scholarly journals Use of factory calibrated real-time continuous glucose monitoring improves time in target and HbA1c in a multi-ethnic cohort of adolescents and young adults with type 1 diabetes: the MILLENNIAL Study

2020 ◽  
Author(s):  
Hood Thabit ◽  
Joshi Navis Prabhu ◽  
Womba Mubita ◽  
Catherine Fullwood ◽  
Shazli Azmi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Young People ◽  
Control Period ◽  
Glucose Monitoring ◽  
Random Order ◽  
Mean Difference ◽  
Time In Range ◽  
Hba1c Levels

<b>Objective: </b>International type 1 diabetes registries have shown that HbA1c levels are highest in young people with type 1 diabetes, however improving their glycaemic control remains a challenge. We propose that use of factory-calibrated Dexcom G6 CGM system would improve glycaemic control in this cohort. <p><b>Research Design and Methods: </b>We conducted a randomized crossover trial in young people with type 1 diabetes (16 – 24 years old), comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded CGM was worn by each participant for 10 days at the start, week-4 and week-7 of the control period. HbA1c measurements were drawn after enrolment, before and after each treatment period. The primary outcome was time in range 70–180mg/dl.</p> <p><b>Results: </b>Time in range was significantly higher during CGM compared to control [35.7±13.5% vs. 24.6±9.3%, mean difference 11.1% (95% CI 7.0 to 15.2, p<0.001)]. CGM use reduced mean sensor glucose [219.7±37.6mg/dl vs. 251.9±36.3mg/dl, mean difference -32.2mg/dl (95% CI -44.5 to -20.0, p<0.001)] and time above range [61.7±15.1% vs. 73.6±10.4%, mean difference 11.9% (95% CI -16.4 to -7.4, p<0.001)]. HbA1c level was reduced by 0.76% (95% CI -1.1 to -0.4) [-8.5mmol/mol (95% CI -12.4 to -4.6, p<0.001)]. Times spent below range (<70mg/dl and <54mg/dl) were low and comparable during both study periods. Sensor wear was 84% during the CGM period.</p> <p><b>Conclusion: </b>CGM use in young people with type 1 diabetes improves time in target and HbA1c levels compared to SMBG.<b> </b></p>

scholarly journals Use of factory calibrated real-time continuous glucose monitoring improves time in target and HbA1c in a multiethnic cohort of adolescents and young adults with type 1 diabetes: the MILLENNIALS Study

2020 ◽  
Author(s):  
Hood Thabit ◽  
Joshi Navis Prabhu ◽  
Womba Mubita ◽  
Catherine Fullwood ◽  
Shazli Azmi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Young People ◽  
Control Period ◽  
Glucose Monitoring ◽  
Random Order ◽  
Mean Difference ◽  
Time In Range ◽  
Hba1c Levels

<b>Objective: </b>International type 1 diabetes registries have shown that HbA1c levels are highest in young people with type 1 diabetes, however improving their glycaemic control remains a challenge. We propose that use of factory-calibrated Dexcom G6 CGM system would improve glycaemic control in this cohort. <p><b>Research Design and Methods: </b>We conducted a randomized crossover trial in young people with type 1 diabetes (16 – 24 years old), comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded CGM was worn by each participant for 10 days at the start, week-4 and week-7 of the control period. HbA1c measurements were drawn after enrolment, before and after each treatment period. The primary outcome was time in range 70–180mg/dl.</p> <p><b>Results: </b>Time in range was significantly higher during CGM compared to control [35.7±13.5% vs. 24.6±9.3%, mean difference 11.1% (95% CI 7.0 to 15.2, p<0.001)]. CGM use reduced mean sensor glucose [219.7±37.6mg/dl vs. 251.9±36.3mg/dl, mean difference -32.2mg/dl (95% CI -44.5 to -20.0, p<0.001)] and time above range [61.7±15.1% vs. 73.6±10.4%, mean difference 11.9% (95% CI -16.4 to -7.4, p<0.001)]. HbA1c level was reduced by 0.76% (95% CI -1.1 to -0.4) [-8.5mmol/mol (95% CI -12.4 to -4.6, p<0.001)]. Times spent below range (<70mg/dl and <54mg/dl) were low and comparable during both study periods. Sensor wear was 84% during the CGM period.</p> <p><b>Conclusion: </b>CGM use in young people with type 1 diabetes improves time in target and HbA1c levels compared to SMBG.<b> </b></p>

scholarly journals Use of factory calibrated real-time continuous glucose monitoring improves time in target and HbA1c in a multiethnic cohort of adolescents and young adults with type 1 diabetes: the MILLENNIALS Study

