scholarly journals Glycaemic Control in Children and Adolescents With Type 1 Diabetes Following a Single Telehealth Visit:What Have We Learned From the COVID-19 Lockdown?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A341-A342
Author(s):  
Marianna Rachmiel ◽  
Yael Lebenthal ◽  
Kineret Mazor-Aronovitch ◽  
Avivit Brener ◽  
Noah Levek ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Dose ◽  
Real Life ◽  
Single Parent ◽  
Clinic Visit ◽  
Considerable Proportion ◽  
Continuous Glucose Monitor ◽  
Life Study ◽  
Single Parent Household

Abstract Aims: Children with chronic diseases were unable to receive their usual care during COVID-19 lockdown. We assessed the feasibility and impact of telehealth visits on the time-in-range (TIR) of pediatric individuals with type 1 diabetes (T1D). Methods: An observational multicenter real-life study. Patients scheduled for an in-clinic visit during the lockdown were offered to participate in a telehealth visit. Sociodemographic, clinical, continuous glucose monitor and pump data were recorded 2 weeks prior and 2 weeks after telehealth visit. The primary endpoint was change in relative-TIR, i.e change in TIR divided by the percent of possible change (∆TIR/(100-TIRbefore)*100). Results: The study group comprised 195 individuals with T1D (47.7% males), mean±SD age 14.6±5.3 years, diabetes duration 6.0±4.6 years. Telehealth was accomplished with 121 patients and their parents (62.0%); 74 (38.0%) did not transfer complete data. Mean TIR was significantly higher for the two-week period after the telehealth visit than for the two-week period prior the visit (62.9±16.0, p<0.001 vs. 59.0±17.2); the improvement in relative-TIR was 5.7±26.1%. Initial higher mean glucose level, lower TIR, less time spent at <54 mg/dl range, longer time spent at 180–250 mg/dl range, higher daily insulin dose and single parent household were associated with improved relative-TIR. Multiple regression logistic analysis demonstrated only initial lower TIR and single-parent household were significant, odds ratio: -0.506, (95%CI -0.99,-0.023), p=0.04 and 13.82, (95%CI 0.621, 27.016), p=0.04, respectively. Conclusions: Pediatric patients with T1D benefited from a telehealth visit during COVID-19. This modality and its benefit should be employed, and used in the future as well. However, this modality is not yet suitable for a considerable proportion of patients.

Frequency of flash glucose monitoring readings, hemoglobin A1c and time in range: a real life study in adults with type 1 diabetes

2020 ◽  
Vol 57 (11) ◽  
pp. 1395-1397 ◽  
Author(s):  
Andrea Laurenzi ◽  
Amelia Caretto ◽  
Mariluce Barrasso ◽  
Andrea Mario Bolla ◽  
Nicoletta Dozio ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Hemoglobin A1c ◽  
Real Life ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Life Study ◽  
Time In Range ◽  
Real Life Study

scholarly journals Combined Algorithm-Based Adaptations of Insulin Dose and Carbohydrate Intake During Exercise in Children With Type 1 Diabetes: Results From the CAR2DIAB Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Philippe Antoine Lysy ◽  
Hélène Absil ◽  
Emy Gasser ◽  
Hasnae Boughaleb ◽  
Thierry Barrea ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Dose ◽  
Real Life ◽  
Severe Hypoglycemia ◽  
Carbohydrate Intake ◽  
Cardiac Evaluation ◽  
Maximum Effort ◽  
Combined Algorithm ◽  
Fast Acting

ObjectivesTo evaluate the evolution of subcutaneous glucose during two sessions of monitored aerobic exercise in children or adolescents with type 1 diabetes after adaptation of insulin doses and carbohydrate intake according to a combined algorithm.MethodsTwelve patients with type 1 diabetes (15.1 ± 2 years; diabetes duration: 9.5 ± 3.1 years) performed two series of exercise sessions after cardiac evaluation. The first series (TE#1) consisted in a monitored exercise of moderate to vigorous intensity coupled with a bout of maximum effort. The second series of exercises (TE#2) was carried out in real life during exercises categorized and monitored by connected watches. TE#2 sessions were performed after adaptation of insulin doses and fast-acting carbohydrates according to decision algorithms.ResultsPatients did not experience episodes of severe hypoglycemia, symptomatic hyperglycemia, or hyperglycemia associated with ketosis. Analysis of CGM data (15 h) during TE#2 sessions revealed an overall improvement in glycemic average [± standard deviation] (104 ± 14 mg/dl vs. 122 ± 17 mg/dl during TE#1; p < 0.001), associated with a decrease in proportion of hyperglycemia in periods ranging from 4 h to 15 h after performing the exercises. The proportion of hypoglycemia was not changed, except during the TE#2 +4–8 h period, where a significant increase in hypoglycemia <60 mg/dl was observed (25% vs. 6.2%; p = 0.04), yet without concurrent complications.ConclusionIn our pediatric series, the application of algorithmic adaptations of insulin doses and carbohydrate intake has globally improved glycemic control during 15 h after real-time exercises performed by children and adolescents with type 1 diabetes.

