scholarly journals Universal Subsidized Continuous Glucose Monitoring Funding for Young People With Type 1 Diabetes: Uptake and Outcomes Over 2 Years, a Population-Based Study

2021 ◽  
Author(s):  
Stephanie R Johnson ◽  
Deborah J Holmes-Walker ◽  
Melissa Chee ◽  
Arul Earnest ◽  
Timothy W Jones ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Population Based ◽  
Insulin Regimen ◽  
Economic Analyses ◽  
Almost All

<b>Objective:</b> Continuous glucose monitoring (CGM) is increasingly used in type 1 diabetes management however funding models vary. This study determined the uptake rate and glycaemic outcomes following a change in national health policy to introduce universal subsidised CGM funding for people with type 1 diabetes aged < 21 years. <p><b>Research Design and Methods:</b> Analysis of longitudinal data from 12 months prior to subsidy until 24 months after. Measures and outcomes included age, diabetes duration, HbA1c, episodes of diabetic ketoacidosis and severe hypoglycaemia, insulin regimen, CGM uptake and percentage CGM use. Two data sources were used: the Australasian Diabetes Database Network (ADDN) registry (a prospective diabetes database) and the National Diabetes Supply Scheme (NDSS) registry that includes almost all individuals with type 1 diabetes nationally.</p> <p><b>Results:</b> CGM uptake increased from 5% pre-subsidy to 79% after two years. After CGM introduction, the odds ratio (OR) of achieving the HbA1c target of <7.0% improved at 12 months (OR 2.5, p<0.001) and was maintained at 24 months (OR 2.3, p<0.001). The OR for suboptimal glycaemic control (HbA1c ≥ 9.0%) decreased to 0.34 (p<0.001) at 24 months. Of CGM users, 65% used CGM >75% of time: these had a lower HbA1c at 24 months compared to those with usage <25% (7.8±1.3% vs 8.6±1.8%, respectively, p<0.001). DKA was also reduced in this group (IRR 0.49, 95% CI 0.33-0.74, p<0.001).</p> <b>Conclusions:</b> <a></a>Following national subsidy, CGM use was high and associated with sustained improvement in glycaemic control. This information will inform economic analyses and future policy and serve as a model of evaluation diabetes technologies.

scholarly journals Universal Subsidized Continuous Glucose Monitoring Funding for Young People With Type 1 Diabetes: Uptake and Outcomes Over 2 Years, a Population-Based Study

2021 ◽  
Author(s):  
Stephanie R Johnson ◽  
Deborah J Holmes-Walker ◽  
Melissa Chee ◽  
Arul Earnest ◽  
Timothy W Jones ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Population Based ◽  
Insulin Regimen ◽  
Economic Analyses ◽  
Almost All

<b>Objective:</b> Continuous glucose monitoring (CGM) is increasingly used in type 1 diabetes management however funding models vary. This study determined the uptake rate and glycaemic outcomes following a change in national health policy to introduce universal subsidised CGM funding for people with type 1 diabetes aged < 21 years. <p><b>Research Design and Methods:</b> Analysis of longitudinal data from 12 months prior to subsidy until 24 months after. Measures and outcomes included age, diabetes duration, HbA1c, episodes of diabetic ketoacidosis and severe hypoglycaemia, insulin regimen, CGM uptake and percentage CGM use. Two data sources were used: the Australasian Diabetes Database Network (ADDN) registry (a prospective diabetes database) and the National Diabetes Supply Scheme (NDSS) registry that includes almost all individuals with type 1 diabetes nationally.</p> <p><b>Results:</b> CGM uptake increased from 5% pre-subsidy to 79% after two years. After CGM introduction, the odds ratio (OR) of achieving the HbA1c target of <7.0% improved at 12 months (OR 2.5, p<0.001) and was maintained at 24 months (OR 2.3, p<0.001). The OR for suboptimal glycaemic control (HbA1c ≥ 9.0%) decreased to 0.34 (p<0.001) at 24 months. Of CGM users, 65% used CGM >75% of time: these had a lower HbA1c at 24 months compared to those with usage <25% (7.8±1.3% vs 8.6±1.8%, respectively, p<0.001). DKA was also reduced in this group (IRR 0.49, 95% CI 0.33-0.74, p<0.001).</p> <b>Conclusions:</b> <a></a>Following national subsidy, CGM use was high and associated with sustained improvement in glycaemic control. This information will inform economic analyses and future policy and serve as a model of evaluation diabetes technologies.

scholarly journals Functional data analysis and prediction tools for continuous glucose-monitoring studies

2020 ◽  
pp. 1-10
Author(s):  
Emrah Gecili ◽  
Rui Huang ◽  
Jane C. Khoury ◽  
Eileen King ◽  
Mekibib Altaye ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Functional Data ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Patient Specific ◽  
Prediction Errors ◽  
Medical Monitoring

