scholarly journals Addressing shortfalls of laboratory HbA1c using a model that incorporates red cell lifespan

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Yongjin Xu ◽  
Richard M Bergenstal ◽  
Timothy C Dunn ◽  
Ramzi A Ajjan
Keyword(s):  
Diabetes Complications ◽  
Glucose Monitoring ◽  
Absolute Difference ◽  
Clinical Implications ◽  
Red Cell ◽  
Diabetes Complication ◽  
Glucose Exposure ◽  
Intracellular Glucose

Laboratory HbA1c does not always predict diabetes complications and our aim was to establish a glycaemic measure that better reflects intracellular glucose exposure in organs susceptible to complications. Six months of continuous glucose monitoring data and concurrent laboratory HbA1c were evaluated from 51 type 1 diabetes (T1D) and 80 type 2 diabetes (T2D) patients. Red blood cell (RBC) lifespan was estimated using a kinetic model of glucose and HbA1c, allowing the calculation of person-specific adjusted HbA1c (aHbA1c). Median (IQR) RBC lifespan was 100 (86–102) and 100 (83–101) days in T1D and T2D, respectively. The median (IQR) absolute difference between aHbA1c and laboratory HbA1c was 3.9 (3.0–14.3) mmol/mol [0.4 (0.3–1.3%)] in T1D and 5.3 (4.1–22.5) mmol/mol [0.5 (0.4–2.0%)] in T2D. aHbA1c and laboratory HbA1c showed clinically relevant differences. This suggests that the widely used measurement of HbA1c can underestimate or overestimate diabetes complication risks, which may have future clinical implications.

scholarly journals Important Drop Rate of Acute Diabetes Complications in People With Type 1 or Type 2 Diabetes After Initiation of Flash Glucose Monitoring in France: The RELIEF Study

2021 ◽  
Author(s):  
Ronan Roussel ◽  
Jean-Pierre Riveline ◽  
Eric Vicaut ◽  
Gérard de Pouvourville ◽  
Bruno Detournay ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetes Complications ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Freestyle Libre ◽  
Before And After ◽  
Acute Diabetes

<b>Objective</b> <p>The RELIEF study assessed rates of hospitalization for acute diabetes complications in France, before and after initiating the FreeStyle Libre system. </p> <p><b>Research Design and Methods</b></p> <p>74,011 patients with type 1 diabetes or type 2 diabetes who initiated the FreeStyle Libre system were identified from the French national claim database (SNDS) using ICD-10 codes, from hospitalizations with diabetes as a contributing diagnosis, or the prescription of insulin. Patients were sub-classified based on SMBG strip-acquisition prior to starting FreeStyle Libre. Hospitalizations for DKA, severe hypoglycemia, diabetes-related coma and hyperglycemia were recorded for the 12 months before and after initiation. </p> <p><b>Results</b></p> <p>Hospitalizations for acute diabetes complications fell in type 1 diabetes (-49.0%) and in type 2 diabetes (-39.4%) following FreeStyle Libre initiation. DKA fell in type 1 diabetes (-56.2%,) and in type 2 diabetes (-52.1%), as did diabetes-related comas in type 1 diabetes (-39.6%) and in type 2 diabetes (-31.9%). Hospitalizations for hypoglycemia and hyperglycemia decreased in type 2 diabetes (-10.8% and -26.5%, respectively). Before initiation, hospitalizations were most marked for people non-compliant with SMBG and for those with highest acquisition of SMBG, which fell by -54.0% and 51.2% respectively following FreeStyle Libre initiation. Persistence with FreeStyle Libre at 12 months was 98.1%.</p> <p><b>Conclusions</b></p> <p>This large retrospective study on hospitalizations for acute diabetes complication shows that a significantly lower incidence of admissions for DKA and for diabetes-related coma is associated with use of flash glucose monitoring. This study has significant implications for patient-centered diabetes care and potentially for long-term health economic outcomes.</p> <br> <p> </p>

Important Drop Rate of Acute Diabetes Complications in People With Type 1 or Type 2 Diabetes After Initiation of Flash Glucose Monitoring in France: The RELIEF Study