scholarly journals Basal Insulin Dose in Adults with Type 1 Diabetes Mellitus on Insulin Pumps in Real-Life Clinical Practice: A Single-Center Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Bartłomiej Matejko ◽  
Aneta Kukułka ◽  
Beata Kieć-Wilk ◽  
Agnieszka Stąpór ◽  
Tomasz Klupa ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Basal Insulin ◽  
Hba1c Level ◽  
Metabolic Diseases ◽  
Insulin Dose ◽  
Real Life ◽  
Pump Therapy ◽  
Single Center Experience

Introduction. Basal insulin (BI) infusion in pump therapy of type 1 diabetes (T1DM) mimics physiological secretion during the night and between meals. The recommended percentage of the total BI to daily insulin dose (termed the %BI) ranges between 30 and 50%. We analyzed whether this recommendation was followed in adults with T1DM from a university center, and whether BI doses were linked with glycemic control. Materials and Methods. We included 260 consecutive patients with T1DM (159 women and 101 men) treated with continuous subcutaneous insulin infusion at the Department of Metabolic Diseases, Krakow, Poland. Data were downloaded from patients’ pumps and collected from medical records. We analyzed the settings of BI and the association of %BI with HbA1c level. Linear regression was performed. Results. The mean age of T1DM individuals was 26.6 ± 8.2 years, BMI was 23.1 ± 3.0 kg/m2, T1DM duration was 13.3 ± 6.4 years, and HbA1c level was 7.4%. There were 69.6% (n=181) of T1DM patients with %BI in the recommended range. The T1DM duration and HbA1c level of patients with a %BI <30% (n=23) was 9.5 years and 6.4%, respectively; for a %BI of 30–50%, it was 13.2 years and 7.4%; and for a %BI >50% (n=56), it was 15.8 years and 7.8% (p<0.001 for both three-group comparisons). Multiple regression identified %BI among independent predictors of the HbA1c level. Conclusion. In this real-life analysis, the recommendations concerning %BI dosing were not followed by almost one-third of adult T1DM patients. Low %BI was associated with better glycemic control; however, this requires further confirmation.

scholarly journals Insulin Basal Dose Is Associated With Better Metabolic Control in Type 1 Diabetes Children and Adolescents

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A660-A660
Author(s):  
Abril Arellano-Llamas ◽  
Luz Elena Mejía-Carmona ◽  
Alicia Rojas-Zacarias ◽  
Oscar Ochoa-Romero ◽  
Irene Díaz-Rodríguez
Keyword(s):  
Type 1 Diabetes ◽  
Metabolic Control ◽  
Basal Insulin ◽  
Glycated Hemoglobin ◽  
Insulin Dose ◽  
Real Life ◽  
Total Daily Dose ◽  
Daily Dose ◽  
Basal Bolus

Abstract Basal insulin dose in type 1 diabetes has been established empirically, since 2011 all guidelines suggest insulin basal dose less than 50% of total insulin dose in the pediatric population. However, in real life, basal dose indication has not changed in all patients in the basal-bolus treatment scheme. Objective: To measure how the physician indicates in real-life basal insulin dose in pediatric patients with type 1 diabetes in the basal-bolus scheme, and correlate this dose with metabolic control measured by glycated hemoglobin. Methods. This was a retrospective study, subjects include pediatric T1D (2 to 16 years, non-obese, using insulin more than 0.3 UI/Kg/d), more than 1 year of diagnostic, none of them in ketoacidosis, attended during 2019. The protocol was revised and accepted in the institution. Data were analyzed with Kruskal-Wallis, U Mann Withney, Pearson correlation test. Results: There were 141 subjects, male (51%), median age 13.3 years (3.6-15.9), median evolution time since diagnosis 8 years (1-14), pre-pubertal (Tanner stage 1, 22%), total daily dose 1.02 UI/Kg/d (0.3-2.19 UI/Kg/d). Basal insulin was glargine 50.4%, and NPH 49.6%, prandial insulin was lispro 66.7%, and regular human 29.8%. Children using 50% or less basal insulin of total insulin dose was 40.4%. The basal dose was 38% of total insulin dose in children less than 6 years, and 59% in children older than 6 years. (p=0.033). Glycated hemoglobin was less than 7.5% in 12.8%. The persons with glycated hemoglobin less than 7.5% used less basal insulin 0.38 u/kg/d, than those with higher glycated hemoglobin 0.57 U/kg/d (p=0.02) with no impact in total insulin dose (0.86 vs 1.05 UI/Kg/d, p=0.129). The correlation of the percentage of insulin basal dose and glycated hemoglobin was 0.279, p=0.001, meaning, more basal insulin, worse diabetes control. Conclusion: Lower basal insulin dose percentage from total daily dose is associated with better metabolic control in children treated with the basal-bolus scheme. There is high clinical inertia in the indication of basal insulin in older children.