Abstract Introduction: To identify phenotypes of type 1 diabetes based on glucose curves from continuous glucose-monitoring (CGM) using functional data (FD) analysis to account for longitudinal glucose patterns. We present a reliable prediction model that can accurately predict glycemic levels based on past data collected from the CGM sensor and real-time risk of hypo-/hyperglycemic for individuals with type 1 diabetes. Methods: A longitudinal cohort study of 443 type 1 diabetes patients with CGM data from a completed trial. The FD analysis approach, sparse functional principal components (FPCs) analysis was used to identify phenotypes of type 1 diabetes glycemic variation. We employed a nonstationary stochastic linear mixed-effects model (LME) that accommodates between-patient and within-patient heterogeneity to predict glycemic levels and real-time risk of hypo-/hyperglycemic by creating specific target functions for these excursions. Results: The majority of the variation (73%) in glucose trajectories was explained by the first two FPCs. Higher order variation in the CGM profiles occurred during weeknights, although variation was higher on weekends. The model has low prediction errors and yields accurate predictions for both glucose levels and real-time risk of glycemic excursions. Conclusions: By identifying these distinct longitudinal patterns as phenotypes, interventions can be targeted to optimize type 1 diabetes management for subgroups at the highest risk for compromised long-term outcomes such as cardiac disease or stroke. Further, the estimated change/variability in an individual’s glucose trajectory can be used to establish clinically meaningful and patient-specific thresholds that, when coupled with probabilistic predictive inference, provide a useful medical-monitoring tool.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Beneficial effect of real-time continuous glucose monitoring system on glycemic control in type 1 diabetic patients: systematic review and meta-analysis of randomized trials

2012 ◽  
Vol 166 (4) ◽  
pp. 567-574 ◽  
Author(s):  
A Szypowska ◽  
A Ramotowska ◽  
K Dżygało ◽  
D Golicki
Keyword(s):  
Systematic Review ◽  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Insulin Pump ◽  
Meta Analysis ◽  
Glucose Monitoring ◽  
Cochrane Library ◽  
Insulin Regimen

ObjectiveReal-time continuous glucose monitoring (RT-CGM) provides detailed information on glucose patterns and trends, thus allowing the patients to manage their diabetes more effectively.DesignThe aim of this study was to explore the potential beneficial effects of the use of RT-CGM on diabetes management compared with self blood glucose measurement (SBGM) in patients with type 1 diabetes mellitus (T1DM), by means of a systematic review and meta-analysis of randomized controlled trials (RCTs).MethodsMEDLINE, EMBASE, and the Cochrane Library were searched through by two independent investigators for RCTs concerning the use of RT-CGM in patients with T1DM. Only studies with a similar insulin regimen in the experimental and control groups were included in the analysis.ResultsSeven RCTs (n=948) met the inclusion criteria. Combined data from all studies showed better HbA1c reduction in subjects using RT-CGM compared with those using SBGM (mean difference (MD) −0.25; 95% confidence interval (95% CI): from −0.34 to −0.17; P<0.001). Patients treated with insulin pump and RT-CGM had a lower HbA1c level compared with subjects managed with insulin pump and SBGM (four RCTs, n=497; MD −0.26; 95% CI: from −0.43 to −0.10; P=0.002). The benefits of applying RT-CGM were not associated with an increasing rate of major hypoglycemic episodes. The use of RT-CGM for over 60–70% of time was associated with a significant lowering of HbA1c.ConclusionsRT-CGM is more beneficial than SBGM in reducing HbA1c in patients with type 1 diabetes. Further studies are needed to evaluate the efficacy of this system in the pediatric population, especially in very young children.

scholarly journals Cutaneous Reactions to Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion Devices in Type 1 Diabetes Mellitus

2020 ◽  
pp. 193229682091889 ◽  
Author(s):  
Rachel S. Rigo ◽  
Laura E. Levin ◽  
Donald V. Belsito ◽  
Maria C. Garzon ◽  
Rachelle Gandica ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Diabetes Management ◽  
Demographic Data ◽  
Glucose Monitoring ◽  
Subcutaneous Insulin ◽  
Cutaneous Reactions

Background: Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are the standard of care for type 1 diabetes in children. There is little reported on device-related skin complications and treatment options. This study documents cutaneous reactions to CGM and CSII devices in children and young adults with type 1 diabetes. Methods: One hundred and twenty-one subjects (3-25 years) with type 1 diabetes and CGM and/or CSII use were recruited over a three-month period from the Naomi Berrie Diabetes Center at Columbia University Irving Medical Center. A five-question survey was completed for each subject detailing demographic data, diabetes management, and device-related skin complications. Results: Sixty percent of subjects reported skin complications related to CGM and/or CSII use. Terms most frequently used to describe cutaneous reactions were “red,” “itchy,” “painful,” and “rash.” Subjects who used both CGM and CSII were more likely to report skin problems than those who used only CSII (odds ratio 2.9, [95% confidence interval: 1.2-6.7]; P = .015). There were no associations between skin complications and sex or race/ethnicity. Twenty-two percent of subjects with adverse skin event(s) discontinued use of a device due to their skin problem. Seven percent were evaluated by a dermatologist. Eighty-one percent used a range of products to treat their symptoms, with variable perceived clinical outcomes. Conclusions: Skin complications related to CSII or CGM devices are commonly reported in pediatric patients with type 1 diabetes and may lead to interruption or discontinuation of device use. Future studies are needed to elucidate the causes of these reactions and determine the best methods for prevention.

