required only a single retrospective calibration without a need for further adjustments over 14 days. The device produced a linear response over the 0-8 mM range with good accuracy. This novel CKM could provide a new dimension of useful automatically collected information for managing diabetes. Passively collected ISF ketone information would be useful for predicting and managing ketoacidosis in patients with type 1 diabetes, as well as other states of abnormal ketonemia. Although additional studies of this CKM will be required to assess performance in intended patient populations and prospective factory calibration will be required to support real time measurements, this novel monitor has the potential to greatly improve outcomes for people with diabetes. In the future, a CKM might be integrated with a continuous glucose monitor in the same sensor platform.

scholarly journals A global perspective on the issue of access to insulin

Diabetologia ◽  
2021 ◽  
Author(s):  
David Beran ◽  
Maria Lazo-Porras ◽  
Camille M. Mba ◽  
Jean Claude Mbanya
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Multinational Companies ◽  
Global Perspective ◽  
Patient Access ◽  
Middle Income ◽  
Middle Income Countries ◽  
Wide Range ◽  
Pricing And Reimbursement

AbstractThe discovery of insulin in 1921 changed the prognosis for people with type 1 diabetes. A century later, availability and affordability of insulin remain a challenge in many parts of the globe. Using the WHO’s framework on understanding the life cycle of medicines, this review details the global and national challenges that affect patients’ abilities to access and afford insulin. Current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95% of global insulin supply. The inclusion of insulin on the WHO’s Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer. Whilst expenses related to diabetes are mostly covered by insurance in high-income countries, many patients from low- and middle-income countries have to pay out of their own pockets. The organisation of diabetes management within the healthcare system also affects patient access to insulin. The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all individuals living with diabetes. Graphical abstract

Sick day advice for people with diabetes

2021 ◽  
Vol 32 (Sup3) ◽  
pp. S10-S13
Author(s):  
Martha Stewart
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Glucose Levels ◽  
Emergency Hospital Admission ◽  
Intercurrent Illness ◽  
Martha Stewart ◽  
The Common ◽  
Tract Infections

In this article Martha Stewart discusses how illness affects diabetes management and outlines the ‘sick-day advice’ that should be shared with people living with type 1 and type 2 diabetes Intercurrent illness can cause glucose levels to rise in people with diabetes mellitus. These illnesses include the common cold, diarrhoea and vomiting, urinary tract infections and COVID-19. If diabetes is not managed well during illness it can escalate and result in more serious conditions, such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS), which would require emergency hospital admission. This article discusses how illness affects diabetes management and outlines the ‘sick-day advice’ that should be shared with people living with type 1 and type 2 diabetes.

Accessibility and Openness to Diabetes Management Support via Mobile Phones: A Survey of People with Type 1 Diabetes Using Advanced Diabetes Technologies (Preprint)

2022 ◽  
Author(s):  
Yu Kuei Lin ◽  
Caroline Richardson ◽  
Iulia Dobrin ◽  
Rodica Pop-Busui ◽  
Gretchen Piatt ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Interactive Voice Response ◽  
Medical Center ◽  
Academic Medical Center ◽  
Text Messages ◽  
Management Support ◽  
Cross Sectional Survey ◽  
Cross Sectional

BACKGROUND Little is known about the feasibility of mobile health (mHealth) support among people with type 1 diabetes (T1D) using advanced diabetes technologies including continuous glucose monitors (CGMs) and hybrid closed-loop insulin pumps (HCLs). OBJECTIVE To evaluate patient access and openness to receiving mHealth diabetes support in people with T1D using CGMs/HCLs. METHODS We conducted a cross-sectional survey among T1D patients using CGMs or HCLs managed in an academic medical center. Participants reported information regarding their mobile device usage, cellular call/text message/internet connectivity, and openness to various channels of mHealth communication (smartphone applications or “apps”, text messages, and interactive voice response calls or IVR calls). Participants’ demographic characteristics and CGM data were collected from medical records. Analyses focused on differences in openness to mHealth and mHealth communication channels across groups defined by demographic variables and measures of glycemic control. RESULTS Among all participants (n=310; 64% female; mean age: 45 (SD:16)), 98% reported active cellphone use, and 80% were receptive to receiving mHealth support to improve glucose control. Among participants receptive to mHealth support, 98% were willing to share CGM glucose data for mHealth diabetes self-care assistance. Most (71%) were open to receiving messages via apps, 56% were open to text messages, and 12% were open to IVR calls. Older participants were more likely to prefer text messages (P=0.009) and IVR (P=0.03) than younger participants. CONCLUSIONS Most people with T1D who use advanced diabetes technologies have access to cell phones and are receptive to receiving mHealth support to improve diabetes control. CLINICALTRIAL Not applicable

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