2020 ◽  
Author(s):  
Hood Thabit ◽  
Joshi Navis Prabhu ◽  
Womba Mubita ◽  
Catherine Fullwood ◽  
Shazli Azmi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Young People ◽  
Control Period ◽  
Glucose Monitoring ◽  
Random Order ◽  
Mean Difference ◽  
Time In Range ◽  
Hba1c Levels

<b>Objective: </b>International type 1 diabetes registries have shown that HbA1c levels are highest in young people with type 1 diabetes, however improving their glycaemic control remains a challenge. We propose that use of factory-calibrated Dexcom G6 CGM system would improve glycaemic control in this cohort. <p><b>Research Design and Methods: </b>We conducted a randomized crossover trial in young people with type 1 diabetes (16 – 24 years old), comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded CGM was worn by each participant for 10 days at the start, week-4 and week-7 of the control period. HbA1c measurements were drawn after enrolment, before and after each treatment period. The primary outcome was time in range 70–180mg/dl.</p> <p><b>Results: </b>Time in range was significantly higher during CGM compared to control [35.7±13.5% vs. 24.6±9.3%, mean difference 11.1% (95% CI 7.0 to 15.2, p<0.001)]. CGM use reduced mean sensor glucose [219.7±37.6mg/dl vs. 251.9±36.3mg/dl, mean difference -32.2mg/dl (95% CI -44.5 to -20.0, p<0.001)] and time above range [61.7±15.1% vs. 73.6±10.4%, mean difference 11.9% (95% CI -16.4 to -7.4, p<0.001)]. HbA1c level was reduced by 0.76% (95% CI -1.1 to -0.4) [-8.5mmol/mol (95% CI -12.4 to -4.6, p<0.001)]. Times spent below range (<70mg/dl and <54mg/dl) were low and comparable during both study periods. Sensor wear was 84% during the CGM period.</p> <p><b>Conclusion: </b>CGM use in young people with type 1 diabetes improves time in target and HbA1c levels compared to SMBG.<b> </b></p>

Increased Time-in-Range with Sotagliflozin as Adjunct Therapy to Insulin in Adults with Type 1 Diabetes as Demonstrated by 24-Week Continuous Glucose Monitoring (inTandem1, inTandem2)

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1179-P ◽  
Author(s):  
THOMAS DANNE ◽  
BERTRAND CARIOU ◽  
JOHN B. BUSE ◽  
SATISH K. GARG ◽  
JULIO ROSENSTOCK ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Adjunct Therapy ◽  
Time In Range

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

The added and interpretative value of CGM-derived parameters in type 1 diabetes depends on the level of glycaemic control.

2020 ◽  
Author(s):  
Helleputte Simon ◽  
De Backer Tine ◽  
Calders Patrick ◽  
Pauwels Bart ◽  
Shadid Samyah ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Glycaemic Control ◽  
Coefficient Of Variation ◽  
Subgroup Analyses ◽  
Time In Range ◽  
Mean Blood Glucose ◽  
Level 2