scholarly journals Technology for Augmenting Type 1 Diabetes Mellitus Management

2019 ◽  
Vol 24 (2) ◽  
pp. 99-106
Author(s):  
Michelle Condren ◽  
Samie Sabet ◽  
Laura J. Chalmers ◽  
Taylor Saley ◽  
Jenna Hopwood
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Insulin Delivery ◽  
Diabetes Mellitus Management

Type 1 diabetes mellitus has witnessed significant progress in its management over the past several decades. This review highlights technologic advancements in type 1 diabetes management. Continuous glucose monitoring systems are now available at various functionality and cost levels, addressing diverse patient needs, including a recently US Food and Drug Administration (FDA)–approved implantable continuous glucose monitoring system (CGMS). Another dimension to these state-of-the-art technologies is CGMS and insulin pump integration. These integrations have allowed for CGMS-based adjustments to basal insulin delivery rates and suspension of insulin delivery when a low blood glucose event is predicted. This review also includes a brief discussion of upcoming technologies such as patch-based CGMS and insulin-glucagon dual-hormonal delivery.

Realtime Continuous Glucose Monitoring in Children and Adolescents— An Overview of the Current Technology and its Impact on Patient Outcomes

2012 ◽  
Vol 08 (01) ◽  
pp. 30
Author(s):  
Jeniece Trast ◽  
Neesha Ramchandani ◽  
◽  
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Patient Outcomes ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Age Groups ◽  
Glucose Monitoring ◽  
Parental Satisfaction ◽  
Patient Use

Continuous glucose monitoring (CGM) systems, available for patient use since 1999, and realtime continuous glucose monitoring (RT-CGM) systems, available since 2006, have helped optimize diabetes management. Previously, RT-CGM studies found benefits mainly in patients with type 1 diabetes over the age of 25. Children and adolescents often present a challenge when managing type 1 diabetes. However, it is now apparent that RT-CGM has clear benefits in these age groups as well as in adults. Not only have studies shown improvements in glycemic control in this population, they have also demonstrated parental satisfaction with the technology. Challenges with RT-CGM use still exist and must be addressed. Nevertheless, RT-CGM is a beneficial tool to assist in diabetes management, and its use should be encouraged in the majority of pediatric patients with type 1 diabetes.

scholarly journals Continuous glucose monitoring reduces pubertal hyperglycemia of type 1 diabetes

2020 ◽  
Vol 33 (7) ◽  
pp. 865-872
Author(s):  
Benjamin Udoka Nwosu ◽  
Shamima Yeasmin ◽  
Sanaa Ayyoub ◽  
Shwetha Rupendu ◽  
Tony R. Villalobos-Ortiz ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Longitudinal Change ◽  
Controlled Study ◽  
Pubertal Status ◽  
Male Age

AbstractBackgroundPhysiologic hyperglycemia of puberty is a major contributor to poor glycemic control in youth with type 1 diabetes (T1D). This study’s aim was to determine the effectiveness of continuous glucose monitoring (CGM) to improve glycemic control in pubertal youth with T1D compared to a non-CGM cohort after controlling for age, sex, BMI, duration, and insulin delivery methodology. The hypothesis is that consistent CGM use in puberty improves compliance with diabetes management, leading to increased percentage (%) time in range (TIR70–180 mg/dL) of glycemia, and lowering of HbA1c.MethodsA longitudinal, retrospective, case-controlled study of 105 subjects consisting of 51 T1D controls (60.8% male) age 11.5 ± 3.8 y; and 54 T1D subjects (48.1% male) age 11.1 ± 5.0 y with confirmed CGM use for 12 months. Pubertal status was determined by Tanner staging. Results were adjusted for baseline HbA1c and diabetes duration.ResultsHbA1c was similar between the controls and the CGM group at baseline: 8.2 ± 1.1% vs 8.3 ± 1.2%, p=0.48 respectively; but was significantly lower in the CGM group 12 months later, 8.2 ± 1.1% vs. 8.7 ± 1.4%, p=0.035. Longitudinal change in HbA1c was similar in the prepubertal cohort between the control- and CGM groups: −0.17 ± 0.98% vs. 0.38 ± 1.5%, p=0.17. In contrast, HbA1c increased with advancing age and pubertal status in the pubertal controls but not in the pubertal CGM group: 0.55 ± 1.4 vs −0.22 ± 1.1%, p=0.020. Percent TIR was inversely related to HbA1c in the CGM group, r=-0.6, p=0.0004, for both prepubertal and pubertal subjects.ConclusionsCGM use significantly improved glycemic control in pubertal youth with T1D compared to non-CGM users.

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