Diabetes Device Downloading: Benefits and Barriers Among Youth With Type 1 Diabetes

Background: The majority of youth with type 1 diabetes (T1D) fail to meet glycemic targets despite increasing continuous glucose monitoring (CGM) use. We therefore aimed to determine the proportion of caregivers who review recent glycemic trends (“retrospective review”) and make ensuant insulin adjustments based on this data (“retroactive insulin adjustments”). We additionally considered that fear of hypoglycemia and frequency of severe hypoglycemia would be associated with performing retrospective review. Methods: We conducted a cross-sectional survey of caregivers of youth with T1D, collecting demographics, diabetes technology usage, patterns of glucose data review/insulin dose self-adjustment, and Hypoglycemia Fear Survey (HFS). Results: Nineteen percent of eligible caregivers (191/1003) responded. Performing retrospective review was associated with younger child age (12.2 versus 15.4, P = .0001) and CGM use (92% versus 73%, P = .004), but was not associated with a significant improvement in child’s HbA1c (7.89 versus 8.04, P = .65). Retrospective reviewers had significantly higher HFS-behavior scores (31.9 versus 27.7, P = .0002), which remained significantly higher when adjusted for child’s age and CGM use ( P = .005). Linear regression identified a significant negative association between HbA1c (%) and number of retroactive insulin adjustments (0.24 percent lower mean HbA1c per additional adjustment made, P = .02). Conclusions: Retrospective glucose data review is associated with improved HbA1c when coupled with data-driven retroactive insulin adjustments. Barriers to data downloading existed even in this cohort of predominantly CGM-using T1D families.

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Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

10.2337/figshare.17136467 ◽

2022 ◽

Author(s):

Yu Kuei Lin ◽

Caroline R. Richardson ◽

Iulia Dobrin ◽

Melissa J. DeJonckheere ◽

Kara Mizokami-Stout ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Survey Study ◽

Cross Sectional Survey ◽

Hypoglycemic Episode ◽

Cross Sectional ◽

The Impact ◽

Level 2

Objective: This study aims to: (1) identify the frequency of severe and level 2 hypoglycemia presenting in people with type 1 diabetes using continuous glucose monitoring systems (CGMs), including those with concomitant closed-loop insulin pumps, in a clinical practice setting; (2) evaluate the impact of beliefs around hypoglycemia in the development of severe and level 2 hypoglycemia in this population. Research Design and Methods: A cross-sectional survey study in adults with type 1 diabetes using CGMs >6 months was conducted at a large tertiary academic center. Participant demographics, 6-month severe hypoglycemia history, hypoglycemia beliefs (with the Attitude to Awareness of Hypoglycemia questionnaire) and 4-week CGM glucose data were collected. Statistical analysis was performed to assess the presentation of severe and level 2 hypoglycemia and identify associated risk factors. Results: A total of 289 participants were recruited (including 257 participants with CGM data within the last 3 months). Of these, 25.6% experienced at least one severe hypoglycemic episode in the last 6 months, and 13.6% presented with ≥1% of time in level 2 hypoglycemia on CGMs. Reporting beliefs about prioritizing hyperglycemia avoidance was associated with severe hypoglycemia development (P<0.001), while having beliefs of minimal concerns for hypoglycemia was associated with spending ≥1% of time in level 2 hypoglycemia (P=0.038). Conclusions: Despite the use of advanced diabetes technologies, severe and level 2 hypoglycemia continues to occur in people with type 1 diabetes and high hypoglycemia risks. Human factors, including beliefs around hypoglycemia, may remain to impact the effectiveness of glucose self-management.

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Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

10.2337/figshare.17136467.v1 ◽

2022 ◽

Author(s):

Yu Kuei Lin ◽

Caroline R. Richardson ◽

Iulia Dobrin ◽

Melissa J. DeJonckheere ◽

Kara Mizokami-Stout ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Survey Study ◽

Cross Sectional Survey ◽

Hypoglycemic Episode ◽

Cross Sectional ◽

The Impact ◽

Level 2

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Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

Diabetes Care ◽

10.2337/dc21-1285 ◽

2022 ◽

Author(s):

Yu Kuei Lin ◽

Caroline R. Richardson ◽

Iulia Dobrin ◽

Melissa J. DeJonckheere ◽

Kara Mizokami-Stout ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Survey Study ◽

