scholarly journals Sustained Continuous Glucose Monitor Use in Low-Income Youth with Type 1 Diabetes Following Insurance Coverage Supports Expansion of Continuous Glucose Monitor Coverage for All

2018 ◽  
Vol 20 (9) ◽  
pp. 632-634 ◽  
Author(s):  
Priya Prahalad ◽  
Ananta Addala ◽  
Bruce A. Buckingham ◽  
Darrell M. Wilson ◽  
David M. Maahs
Keyword(s):  
Type 1 Diabetes ◽  
Low Income ◽  
Insurance Coverage ◽  
Continuous Glucose Monitor

scholarly journals Substantial Intra-Individual Variability in Post-Prandial Time to Peak in Controlled and Free-Living Conditions in Children with Type 1 Diabetes

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4154
Author(s):  
Emily Bell ◽  
Sabrina Binkowski ◽  
Elaine Sanderson ◽  
Barbara Keating ◽  
Grant Smith ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Individual Variability ◽  
Living Conditions ◽  
Optimal Time ◽  
Daily Routine ◽  
Free Living ◽  
Continuous Glucose Monitor ◽  
Time To Peak ◽  
Free Living Conditions

The optimal time to bolus insulin for meals is challenging for children and adolescents with type 1 diabetes (T1D). Current guidelines to control glucose excursions do not account for individual differences in glycaemic responses to meals. This study aimed to examine the within- and between-person variability in time to peak (TTP) glycaemic responses after consuming meals under controlled and free-living conditions. Participants aged 8–15 years with T1D ≥ 1 year and using a continuous glucose monitor (CGM) were recruited. Participants consumed a standardised breakfast for six controlled days and maintained their usual daily routine for 14 free-living days. CGM traces were collected after eating. Linear mixed models were used to identify within- and between-person variability in the TTP after each of the controlled breakfasts, free-living breakfasts (FLB), and free-living dinners (FLD) conditions. Thirty participants completed the study (16 females; mean age and standard deviation (SD) 10.5 (1.9)). The TTP variability was greater within a person than the variability between people for all three meal types (between-person vs within-person SD; controlled breakfast 18.5 vs 38.9 minutes; FLB 14.1 vs 49.6 minutes; FLD 5.7 vs 64.5 minutes). For the first time, the study showed that within-person variability in TTP glycaemic responses is even greater than between-person variability.

scholarly journals Alarm Settings of Continuous Glucose Monitoring Systems and Associations to Glucose Outcomes in Type 1 Diabetes

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Yu Kuei Lin ◽  
Danielle Groat ◽  
Owen Chan ◽  
Man Hung ◽  
Anu Sharma ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Monitoring ◽  
Continuous Glucose Monitor ◽  
Cross Sectional ◽  
Therapeutic Goals ◽  
Glucose Levels ◽  
Alarm Threshold ◽  
Negative Impacts ◽  
Average Glucose

Abstract Context Little evidence exists regarding the positive and negative impacts of continuous glucose monitor system (CGM) alarm settings for diabetes control in patients with type 1 diabetes (T1D). Objective Evaluate the associations between CGM alarm settings and glucose outcomes. Design and Setting A cross-sectional observational study in a single academic institution. Patients and Main Outcome Measures CGM alarm settings and 2-week CGM glucose information were collected from 95 T1D patients with > 3 months of CGM use and ≥ 86% active usage time. The associations between CGM alarm settings and glucose outcomes were analyzed. Results Higher glucose thresholds for hypoglycemia alarms (ie, ≥ 73 mg/dL vs < 73 mg/dL) were related to 51% and 65% less time with glucose < 70 and < 54 mg/dL, respectively (P = 0.005; P = 0.016), higher average glucose levels (P = 0.002) and less time-in-range (P = 0.005), but not more hypoglycemia alarms. The optimal alarm threshold for < 1% of time in hypoglycemia was 75 mg/dL. Lower glucose thresholds for hyperglycemia alarms (ie, ≤ 205 mg/dL vs > 205 mg/dL) were related to lower average glucose levels and 42% and 61% less time with glucose > 250 and > 320 mg/dL (P = 0.020, P = 0.016, P = 0.007, respectively), without more hypoglycemia. Lower alarm thresholds were also associated with more alarms (P < 0.0001). The optimal alarm threshold for < 5% of time in hyperglycemia and hemoglobin A1c ≤ 7% was 170 mg/dL. Conclusions Different CGM glucose thresholds for hypo/hyperglycemia alarms are associated with various hypo/hyperglycemic outcomes. Configurations to the hypo/hyperglycemia alarm thresholds could be considered as an intervention to achieve therapeutic goals.

scholarly journals Pediatric Medicaid Patients With Type 1 Diabetes Benefit From Continuous Glucose Monitor Technology