OBJECTIVE: In type 1 diabetes mellitus (T1DM) management, CGM-derived parameters can provide additional insights, with the concept of time in range (TIR) and other parameters reflecting glycaemic control and variability (GV) being put forward. This study aimed to examine the added and interpretative value of the CGM-derived indices TIR and coefficient of variation (CV%) in T1DM patients stratified according to their level of glycaemic control by means of HbA1c. METHODS: T1DM patients with a minimum disease duration of 10 years and without known macrovascular disease were enrolled. Patients were equipped with a blinded CGM device (Dexcom G4) for seven days. TIR (70–180 mg/dl), time in hypoglycaemia (total: <70 mg/dl; level 2: <54 mg/dl) and hyperglycaemia (total: >180 mg/dl; level 2: >250 mg/dl) were determined, and CV% (=standard deviation(SD)/mean blood glucose(MBG)) was used as parameter for GV. Pearson and Spearman correlations, and regression analysis was used to examine associations. RESULTS: 95 patients (age: 45±10 years; HbAc1: 7.7±0.8%) were included (MBG: 159±31 mg/dl; TIR 55.8±14.9%; CV%: 43.5±7.8%) and labeled as having good (HbA1c ≤7%; n=20), moderate (7–8%; n=44) or poor (>8%; n=31) glycaemic control. HbA1c was significantly associated with MBG (rs=0.48, p<0.001) and time spent in hyperglycaemia (total: rs=0.52; level 2: r=0.46; p<0.001), but not with time in hypoglycaemia and CV%, even after analysis in HbA1c subgroups. Similarly, TIR was negatively associated with HbA1c (r=−0.53; p<0.001), MBG (rs=−0.81; p<0.001) and time in hyperglycaemia (total: rs=−0.90; level 2: rs=−0.84; p<0.001), but not with time in hypoglycaemia. Subgroup analyses, however, showed that TIR did associate with shorter time in level 2 hypoglycaemia in those patients with good (rs=−0.60; p=0.007) and moderate (rs=−0.25; p=0.047) glycaemic control. In contrast, CV% was strongly positively associated with time in hypoglycaemia (total: rs=0.78; level 2: rs=0.76; p<0.001), but not with TIR or time in hyperglycaemia in the entire cohort, although subgroup analyses showed that TIR was negatively associated with CV% in patients with good glycaemic control (r=−0.81, p<0.001) and positively in patients with poor glycaemic control (r=0.47; p<0.01). CONCLUSION: This study demonstrates that CGM-derived metrics TIR and CV% relate with clinically important situations, TIR being strongly dependent on hyperglycaemia and CV% being reflective of hypoglycaemic risk. However, the interpretation and applicability of TIR and CV%, and their relationship, depends on the level of glycaemic control of the individual patient, with CV% generally adding less clinically relevant information in those with poor control. This illustrates the need for further research and evaluation of composite measures of glycaemic control in T1DM. Abbreviations: T1DM = Type 1 diabetes mellitus; CGM = Continuous glucose monitoring; TIR = Time in range; TAR = Time above range; TBR = Time below range; GV = Glycaemic variability; CV% = Coefficient of variation; MBG = Mean blood glucose.

scholarly journals Factors associated with high levels of glycated haemoglobin in patients with type 1 diabetes: a multicentre study in Brazil

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018094 ◽  
Author(s):  
Carine Sousa Andrade ◽  
Guilherme Sousa Ribeiro ◽  
Carlos Antonio Souza Teles Santos ◽  
Raimundo Celestino Silva Neves ◽  
Edson Duarte Moreira
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Hba1c Level ◽  
Glycated Haemoglobin ◽  
Poor Adherence ◽  
Adherence To Diet ◽  
The Mean ◽  
Lower Education ◽  
Hba1c Levels

ObjectiveLong-term complications of type 1 diabetes mellitus (DM1) can be prevented with adequate glycaemic control. However, high levels of glycated haemoglobin (HbA1c) occur in 60%–90% of the patients with DM1. Thus, we aimed to investigate the role of sociodemographic, behavioural and clinical factors on the HbA1c levels of patients with DM1 in Brazil.Design, setting and participantsA cross-sectional study was conducted in ambulatory patients with DM1 aged ≥18 years from 10 Brazilian cities. Sociodemographic, behavioural and clinical data were obtained through interviews.Main outcome measuresHbA1c level was measured by liquid chromatography. Hierarchical multiple variable linear regression models were used to identify factors correlated with high levels of HbA1c.ResultsOf 979 patients with DM1, 63.8% were women, and the mean age was 40 (SD 14.6) years. The mean HbA1c level was 9.4% (SD 2.2%), and 89.6% of the patients had HbA1c ≥7.0%. Factors independently correlated with increased HbA1c levels included: lower education, non-participation in diabetes classes/lecture during the year before, having a self-perception of poor adherence to diet and insulin, not having private medical care and not measuring the HbA1c levels in the prior year. Of note, poor adherence to diet and insulin were the independent factors most strongly associated with high levels of HbA1c (mean increment in HbA1c levels of 0.88% and 1.25%, respectively).ConclusionPoor glycaemic control, which is common among Brazilian patients with DM1, is associated with lower education, self-perception of insufficient adherence to diet and insulin and inadequate monitoring of HbA1c levels. Specific actions, particularly those targeting improving adherence to diet and insulin, may contribute to successful management of patients with DM1.

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