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Diabetes Technology & Therapeutics

Priya Prahalad, Ananta Addala, Bruce Buckingham, Darrell M Wilson, David M Maahs
No abstract text is available yet for this article.
July 18, 2018: Diabetes Technology & Therapeutics
Sarit Polsky, Mengdi Wu, Bruce W Bode, Stephanie N DuBose, Robin S Goland, David M Maahs, Nicole C Foster, Anne L Peters, Carol J Levy, Viral N Shah, Roy W Beck
BACKGROUND: Gestational tight glycemic control is critical for women with type 1 diabetes (T1D). Limited data exist on the adoption and retention of diabetes technologies among women in different parity strata. METHODS: We compared T1D management between T1D Exchange clinic registry participants (mean age 28 ± 9 years, 84% white non-Hispanic, and median T1D duration 13 years) who were pregnant at enrollment or year 1 follow-up ("recently pregnant" between 2010 and 2013, n = 214), ever (but not recently) pregnant (n = 1540), and never pregnant (n = 2586)...
July 10, 2018: Diabetes Technology & Therapeutics
Marc D Breton, Stephen D Patek, Dayu Lv, Elaine Schertz, Jessica Robic, Jennifer Pinnata, Laura Kollar, Charlotte Barnett, Christian Wakeman, Mary Oliveri, Chiara Fabris, Daniel Chernavvsky, Boris P Kovatchev, Stacey M Anderson
BACKGROUND: Glucose variability (GV) remains a key limiting factor in the success of diabetes management. While new technologies, for example, accurate continuous glucose monitoring (CGM) and connected insulin delivery devices, are now available, current treatment standards fail to leverage the wealth of information generated. Expert systems, from automated insulin delivery to advisory systems, are a key missing element to richer, more personalized, glucose management in diabetes. METHODS: Twenty four subjects with type 1 diabetes mellitus (T1DM), 15 women, 37 ± 11 years of age, hemoglobin A1c 7...
July 6, 2018: Diabetes Technology & Therapeutics
Katerina Stechova, Miroslav Vanis, Martina Tuhackova, Krzysztof Urbaniec, Milan Kvapil
BACKGROUND: To improve insulin pump therapy results, a special test for patients was devised. The model successfully used to achieve a license to operate different machines was followed. METHODS: The test (a practice and a full run, with a time limit) contained 42 questions, each with four optional choices, and could be answered online. Patients could familiarize themselves with the whole question pool first. Patients could repeat a full run attempt if they failed and were offered focused remedial education...
June 8, 2018: Diabetes Technology & Therapeutics
Lisa Bonato, Nadine Taleb, Véronique Gingras, Virginie Messier, Fernand Gobeil, Julie Ménard, Jean-Luc Ardilouze, Rémi Rabasa-Lhoret
Increasing proportions of patients with diabetes use continuous subcutaneous insulin infusion (CSII) therapy mostly due to its clinical efficacy and flexibility for insulin dosing and adjustments. Some challenges are nevertheless associated with this technology. A key and underlooked component of CSII technical difficulties is the subcutaneous catheter used to infuse insulin. Several adverse events (AEs) have been experienced by patients in relation to catheters, such as blockage, kinking, and insertion site reactions, including irritation, infections, lipohypertrophies etc...
July 2018: Diabetes Technology & Therapeutics
Johan Jendle, Lutz Heinemann
No abstract text is available yet for this article.
July 2018: Diabetes Technology & Therapeutics
Jordan E Pinsker, Alejandro J Laguna Sanz, Joon Bok Lee, Mei Mei Church, Camille Andre, Laura E Lindsey, Francis J Doyle, Eyal Dassau
BACKGROUND: We investigated the safety and efficacy of the addition of a trust index to enhanced Model Predictive Control (eMPC) Artificial Pancreas (AP) that works by adjusting the responsiveness of the controller's insulin delivery based on the confidence intervals around predictions of glucose trends. This constitutes a dynamic adaptation of the controller's parameters in contrast with the widespread AP implementation of individualized fixed controller tuning. MATERIALS AND METHODS: After 1 week of sensor-augmented pump (SAP) use, subjects completed a 48-h AP admission that included three meals/day (carbohydrate range 29-57 g/meal), a 1-h unannounced brisk walk, and two overnight periods...