Diabetes Care ◽  
2021 ◽  
pp. dc201690
Author(s):  
Ronan Roussel ◽  
Jean-Pierre Riveline ◽  
Eric Vicaut ◽  
Gérard de Pouvourville ◽  
Bruno Detournay ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Complications ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Acute Diabetes ◽  
Drop Rate

scholarly journals HbA1c Is Disproportionately Higher in Women and Older People With Type 1 Diabetes Compared With Flash Glucose Monitoring Metrics of Glycemic Control

2020 ◽  
pp. 193229682096733
Author(s):  
Roland H. Stimson ◽  
Anna R. Dover ◽  
Shareen Forbes ◽  
Mark W. J. Strachan ◽  
John A. McKnight ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Older People ◽  
Microvascular Complications ◽  
Glucose Monitoring ◽  
Cross Sectional Study ◽  
Clinical Implications ◽  
Older Individuals ◽  
Cross Sectional ◽  
Glucose Exposure

Aims: Discrepancy between HbA1c and glucose exposure may have significant clinical implications. We sought to assess predictors of disparity between HbA1c and flash monitoring metrics and how these relate to microvascular complications. Methods: We conducted a cross-sectional study of adults with type 1 diabetes ( n = 518). We assessed the relationship between clinic HbA1c and flash monitoring metrics, predictors of discrepancy between these measurements, and whether discrepancy was associated with microvascular complications. Results: Actual HbA1c and estimated HbA1c were strongly correlated ( r = .779, P < .001). The likelihood of having a higher actual HbA1c than estimated HbA1c was greater with increasing age (OR = 1.055 per year, P < .001) and lower in men (OR = .208, P < .001). HbA1c was significantly lower in men (58 mmol/mol [51-67]) (7.5% [6.8-8.3]) compared to women (61 mmol/mol [54-70], P = .021) (7.7% [7.1-8.6]), despite no significant differences in any flash monitoring metrics. Whereas HbA1c was not different between younger (≤39 years) and older individuals (>39 years) despite significantly higher glucose exposure, in younger people, based on multiple flash monitoring metrics. Having a lower estimated than actual HbA1c was independently associated with a lower prevalence of retinopathy (OR = .55, P = .004). Conclusions: HbA1c appears to overestimate glucose exposure in women and older people with type 1 diabetes. This has potentially important clinical implications, as is hinted at by the independent relationship with retinopathy prevalence. It may also be of relevance when considering the use of HbA1c for the diagnosis of diabetes.

scholarly journals Important Drop Rate of Acute Diabetes Complications in People With Type 1 or Type 2 Diabetes After Initiation of Flash Glucose Monitoring in France: The RELIEF Study

2021 ◽  
Author(s):  
Ronan Roussel ◽  
Jean-Pierre Riveline ◽  
Eric Vicaut ◽  
Gérard de Pouvourville ◽  
Bruno Detournay ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetes Complications ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Freestyle Libre ◽  
Before And After ◽  
Acute Diabetes

<b>Objective</b> <p>The RELIEF study assessed rates of hospitalization for acute diabetes complications in France, before and after initiating the FreeStyle Libre system. </p> <p><b>Research Design and Methods</b></p> <p>74,011 patients with type 1 diabetes or type 2 diabetes who initiated the FreeStyle Libre system were identified from the French national claim database (SNDS) using ICD-10 codes, from hospitalizations with diabetes as a contributing diagnosis, or the prescription of insulin. Patients were sub-classified based on SMBG strip-acquisition prior to starting FreeStyle Libre. Hospitalizations for DKA, severe hypoglycemia, diabetes-related coma and hyperglycemia were recorded for the 12 months before and after initiation. </p> <p><b>Results</b></p> <p>Hospitalizations for acute diabetes complications fell in type 1 diabetes (-49.0%) and in type 2 diabetes (-39.4%) following FreeStyle Libre initiation. DKA fell in type 1 diabetes (-56.2%,) and in type 2 diabetes (-52.1%), as did diabetes-related comas in type 1 diabetes (-39.6%) and in type 2 diabetes (-31.9%). Hospitalizations for hypoglycemia and hyperglycemia decreased in type 2 diabetes (-10.8% and -26.5%, respectively). Before initiation, hospitalizations were most marked for people non-compliant with SMBG and for those with highest acquisition of SMBG, which fell by -54.0% and 51.2% respectively following FreeStyle Libre initiation. Persistence with FreeStyle Libre at 12 months was 98.1%.</p> <p><b>Conclusions</b></p> <p>This large retrospective study on hospitalizations for acute diabetes complication shows that a significantly lower incidence of admissions for DKA and for diabetes-related coma is associated with use of flash glucose monitoring. This study has significant implications for patient-centered diabetes care and potentially for long-term health economic outcomes.</p> <br> <p> </p>

