Self-Management Behaviors in Adults on Insulin Pump Therapy

Background: Successful diabetes management requires behavioral changes. Little is known about self-management behaviors (SMB) in adults on insulin pump (IP) therapy. Objective: Analyze and characterize observed common diabetes SMB in adult participants with type 1 diabetes (T1D) using IPs and to correlate behaviors with glycemic outcomes based on participant’s individual glucose targets. Materials and Methods: One month of IP data from adults with T1D were downloaded. Computer programs were written to automatically quantify the observed frequency of expected behaviors such as: insulin bolusing, checking blood glucose (BG), and recording carbohydrate intake, and other interactions with the IP. Results: Nineteen participants were recruited and 4,249 IP interactions were analyzed to ascertain behaviors. Intersubject variability of adherence to minimally expected behaviors was observed: daily documentation of carbohydrates and BG checks in 76.6 (31.7)% and 60.0 (32.5)%, respectively, and bolusing without consulting the IPBC in 13.0 (16.9)% of delivered boluses, while daily insulin bolus delivery was consistent 96.8 (5.7)%. Higher frequency of adherence to daily behaviors correlated with a higher number of glucose readings at target. Conclusion: Results indicate variability in SMB and do not always match recommendations. Case-scenarios based on observed real-life SMB could be incorporated into interviews/surveys to elucidate ways to improve SMB.

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Self-Management Behaviors of Patients with Type 1 Diabetes: Comparing Two Sources of Patient-Generated Data

Applied Clinical Informatics ◽

10.1055/s-0039-1701002 ◽

2020 ◽

Vol 11 (01) ◽

pp. 070-078

Author(s):

George Karway ◽

Maria Adela Grando ◽

Kevin Grimm ◽

Danielle Groat ◽

Curtiss Cook ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetes Management ◽

Insulin Pump ◽

Assessment Tools ◽

Insulin Pump Therapy ◽

Self Management ◽

Pump Therapy ◽

Mixed Effect ◽

Management Behaviors

Abstract Objectives This article aims to evaluate adult type 1 diabetes mellitus (T1DM) self-management behaviors (SMBs) related to exercise and alcohol on a survey versus a smartphone app to compare self-reported and self-tracked SMBs, and examine inter- and intrapatient variability. Methods Adults with T1DM on insulin pump therapy were surveyed about their alcohol, meal, and exercise SMBs. For 4 weeks, participants self-tracked their alcohol, meal, and exercise events, and their SMBs corresponding with these events via an investigator-developed app. Descriptive statistics and generalized linear mixed-effect models were used to analyze the data Results Thirty-five participants self-tracked over 5,000 interactions using the app. Variability in how participants perceived the effects of exercise and alcohol on their blood glucose was observed. The congruity between SMBs self-reported on the survey and those self-tracked with the app was measured as mean (SD). The lowest congruity was for alcohol and exercise with 61.9% (22.7) and 66.4% (20.2), respectively. Congruity was higher for meals with 80.9% (21.0). There was significant daily intra- and interpatient variability in SMBs related to preprandial bolusing: recommended bolus, p < 0.05; own bolus choice, p < 0.01; and recommended basal adjustment, p < 0.01. Conclusion This study highlights the variability in intra- and interpatient SMBs obtained through the use of a survey and app. The outcomes of this study indicate that clinicians could use both one-time and every-day assessment tools to assess SMBs related to meals. For alcohol and exercise, further research is needed to understand the best assessment method for SMBs. Given this degree of patient variability, there is a need for an educational intervention that goes beyond the traditional “one-size-fits-all” approach of diabetes management to target individualized treatment barriers.

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Self-Reported Compensation Techniques for Carbohydrate, Exercise, and Alcohol Behaviors in Patients With Type 1 Diabetes on Insulin Pump Therapy

Journal of Diabetes Science and Technology ◽

10.1177/1932296817718848 ◽

2017 ◽

Vol 12 (2) ◽

pp. 412-414 ◽

Cited By ~ 3

Author(s):

Danielle Groat ◽

Hiral Soni ◽

Maria Adela Grando ◽

Bithika Thompson ◽

Curtiss B. Cook

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Insulin Pump ◽

Insulin Pump Therapy ◽

Self Management ◽

Pump Therapy ◽

Electronic Survey ◽

Alcohol Behaviors ◽

Management Behaviors

Studies have found variability in self-care behaviors in patients with type 1 diabetes, particularly when incorporating exercise and alcohol consumption. The objective of this study was to provide results from a survey to understand (1) insulin pump behaviors, (2) reported self-management behaviors for exercise and alcohol, and (3) perceptions of the effects of exercise and alcohol on blood glucose (BG) control. Fourteen participants from an outpatient endocrinology practice were recruited and administered an electronic survey. Compensation techniques for exercise and alcohol, along with reasons for employing the techniques were identified. Also identified were factors that participants said affected BG control with regard to exercise and alcohol. These results confirm the considerable inconsistency patients have about incorporating exercise and alcohol into decisions about self-management behaviors.