July 2018: Diabetes Technology & Therapeutics
Zoe A Stewart, Jennifer M Yamamoto, Malgorzata E Wilinska, Sarah Hartnell, Conor Farrington, Roman Hovorka, Helen R Murphy
Tight glucose control during labor and delivery is recommended for pregnant women with type 1 diabetes. This can be challenging to achieve using the current treatment modalities. The automated nature of closed loop and its ability to adapt to real-time glucose levels make it well suited for use during labor, delivery, and the immediate postpartum period. We report observational data of participants from two randomized crossover trials who chose to continue using closed loop during labor, delivery, and postpartum...
July 2018: Diabetes Technology & Therapeutics
Sunil S Gupta, Kavita S Gupta, Sachin S Gathe, Parvinder Bamrah, Shlok S Gupta
BACKGROUND: Lipohypertrophy (LH) at insulin injection sites is a common but preventable complication in type 1 diabetes mellitus (T1DM). We evaluated the prevalence, contributing risk factors, and consequences of LH, specifically the glycemic variability (GV) among T1DM patients. METHODS: This is a cross-sectional study conducted at a tertiary care center in India, wherein 139 subjects with T1DM were randomly selected and evaluated for the presence of LH through visual and palpation examinations...
July 2018: Diabetes Technology & Therapeutics
Anna Korsgaard Berg, Kirsten Nørgaard, Jacob P Thyssen, Claus Zachariae, Eva Hommel, Karen Rytter, Jannet Svensson
BACKGROUND: In the future, widespread use of closed-loop infusion (artificial pancreas) systems to treat type 1 diabetes (T1D) may significantly improve glycemic control and enhance treatment flexibility. However, the infusion sets and plasters necessary for these treatments can cause dermatological complications that may hamper the spread of the new technology; few studies have investigated these complications in adults. The aim of this study was to describe the dermatological complications associated with continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in adults...
July 2018: Diabetes Technology & Therapeutics
Shelagh A Mulvaney, Sarah Vaala, Korey K Hood, Cindy Lybarger, Rachel Carroll, Laura Williams, Douglas C Schmidt, Kevin Johnson, Mary S Dietrich, Lori Laffel
BACKGROUND: Integration of momentary contextual and psychosocial factors within self-management feedback may provide more specific, engaging, and personalized targets for problem solving. METHODS: Forty-four youth ages 13-19 with type 1 diabetes (T1D) were provided a Bluetooth meter and completed the 30-day protocol. Participants were randomized to "app + meter" or "meter-only" groups. App + meter participants completed mealtime and bedtime assessment each day...
July 2018: Diabetes Technology & Therapeutics
Jun Yang Lee, Shaun Wen Huey Lee
BACKGROUND: Telemedicine has been utilized increasingly worldwide for diabetes management, due to its potential to improve healthcare access and clinical outcomes. Few studies have assessed the economic benefits of telemedicine, which may contribute to underfunding in potentially important programs. We aim to systematically review the literature on economic evaluations of telemedicine in diabetes care, assess the quality, and summarize the evidence on driver of cost-effectiveness. MATERIALS AND METHODS: A literature search was performed in 10 databases from inception until February 2018...
July 2018: Diabetes Technology & Therapeutics
Viral N Shah, Lori M Laffel, R Paul Wadwa, Satish K Garg
BACKGROUND: This study assessed the accuracy of a factory-calibrated 10-day real-time continuous glucose monitoring (CGM) system (G6), which includes an automated sensor applicator. METHODS: Seventy-six participants with insulin-treated diabetes were enrolled at four U.S. sites as part of a larger study of G6 system performance. In-clinic visits for frequent comparative blood glucose measurements using a reference instrument (YSI) were conducted on days 1, 4-5, 7, and/or 10 of system use...