68-LB: Acute Diabetes Events and All-Cause Hospitalizations among Continuous Glucose Monitoring Device Recipients with Type 1 and Type 2 Diabetes: A Comparison of FreeStyle Libre and Dexcom

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 68-LB
Author(s):  
IRL B. HIRSCH ◽  
GREGORY J. ROBERTS ◽  
JENNIFER JOSEPH ◽  
YELENA NABUTOVSKY ◽  
NAUNIHAL VIRDI ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Monitoring Device ◽  
Freestyle Libre ◽  
Acute Diabetes

Reference Guide for Integrating Continuous Glucose Monitoring Into Clinical Practice

2018 ◽  
Vol 45 (1_suppl) ◽  
pp. 3S-20S ◽  
Author(s):  
Davida F. Kruger ◽  
Steve V. Edelman ◽  
Deborah A. Hinnen ◽  
Christopher G. Parkin
Keyword(s):  
Clinical Practice ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Health Care Team ◽  
Basic Knowledge ◽  
Reference Guide ◽  
Comprehensive Information ◽  
Effective Use

Purpose Large randomized trials have demonstrated the efficacy of continuous glucose monitoring (CGM) in persons with type 1 diabetes and insulin-treated type 2 diabetes. The purpose of this article is to provide basic knowledge about CGM technology, discuss the use of CGM data in clinical practice, and direct clinicians to online resources that provide comprehensive information and tools relevant to patient selection, education/training, and reimbursement. Conclusions Effective use of CGM requires all members of the health care team to become knowledgeable and skilled in integrating CGM into their practices and in teaching their patients how to safely incorporate CGM use into their daily diabetes self-management.

scholarly journals Resistance to Acetaminophen Interference in a Novel Continuous Glucose Monitoring System

2018 ◽  
Vol 12 (2) ◽  
pp. 393-396 ◽  
Author(s):  
Peter Calhoun ◽  
Terri Kang Johnson ◽  
Jonathan Hughes ◽  
David Price ◽  
Andrew K. Balo
Keyword(s):  
Type 2 Diabetes ◽  
Real Time ◽  
Monitoring System ◽  
Continuous Glucose Monitoring ◽  
Interference Effect ◽  
Glucose Monitoring ◽  
Post Dose ◽  
The Difference

Acetaminophen (APAP) can cause erroneously high readings in real-time continuous glucose monitoring (rtCGM) systems. APAP-associated bias in an investigational rtCGM system (G6) was evaluated by taking the difference in glucose measurements between rtCGM and YSI from 1 hour before to 6 hours after a 1-g oral APAP dose in 66 subjects with type 1 or type 2 diabetes. The interference effect was defined as the average post-dose (30-90 minutes) bias minus the average baseline bias for each subject. The clinically meaningful interference effect was defined as 10 mg/dL. The G6 system’s overall mean (±SD) interference effect was 3.1 ± 4.8 mg/dL (one-sided upper 95% CI = 4.1 mg/dL), significantly lower than 10 mg/dL. The G6 system’s resistance to APAP interference should provide reassurance to those using the drug.

scholarly journals Effects of Flash Glucose Monitoring on Dietary Variety, Physical Activity, and Self-Care Behaviors in Patients with Diabetes