Cross Sectional Survey ◽

Hypoglycemic Episode ◽

Cross Sectional ◽

The Impact ◽

Level 2

OBJECTIVE This study aimed to 1) identify the frequency of severe and level 2 hypoglycemia presenting in individuals with type 1 diabetes using continuous glucose monitoring systems (CGMs), including those with concomitant closed-loop insulin pumps, in a clinical practice setting, and; 2) evaluate the impact of beliefs around hypoglycemia in the development of severe and level 2 hypoglycemia in this population. RESEARCH DESIGN AND METHODS A cross-sectional survey study in adults with type 1 diabetes using CGMs >6 months was conducted at a large tertiary academic center. Participant demographics, 6-month severe hypoglycemia history, hypoglycemia beliefs (with the Attitude to Awareness of Hypoglycemia questionnaire), and 4-week CGM glucose data were collected. Statistical analysis was performed to assess the presentation of severe and level 2 hypoglycemia and identify associated risk factors. RESULTS A total of 289 participants were recruited (including 257 participants with CGM data within the last 3 months). Of these, 25.6% experienced at least one severe hypoglycemic episode in the last 6 months, and 13.6% presented with ≥1% of time in level 2 hypoglycemia on CGMs. Reporting beliefs about prioritizing hyperglycemia avoidance was associated with severe hypoglycemia development (P < 0.001), while having beliefs of minimal concerns for hypoglycemia was associated with spending ≥1% of time in level 2 hypoglycemia (P = 0.038). CONCLUSIONS Despite the use of advanced diabetes technologies, severe and level 2 hypoglycemia continues to occur in individuals with type 1 diabetes and high hypoglycemia risks. Human factors, including beliefs around hypoglycemia, may continue to impact the effectiveness of glucose self-management.

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Assessment of Safety and Glycemic Control During Football Tournament in Children and Adolescents With Type 1 Diabetes—Results of GoalDiab Study

Pediatric Exercise Science ◽

10.1123/pes.2018-0264 ◽

2019 ◽

Vol 31 (4) ◽

pp. 401-407 ◽

Cited By ~ 1

Author(s):

Andrzej Gawrecki ◽

Aleksandra Araszkiewicz ◽

Agnieszka Szadkowska ◽

Grzegorz Biegański ◽

Jan Konarski ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Glycemic Control ◽

Children And Adolescents ◽

Insulin Dose ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Low Glucose ◽

Lactate Levels

Purpose: To assess glycemic control and safety of children and adolescents with type 1 diabetes participating in a 2-day football tournament. Methods: In total, 189 children with type 1 diabetes from 11 diabetes care centers, in Poland, participated in a football tournament in 3 age categories: 7–9 (21.2%), 10–13 (42.9%), and 14–17 (36%) years. Participants were qualified and organized in 23 football teams, played 4 to 6 matches of 30 minutes, and were supervised by a medical team. Data on insulin dose and glycemia were downloaded from personal pumps, glucose meters, continuous glucose monitoring, and flash glucose monitoring systems. Results: The median level of blood glucose before the matches was 6.78 (4.89–9.39) mmol/L, and after the matches, it was 7.39 (5.5–9.87) mmol/L (P = .001). There were no episodes of severe hypoglycemia or ketoacidosis. The number of episodes of low glucose value (blood glucose ≤3.9 mmol/L) was higher during the tournament versus 30 days before: 1.2 (0–1.5) versus 0.7 (0.3–1.1) event/person/day, P < .001. Lactate levels increased during the matches (2.2 [1.6–4.0] mmol/L to 4.4 [2.6–8.5] mmol/L after the matches, P < .001). Conclusions: Large football tournaments can be organized safely for children with type 1 diabetes. For the majority of children, moderate mixed aerobic–anaerobic effort did not adversely affect glycemic results and metabolic safety.

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Tackling hypoglycemia in children: teams, targets and technology

Diabetologia Hungarica ◽

10.24121/dh.2021.1 ◽

2021 ◽

Vol 29 (1) ◽

pp. 11-19

Author(s):

Thomas Danne

Keyword(s):

Type 1 Diabetes ◽

Diabetes Education ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Glycemic Variability ◽

Multidisciplinary Teams ◽

Team Approach ◽

Glycemic Targets ◽

Bolus Insulin

On the occasion of the Somogyi Award lecture this review focusses on the current advances in tackling hypoglycemia in pediatric patients with type 1 diabetes providing evidence for the importance of multidisciplinary teams, ambitious glycemic targets and implementation of diabetes technology. Meal-related intensified insulin replacement with differential substitution of basal- and bolus insulin is the therapy of choice in the care of children and adolescents with type 1 diabetes. The use of insulin pumps and continuous glucose monitoring devices is increasing rapidly, with the type of insulin therapy (insulin pen or pump) depending on the age of the patients and family preference. Education appropriate to the age and current challenges is essential for the children's participation in everyday life as undisturbed as possible. New parameters like time in range and time below range suitable for identifying high glycemic variability as risk factor for severe hypoglycemia complement the HbA1c targets and the ambulatory glucose profile (AGP) in a shared decision making on therapeutic adjustments between the diabetes team and people with diabetes. Automated insulin delivery as a hybrid closed loop or dosing advice using artificial intelligence are becoming a clinical reality. However, diabetes education as a team approach, defining clear targets with outcomes evaluated in multinational registries like SWEET remain important for shaping the future of pediatric diabetology.