June 2018: Diabetes Technology & Therapeutics
Shengsheng Yu, Biju Varughese, Zhiyi Li, Pam R Kushner
BACKGROUND: Traditional continuous glucose monitoring (CGM) provides detailed information on glucose patterns and trends to inform daily diabetes management decisions, which is particularly beneficial for patients with a history of hypoglycemia unawareness. However, a high level of patient adherence (≥70%) is required to achieve clinical benefits. The aim of this study was to assess the impact of real-world patient nonadherence and early discontinuation on healthcare resource use. METHODS: A cost calculator was designed to evaluate monthly healthcare resource waste within the first year of traditional CGM initiation by combining estimates of real-world nonadherence and early discontinuation from the literature with the wholesale acquisition costs of the current technology in the United States (for a commercial payer and for Medicare), or its equivalent in Sweden, Germany, or the Netherlands...
June 2018: Diabetes Technology & Therapeutics
Sophie Guilmin-Crépon, Jean-Claude Carel, Julien Schroedt, Erwan Scornet, Corinne Alberti, Nadia Tubiana-Rufi
BACKGROUND: Glycemic variability (GV) can be used to assess glycemic control in diabetes, but there is no clear consensus concerning the methods to use for its assessment. Methodological differences have resulted in differences in the outcome of GV metrics used in research studies, controversies over clinical impact, and an absence of integration into routine care. AIM: To identify the indicators of GV most meaningful for clinicians, patients, and clinical researchers...
June 2018: Diabetes Technology & Therapeutics
Rayhan A Lal, Bruce Buckingham, David M Maahs
No abstract text is available yet for this article.
June 2018: Diabetes Technology & Therapeutics
David Rodbard
Glycemic variability (GV) is a major consideration when evaluating quality of glycemic control. GV increases progressively from prediabetes through advanced T2D and is still higher in T1D. GV is correlated with risk of hypoglycemia. The most popular metrics for GV are the %Coefficient of Variation (%CV) and standard deviation (SD). The %CV is correlated with risk of hypoglycemia. Graphical display of glucose by date, time of day, and day of the week, and display of simplified glucose distributions showing % of time in several ranges, provide clinically useful indicators of GV...
June 2018: Diabetes Technology & Therapeutics
Thomas Danne, Torben Biester, Olga Kordonouri
The sodium-glucose cotransporter type 1 (SGLT1) is the primary transporter for absorption of glucose and galactose in the gastrointestinal tract. Inhibition blunts and delays postprandial glucose (PPG) excursion. Sodium-glucose cotransporter type 2 (SGLT2) is expressed in the kidney, where it reabsorbs 90% of filtered glucose. Thus, a dual SGLT1 and SGLT2 inhibition (compared with selective SGLT2 inhibition) could result in lower PPG and robust A1c reduction even in patients with reduced kidney function. Sotagliflozin is an oral potent dual inhibitor of the insulin-independent SGLT1 and SGLT2...
June 2018: Diabetes Technology & Therapeutics
Laurel H Messer, Cari Berget, Christie Beatson, Sarit Polsky, Gregory P Forlenza
Skin integrity and diabetes device placement are ongoing concerns for people with diabetes who utilize continuous glucose monitors (CGMs) and continuous subcutaneous insulin infusion pumps. This is especially significant for individuals with skin sensitivities, pediatric patients, and those who use devices chronically. Dermatological complications are often cited as a barrier to device use and a reason for device discontinuation. Furthermore, it is a frequent topic of discussion in diabetes follow-up visits, although little evidence-based literature exists to guide providers in managing skin integrity issues...
June 2018: Diabetes Technology & Therapeutics
Laurel H Messer
No abstract text is available yet for this article.
June 2018: Diabetes Technology & Therapeutics
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