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Fasting during the holy month of Ramadan among older children and adolescents with type 1 diabetes in Kuwait

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0009 ◽

2019 ◽

Vol 32 (8) ◽

pp. 843-849 ◽

Cited By ~ 1

Author(s):

Kholoud Mohamed ◽

Dalia Al-Abdulrazzaq ◽

Amel Fayed ◽

Eman El Busairi ◽

Faisal Al Shawaf ◽

...

Keyword(s):

Type 1 Diabetes ◽

Children And Adolescents ◽

Diabetes Management ◽

Insulin Pump ◽

Control Level ◽

Insulin Pump Therapy ◽

Insulin Regimen ◽

Pump Therapy ◽

Significant Difference

Abstract Background To evaluate the safety of fasting during the holy month of Ramadan among children and adolescent with type 1 diabetes (T1D). Methods A retrospective cohort study of 50 children and adolescents with T1D whose mean age was 12.7 ± 2.1 years was conducted. Twenty-seven patients (54%) were on multiple daily injections (MDI) insulin regimen and 23 (46%) were on insulin pump therapy. Before fasting for Ramadan, children and their families were evaluated and educated about diabetes management during Ramadan. Hemoglobin A1c (HbA1c), weight, number of days fasted, hypoglycemia and hyperglycemia episodes, and emergency hospital visits were collected and analyzed after completing the month. Participants were compared according to the insulin treatment regimen and their glycemic control level before Ramadan. Results The children were able to fast 20 ± 9.9 days of Ramadan, and the most common cause for breaking the fast was mild hypoglycemia (7.8% among all cases). There was no significant difference between the two insulin regimen groups in breaking fast days, frequency of hypo- or hyperglycemia, weight and HbA1c changes post Ramadan. Patients with HbA1c ≤ 8.5% were able to fast more days during Ramadan with significantly less-frequent hypoglycemic attacks as compared to patients with HbA1c > 8.5 (1.2 ± 1.5 vs. 3.3 ± 2.9 days of hypoglycemia, p = 0.01, respectively). Conclusions Fasting for children with T1D above the age of 10 years is feasible and safe in both pump and non-pump users, and well-controlled patients are less likely to develop complications. Education of the families and their children before Ramadan, along with intensive monitoring of fasting children during the month are crucial.

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PMD82 - COST-EFFECTIVENESS OF INSULIN PUMP THERAPY IN ADULTS WITH TYPE 1 DIABETES MELLITUS (T1DM)- THE EMIPE STUDY : A REAL-LIFE EVIDENCE STUDY IN FRANCE

Value in Health ◽

10.1016/j.jval.2018.09.1531 ◽

2018 ◽

Vol 21 ◽

pp. S257

Author(s):

J. Dinet ◽

V. Georgescu ◽

G. Bourel ◽

E. Renard

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Cost Effectiveness ◽

Type 1 Diabetes Mellitus ◽

Insulin Pump ◽

Real Life ◽

Insulin Pump Therapy ◽

Pump Therapy

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Experiences and real life management of insulin pump therapy in adults with type 1 diabetes

Endocrinología Diabetes y Nutrición (English ed ) ◽

10.1016/j.endien.2019.01.004 ◽

2019 ◽

Vol 66 (2) ◽

pp. 117-123

Author(s):

Carmen Quirós ◽

Marga Jansà ◽

Clara Viñals ◽

Marga Giménez ◽

Daria Roca ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Pump ◽

Real Life ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Life Management

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Pediatric Smart Insulin Pen Use: The Next Best Thing

Journal of Diabetes Science and Technology ◽

10.1177/19322968211041362 ◽

2021 ◽

pp. 193229682110413

Author(s):

Jeniece Ilkowitz ◽

Vanessa Wissing ◽

Mary Pat Gallagher

Keyword(s):

Gold Standard ◽

Diabetes Management ◽

Insulin Pump ◽

Pediatric Population ◽

Data Driven ◽

Insulin Pump Therapy ◽

Management Tool ◽

Self Management ◽

Clinical Use ◽

Pump Therapy

In the pediatric population, insulin pump therapy, or CSII, is often considered the gold standard for intensive diabetes management. Insulin pump technology offers families and caregivers many beneficial features including a calculator for insulin dosing and the ability to review diabetes management data to provide data-driven diabetes management. However, for those who find CSII challenging or choose to use multiple daily injections (MDI) there is an option that offers similar features called the Smart Insulin Pen (SIP). Even though SIP technology provides a safe and data-driven diabetes self-management tool for the pediatric population using MDI, there is limited pediatric specific literature. This article will describe current options, data-driven diabetes management, benefits, challenges and clinical use of SIP technology in the pediatric population.