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Anxiety, depression, and glycemic control during Covid-19 pandemic in youths with type 1 diabetes

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0153 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Maria Cusinato ◽

Mariangela Martino ◽

Alex Sartori ◽

Claudia Gabrielli ◽

Laura Tassara ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Psychological Impact ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Well Being ◽

Glucose Variability ◽

Threshold Score ◽

The Impact

Abstract Objectives Our study aims to assess the impact of lockdown during the coronavirus disease 2019 pandemic on glycemic control and psychological well-being in youths with type 1 diabetes. Methods We compared glycemic metrics during lockdown with the same period of 2019. The psychological impact was evaluated with the Test of Anxiety and Depression. Results We analyzed metrics of 117 adolescents (87% on Multiple Daily Injections and 100% were flash glucose monitoring/continuous glucose monitoring users). During the lockdown, we observed an increase of the percentage of time in range (TIR) (p<0.001), with a significant reduction of time in moderate (p=0.002), and severe hypoglycemia (p=0.001), as well as the percentage of time in hyperglycemia (p<0.001). Glucose variability did not differ (p=0.863). The glucose management indicator was lower (p=0.001). 7% of youths reached the threshold-score (≥115) for anxiety and 16% for depression. A higher score was associated with lower TIR [p=0.028, p=0.012]. Conclusions Glycemic control improved during the first lockdown period with respect to the previous year. Symptoms of depression and anxiety were associated with worse glycemic control; future researches are necessary to establish if this improvement is transient and if psychological difficulties will increase during the prolonged pandemic situation.

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Prevalence of bone fracture and its association with severe hypoglycemia in Japanese patients with type 1 diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-002099 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002099

Author(s):

Yuji Komorita ◽

Masae Minami ◽

Yasutaka Maeda ◽

Rie Yoshioka ◽

Toshiaki Ohkuma ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Fracture Risk ◽

Bone Fracture ◽

Severe Hypoglycemia ◽

Japanese Patients ◽

Anatomic Site ◽

Cross Sectional ◽

History Of

IntroductionType 1 diabetes (T1D) is associated with higher fracture risk. However, few studies have investigated the relationship between severe hypoglycemia and fracture risk in patients with T1D, and the results are controversial. Besides, none has investigated the risk factors for fracture in Asian patients with T1D. The aim of the present study was to investigate the prevalence of bone fracture and its relationship between severe hypoglycemia and other risk factors in Japanese patients with T1D.Research design and methodsThe single-center cross-sectional study enrolled 388 Japanese patients with T1D (mean age, 45.2 years; women, 60.4%; mean duration of diabetes, 16.6 years) between October 2019 and April 2020. The occurrence and circumstances of any fracture after the diagnosis of T1D were identified using a self-administered questionnaire. The main outcomes were any anatomic site of fracture and fall-related fracture. Severe hypoglycemia was defined as an episode of hypoglycemia that required the assistance of others to achieve recovery.ResultsA total of 92 fractures occurred in 64 patients, and 59 fractures (64%) were fall-related. Only one participant experienced fracture within the 10 years following their diagnosis of diabetes. In logistic regression analysis, the multivariate-adjusted ORs (95% CIs) of a history of severe hypoglycemia were 2.11 (1.11 to 4.09) for any fracture and 1.91 (0.93 to 4.02) for fall-related fracture. Fourteen of 18 participants with multiple episodes of any type of fracture had a history of severe hypoglycemia (p<0.001 vs no fracture).ConclusionsWe have shown that a history of severe hypoglycemia is significantly associated with a higher risk of bone fracture in Japanese patients with T1D.

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Patient Demographics and Clinical Outcomes Among Type 1 Diabetes Patients Using Continuous Glucose Monitors: Data From T1D Exchange Real-World Observational Study

Journal of Diabetes Science and Technology ◽

10.1177/19322968211049783 ◽

2021 ◽

pp. 193229682110497

Author(s):

Daniel J. DeSalvo ◽

Nudrat Noor ◽

Cicilyn Xie ◽

Sarah D. Corathers ◽

Shideh Majidi ◽

...

Keyword(s):

Type 1 Diabetes ◽

Quality Improvement ◽

Clinical Outcomes ◽

Real World ◽

Private Insurance ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Electronic Health Record Data ◽

Diabetes Patients

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

10.2196/preprints.36140 ◽

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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