Continuous Glucose Monitoring Versus Self-monitoring of Blood Glucose in Children with Type 1 Diabetes—The Pros and Cons

2012 ◽  
Vol 08 (01) ◽  
pp. 27 ◽  
Author(s):  
Susana R Patton ◽  
Mark A Clements ◽  
◽  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Insulin Dose ◽  
Healthcare Providers ◽  
Glucose Monitoring ◽  
Continuous Glucose Monitor ◽  
Self Monitoring ◽  
Advantages And Disadvantages ◽  
Pros And Cons

Glucose monitoring is essential for modern diabetes treatment and the achievement of near-normal glycemic levels. Monitoring of blood glucose provides the data necessary for patients to make daily management decisions related to food intake, insulin dose, and physical exercise and it can enable patients to avoid potentially dangerous episodes of hypo- and hyperglycemia. Additionally, monitoring can provide healthcare providers with the information needed to identify glycemic patterns, educate patients, and adjust insulin. Presently, youth with type 1 diabetes can self-monitor blood glucose via home blood glucose meters, or monitor glucose concentrations nearly continuously using a continuous glucose monitor. There are advantages and disadvantages to the use of either of these technologies. This article describes the two technologies and the research supporting their use in the management of youth with type 1 diabetes in order to weigh their relative pros and cons.

scholarly journals A “Slide Rule” to Adjust Insulin Dose Using Trend Arrows in Adults with Type 1 Diabetes: Test in Silico and in Real Life

2021 ◽  
Author(s):  
Daniela Bruttomesso ◽  
Federico Boscari ◽  
Giuseppe Lepore ◽  
Giulia Noaro ◽  
Giacomo Cappon ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
In Silico ◽  
Insulin Dose ◽  
Real Life ◽  
Slide Rule

scholarly journals The Hypoglycaemia-Hyperglycaemia Minimizer System in the Management of Type 1 Diabetes

2016 ◽  
Vol 12 (1) ◽  
pp. 18
Author(s):  
Brian L Levy ◽  
◽  
Thomas W McCann ◽  
Jr and Daniel A Finan ◽  
◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Insulin Infusion ◽  
Closed Loop ◽  
Insulin Dose ◽  
Infusion Pump ◽  
Artificial Pancreas ◽  
Continuous Glucose Monitor ◽  
Glucose Levels

Living with type 1 diabetes (T1D) presents many challenges in terms of daily living. Insulin users need to frequently monitor their blood glucose levels and take multiple injections per day and/or multiple boluses through an insulin infusion pump, with the consequences of failing to match the insulin dose to the body’s needs resulting in hypoglycaemia and hyperglycaemia. The former can result in seizures, coma and even death; the latter can have both acute and long-term health implications. Many patients with T1D also fail to meet their treatment goals. In order to reduce the burdens of self-administering insulin, and improve efficacy and safety, there is a need to at least partially remove the patient from the loop via a closed-loop ‘artificial pancreas’ system. The Hypoglycaemia-Hyperglycaemia Minimizer (HHM) System, comprising a continuous, subcutaneous insulin infusion pump, continuous glucose monitor (CGM) and closed-loop insulin dosing algorithm, is able to predict changes in blood glucose and adjust insulin delivery accordingly to help keep the patient at normal glucose levels. Early clinical data indicate that this system is feasible, effective and safe, and has the potential to dramatically improve the therapeutic outcomes and quality of life for people with T1D.

1066-P: Improvement in Time-in-Range (TIR) with Real-Life Use of Hybrid Closed-Loop System in Patients with Type 1 Diabetes (T1D)

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1066-P
Author(s):  
HALIS K. AKTURK ◽  
DOMINIQUE A. GIORDANO ◽  
HAL JOSEPH ◽  
SATISH K. GARG ◽  
JANET K. SNELL-BERGEON
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Real Life ◽  
Loop System ◽  
Closed Loop System ◽  
Time In Range
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