Glycemic Control and Hospital Admission Risk in Type 1 Diabetes is Related to the Use of Carbohydrate Counting and Frequency of Self- Monitoring of Blood Glucose: RSD1 Study

BACKGROUND Smartphone and Web technology can improve the health care process, especially in chronic diseases. OBJECTIVE The aim of this study was to investigate whether the use of blood glucose (BG) data management system, which enables connection to smartphones, the Web, the cloud, and downloading, can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). METHODS This study was a prospective, single-arm, cohort feasibility study with 6 months of duration. T1DM subjects enrolled had experience in self-monitoring blood glucose, but were download data naïve. Fasting BG and glycated hemoglobin (HbA1c) were collected at the enrollment and at follow-up. Subjects were divided into Downloader (DL) and No-downloader (NDL). RESULTS A total of 63 subjects were analyzed, of which 30 were classified as DL and 33 as NDL. At the end of the study, DL had significantly lower HbA1c, mean daily glucose, standard deviation, percentage of BG values above target, and pre- and postprandial (lunch and dinner) values compared with NDL (all P<.05). The percentage of BG values within treatment target was significantly higher in DL compared with NDL (47% [SD 9] vs 37% [SD 13]; P=.001). CONCLUSIONS The findings suggest that, in T1DM, downloading of BG from data management system, which enables connection to smartphones, the Web, and the cloud, might be a valuable contributor to improved glycemic control.

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The relationship between the frequency of self‐monitoring of blood glucose and glycemic control in patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion or on multiple daily injections

Journal of Diabetes Investigation ◽

10.1111/jdi.12362 ◽

2015 ◽

Vol 6 (6) ◽

pp. 687-691 ◽

Cited By ~ 17

Author(s):

Takashi Murata ◽

Kokoro Tsuzaki ◽

Fumi Yoshioka ◽

Hiroshi Okada ◽

Junichiro Kishi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Blood Glucose ◽

Glycemic Control ◽

Continuous Subcutaneous Insulin Infusion ◽

Insulin Infusion ◽

Subcutaneous Insulin ◽

Self Monitoring ◽

The Relationship

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MON-625 Utility of Continuous Glucose Monitoring in Children with Type 1 Diabetes: Is HbA1c Enough?

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.649 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Lindsey L Owens ◽

Sweta Chalise ◽

Neha Vyas ◽

Shilpa Gurnurkar

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Glycemic Control ◽

Continuous Glucose Monitoring ◽

Pediatric Patients ◽

Glucose Monitoring ◽

Self Monitoring ◽

Average Change ◽

Hba1c Levels

Abstract Introduction: Type 1 diabetes is an autoimmune condition resulting in insulin deficiency that requires daily insulin therapy and self-monitoring of blood glucose. Continuous glucose monitoring (CGM) systems allow for measurement of interstitial fluid glucose levels in a continuous fashion to identify variations and trends that are not feasible with conventional self-monitoring. Hemoglobin A1C (HbA1C) is the method used to assess adequate glycemic control and relates to future risk of developing complications. Current evidence has shown improvement in HbA1C with concomitant use of CGM in adults over 25 years of age with Type 1 diabetes, whereas studies in children and adolescents have failed to show this. However, it is important to note the limitations in HbA1C use as it is a marker of average blood glucose over 3 months but does not reflect glycemic variability. More recent data has suggested that factors such as time in range (TIR), which can be determined with CGM use, are also associated with decrease risk of diabetes complications. Methods: The goal of our study was to analyze the change in HbA1C levels after using a CGM (DEXCOM G4, G5, G6) over a 6-month period in pediatric patients with Type I diabetes. Two HBA1c levels 3 months apart from 92 patients were collected before using a CGM and two while using a CGM. Results were compared by using a dependent samples t-test. IBM SPSS 25.0 was used for data analysis. Results: Preliminary analysis indicates the average change in HBA1C among the patients (N=92) before (-0.08 ± 1.16) and while using the CGM (0.12 ± 1.00) was not significantly different (t (79) = -1.27, p = 0.21). The average change in HBA1C was also not significantly different (p>0.05) among the patients before and while using the CGM for gender (males and females), age groups (0-7 years, 8-14 years, and 15-24 years), and generations of DEXCOM used (G4, G5, and G6). Conclusion: As has been shown in other studies, we did not find a significant change in HbA1c after CGM use for 6 months in our patients. While HbA1C is a reflection of blood sugars over a 3-month period, it does not provide information about glycemic excursions. Metrics derived from CGM use, such as TIR, can provide actionable information which we did not address in our study. There have been reports of the association between TIR and long-term complications of diabetes. Most data comes from studies in adults and pediatric data is lacking. We propose that future studies must look into CGM metrics such as TIR to better define glycemic control in pediatric patients with diabetes mellitus.

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Accuracy of Blood Glucose Meters for Self-Monitoring Affects Glucose Control and Hypoglycemia Rate in Children and Adolescents with Type 1 Diabetes

Diabetes Technology & Therapeutics ◽

10.1089/dia.2014.0262 ◽

2015 ◽

Vol 17 (4) ◽

pp. 275-282 ◽

Cited By ~ 20

Author(s):

Claudia Boettcher ◽

Axel Dost ◽

Stefan A. Wudy ◽

Marion Flechtner-Mors ◽

Martin Borkenstein ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Children And Adolescents ◽

Glucose Control ◽

Self Monitoring

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A Time-Friendly, Feasible Measure of Nutrition Knowledge in Type 1 Diabetes: The Electronic Nutrition and Carbohydrate Counting Quiz (eNCQ)

Journal of Diabetes Science and Technology ◽

10.1177/1932296818778608 ◽

2018 ◽

Vol 13 (1) ◽

pp. 68-74

Author(s):

Arwen M. Marker ◽

Amy E. Noser ◽

Nicole Knecht ◽

Mark A. Clements ◽

Susana R. Patton

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Nutrition Education ◽

Diabetes Management ◽

Clinical Care ◽

Nutrition Knowledge ◽

Diabetes Diagnosis ◽

Carbohydrate Counting ◽

One Year

Background: Greater knowledge about nutrition and carbohydrate counting are associated with improved glycemic control and quality of life in youth with type 1 diabetes (T1D). However, limited assessments of nutrition and carbohydrate knowledge have been developed, and existing measures can be time-consuming, overly broad, or not conducive to routine clinical use. To fill this gap, we developed and examined the feasibility of administering the electronic Nutrition and Carbohydrate Counting Quiz (eNCQ). Method: Ninety-two caregivers and 70 youth with T1D (mean age 12.5 years; mean time since diagnosis 5 years; English speaking) completed the 19-item eNCQ via tablet during a routine clinical visit. Completion time and item completion rates were used to assess feasibility. Relationships between eNCQ scores and patient demographics, diabetes management, and health outcomes were examined. Results: Participants took 10 minutes, on average, to complete the eNCQ. Total and Carbohydrate subscale scores (youth report) were negatively correlated with youth hemoglobin A1c (total r = –.38, carbohydrate r = –.38, Ps < .05), indicating that greater nutrition knowledge related to better glycemic control. Nutrition knowledge scores were generally high, but knowledge was negatively related to time since diabetes diagnosis ( r = –.276, P < .05). Conclusions: Findings support feasibility of the eNCQ to assess nutrition knowledge in routine clinical care. Following additional acceptability and validity testing, the eNCQ may identify families in need of further nutrition education. Nutrition assessment is particularly indicated for youth over one year since T1D diagnosis, as these families displayed lower nutrition knowledge and may need continuing education to maintain diabetes-specific nutrition knowledge over time.

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