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Generic and disease-specific quality of life in adolescents with type 1 diabetes: comparison to age-matched healthy peers

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2015-0397 ◽

2016 ◽

Vol 29 (7) ◽

Cited By ~ 4

Author(s):

Andrea Lukács ◽

Péter Sasvári ◽

András Török ◽

László Barkai

Keyword(s):

Quality Of Life ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Diabetes Management ◽

Insulin Pump ◽

Insulin Pump Therapy ◽

Regular Exercise ◽

Pump Therapy

AbstractThis study aimed to evaluate the health-related quality of life (HRQoL) of adolescents with type 1 diabetes (T1DM) on the basis of the pediatric quality of life inventory™ (PedsQL™) generic and diabetes-specific modules, and to compare it to that of healthy peers.This retrospective case-control study involved 650 participants between ages of 13 and 19 years including 296 adolescents with T1DM from four diabetes centers and 354 healthy peers matched for age and gender from three different cities of the country. Participants completed the validated PedsQL™ for assessing the HRQoL. The analysis included an independent t-test to compare the means of the total and subscales of the PedsQL™ between boys and girls as well as between a healthy group and a group with T1DM. Gender differences in exercise, insulin therapy modalities were evaluated with the Pearson χAdolescents with T1DM have similar HRQoL in all domains when compared to their healthy counterparts. Females report worse HRQoL regardless of the presence of the disease. Insulin pump therapy facilitates better glycemic control and HRQoL. Regular exercise positively correlates with the generic HRQoL in both groups; however, it has no relationship with glycemic control.Optimal metabolic control and improved HRQoL are the eventual goals of diabetes management. Despite the difficulties, adolescents with diabetes can manage their disease well and live normal lives, similar to their healthy peers. Although diabetes-related problems exist, it seems that regular exercise and staying physically active, as well as promoting insulin pump therapy where it is applicable are related to favorable HRQoL.

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Pharmacotherapy of type1 diabetes in children and adolescents: more than insulin?

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018818763247 ◽

2018 ◽

Vol 9 (5) ◽

pp. 157-166 ◽

Cited By ~ 3

Author(s):

Torben Biester ◽

Olga Kordonouri ◽

Thomas Danne

Keyword(s):

Type 1 Diabetes ◽

Insulin Pump ◽

Real Life ◽

Glucose Monitoring ◽

Insulin Analogues ◽

Insulin Pump Therapy ◽

Daily Injection ◽

Great Success ◽

Pump Therapy

For paediatric patients with type 1 diabetes, intensified insulin therapy with either multiple daily injection or insulin pump therapy is currently the only method of treatment. To optimize this therapy, insulin analogues are fixed parts of all therapy regimens. New ultra-rapid insulins seem to be beneficial not only in adults but also in this age group. New developments in long-acting analogues have demonstrated safety and will be regular in paediatrics, we hope, soon. Furthermore, the psychosocial approach for consideration of real-life aspects becomes more the focus of therapeutic regimens and is implemented into international guidelines. Technical improvements, such as continuous glucose monitoring, particularly in combination with pump therapy, support the great success of rapid-acting analogues by reducing hypoglycaemias. Non-insulin agents such as SGLT2-inhibitors show beneficial aspects in people with type 1 diabetes. For outpatient care with these currently off-label-used drugs, special training for measurement of ketones should be imperative.

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Characterization of Exercise and Alcohol Self-Management Behaviors of Type 1 Diabetes Patients on Insulin Pump Therapy

Journal of Diabetes Science and Technology ◽

10.1177/1932296816663746 ◽

2016 ◽

Vol 11 (2) ◽

pp. 240-246 ◽

Cited By ~ 5

Author(s):

Maria Adela Grando ◽

Danielle Groat ◽

Hiral Soni ◽

Mary Boyle ◽

Marilyn Bailey ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Insulin Pump ◽

Blood Glucose Control ◽

Real Life ◽

Insulin Pump Therapy ◽

Insulin Pumps ◽

Pump Therapy ◽

Diabetes Patients

Background: There is a lack of systematic ways to analyze how diabetes patients use their insulin pumps to self-manage blood glucose to compensate for alcohol ingestion and exercise. The objective was to analyze “real-life” insulin dosing decisions occurring in conjunction with alcohol intake and exercise among patients using insulin pumps. Methods: We recruited adult type 1 diabetes (T1D) patients on insulin pump therapy. Participants were asked to maintain their daily routines, including those related to exercising and consuming alcohol, and keep a 30-day journal on exercise performed and alcohol consumed. Thirty days of insulin pump data were downloaded. Participants’ actual insulin dosing behaviors were compared against their self-reported behaviors in the setting of exercise and alcohol. Results: Nineteen T1D patients were recruited and over 4000 interactions with the insulin pump were analyzed. The analysis exposed variability in how subjects perceived the effects of exercise/alcohol on their blood glucose, inconsistencies between self-reported and observed behaviors, and higher rates of blood glucose control behaviors for exercise versus alcohol. Conclusion: Compensation techniques and perceptions on how exercise and alcohol affect their blood glucose levels vary between patients. Improved individualized educational techniques that take into consideration a patient’s unique life style are needed to help patients effectively apply alcohol and exercise compensation techniques.

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