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Satoshi Ida ◽  
Ryutaro Kaneko ◽  
Kanako Imataka ◽  
Kaoru Okubo ◽  
Yoshitaka Shirakura ◽  
...  
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Type 1 Diabetes Mellitus ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring

The aim of this study was to evaluate the effects of flash glucose monitoring on dietary variety, physical activity, and self-care behavior in patients with diabetes. This study included outpatients with diabetes using insulin who presented at the Department of Diabetes and Metabolism of the Ise Red Cross Hospital. Before initiating flash glucose monitoring and 12 weeks after its initiation, blood glucose-related parameters were assessed and self-administered questionnaires were completed (Dietary Variety Score (DVS), the International Physical Activity Questionnaire (IPAQ), the Summary of Diabetes Self-Care Activities Measure (SDSCA), and the Diabetes Treatment Satisfaction Questionnaire (DTSQ)) and compared between the two time points. We analyzed 42 patients with type 1 diabetes mellitus and 48 patients with type 2 diabetes mellitus. In patients with type 2 diabetes mellitus, but not type 1 diabetes mellitus, there was an increase in moderate/high category scores for IPAQ (P<0.001) and for treatment satisfaction reported via DTSQ. Furthermore, in patients with type 2 diabetes mellitus, the glycemic excursion index improved significantly and HbA1c decreased significantly (from 7.7 (1.2) to 7.4 (0.8), P=0.025). Results showed that standard deviation and mean amplitude of glycemic excursions significantly decreased in patients with type 1 diabetes mellitus (from 71.2 (20.4) to 66.2 (17.5), P=0.033 and from 124.6 (31.9) to 108.1 (28.4), P<0.001, respectively). Flash glucose monitoring is a useful tool to improve physical activity in patients with type 2 diabetes.

Overestimation of Risk and Increased Fear of Long-term Complications of Diabetes in People with Type 1 and 2 Diabetes

2019 ◽  
Vol 127 (10) ◽  
pp. 645-652 ◽  
Author(s):  
Florian Arend ◽  
Ulrich A. Müller ◽  
Andreas Schmitt ◽  
Margarete Voigt ◽  
Nadine Kuniss
Keyword(s):  
Diabetes Complications ◽  
Metabolic Diseases ◽  
Population Based ◽  
Diabetes Type ◽  
Complications Of Diabetes ◽  
Personal Risk ◽  
Disease Management Programmes

AbstrAct Objective The quality report of the disease management programmes of North Rhine Westphalia 2016 showed prevalences for long-term complications (neuropathy, nephropathy, retinopathy) of less than 30% for people with diabetes type 1 (DM1) and type 2 (DM2). The aim of this study was to assess risk expectations and fear regarding long-term complications of diabetes in people with DM1 and DM2. Methods We assessed risk expectations and fear regarding diabetes complications in people with DM1 (n=110) and DM2 (n=143 without insulin, n=249 with insulin) visiting an University outpatient department of metabolic diseases. Fear of long-term complications was measured with the “Fear of Complications Questionnaire (FCQ)” (range 0–45 points, scores ≥30 suggest elevated fear). Participants were asked to estimate general and personal risks of long-term complications 10 years after developing diabetes in %. Results Elevated fear of complications (FCQ scores ≥30) was observed in 34.5, 25.9, and 43.0% of those with DM1, DM2 without insulin and DM2 with insulin, respectively. Participants estimated a mean general risk of diabetes-related complications after 10 years amounting to 45.9±15.8% (DM1), 49.7±15.4% (DM2 without insulin), and 52.5±16.4% (DM2 with insulin) and personal risk with 52.5±24.4% (DM1), 45.8±22.7% (DM2 without insulin), and 54.1±23.4% (DM2 with insulin), respectively. Higher risk expectations were associated with higher fear of complications (p<0.001). Conclusion Risk estimations regarding long-term complications were exaggerated in people with DM1 and DM2. About one third of the participants reported elevated fear of complications. Participants’ risk expectations and fear regarding diabetes complications appear excessive compared to population-based prevalence rates.

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