2020 ◽  
pp. 193229682090621
Author(s):  
Sonalee J. Ravi ◽  
Alexander Coakley ◽  
Tim Vigers ◽  
Laura Pyle ◽  
Gregory P. Forlenza ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Pump ◽  
Diabetes Duration ◽  
Continuous Glucose Monitor ◽  
Percent Time ◽  
Time In Range ◽  
Continuous Glucose Monitors ◽  
Hispanic White

Background: We determined the uptake rate of continuous glucose monitors (CGMs) and examined associations of clinical and demographic characteristics with CGM use among patients with type 1 diabetes covered by Colorado Medicaid during the first two years of CGM coverage with no out-of-pocket cost. Method: We retrospectively reviewed data from 892 patients with type 1 diabetes insured by Colorado Medicaid (Colorado Health Program [CHP] and CHP+, Colorado Medicaid expansion). Demographics, insulin pump usage, CGM usage, and hemoglobin A1c (A1c) were extracted from the medical record. Data downloaded into CGM software at clinic appointments were reviewed to determine 30-day use prior to appointments. Subjects with some exposure to CGM were compared to subjects never exposed to CGM, and we examined the effect of CGM use on glycemic control. Results: Twenty percent of subjects had some exposure to CGM with a median of 22 [interquartile range 8, 29] days wear. Sixty one percent of CGM users had >85% sensor wear. Subjects using CGM were more likely to be younger ( P < .001), have shorter diabetes duration ( P < .001), and be non-Hispanic White ( P < .001) than nonusers. After adjusting for age and diabetes duration, combined pump and CGM users had a lower A1c than those using neither technology ( P = .006). Lower A1c was associated with greater CGM use ( P = .002) and increased percent time in range ( P < .001). Conclusion: Pediatric Medicaid patients successfully utilized CGM. Expansion of Medicaid coverage for CGM may help improve glycemic control and lessen disparities in clinical outcomes within this population.

scholarly journals Continuous Glucose Monitor Use With Remote Monitoring Reduces Fear of Hypoglycemia in Pregnant Women With Type 1 Diabetes: A Pilot Study

2019 ◽  
Vol 14 (1) ◽  
pp. 191-192
Author(s):  
Sarit Polsky ◽  
Rachel Garcetti ◽  
Laura Pyle ◽  
Prakriti Joshee ◽  
Jamie K. Demmitt ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Pilot Study ◽  
Pregnant Women ◽  
Remote Monitoring ◽  
Continuous Glucose Monitor ◽  
Fear Of Hypoglycemia

scholarly journals Sensor-Augmented Insulin Pumps and Hypoglycemia Prevention in Type 1 Diabetes

2016 ◽  
Vol 11 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Isabelle Steineck ◽  
Ajenthen Ranjan ◽  
Kirsten Nørgaard ◽  
Signe Schmidt
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Insulin Pumps ◽  
Continuous Glucose Monitor ◽  
Insulin Suspension ◽  
Multiple Daily Injections

Hypoglycemia can lead to seizures, unconsciousness, or death. Insulin pump treatment reduces the frequency of severe hypoglycemia compared with multiple daily injections treatment. The addition of a continuous glucose monitor, so-called sensor-augmented pump (SAP) treatment, has the potential to further limit the duration and severity of hypoglycemia as the system can detect and in some systems act on impending and prevailing low blood glucose levels. In this narrative review we summarize the available knowledge on SAPs with and without automated insulin suspension, in relation to hypoglycemia prevention. We present evidence from randomized trials, observational studies, and meta-analyses including nonpregnant individuals with type 1 diabetes mellitus. We also outline concerns regarding SAPs with and without automated insulin suspension. There is evidence that SAP treatment reduces episodes of moderate and severe hypoglycemia compared with multiple daily injections plus self-monitoring of blood glucose. There is some evidence that SAPs both with and without automated suspension reduces the frequency of severe hypoglycemic events compared with insulin pumps without continuous glucose monitoring.

scholarly journals MON-097 Continuous Glucose Monitoring in Youth with Type 1 Diabetes; Parental Anxiety and Parent Defined Outcomes: Results of Follow up Surveys

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Lina Alkhaled ◽  
MaryAnn O’Riordan ◽  
Sarah A MacLeish ◽  
Rebecca Hazen ◽  
Jamie Wood
Keyword(s):  
Type 1 Diabetes ◽  
Insurance Coverage ◽  
Glucose Monitoring ◽  
Demographic Variables ◽  
Potential Barriers ◽  
Fear Of Hypoglycemia ◽  
Continuous Glucose Monitors ◽  
Insurance Approval

Abstract Continuous glucose monitors (CGMs) can be helpful in management of type 1 diabetes (T1D). Our objectives were to explore parental reason for adding CGM to their child’s T1D management and to describe potential barriers to starting CGM. Prior to CGM initiation, the primary caregiver of a child with T1D completed validated questionnaires including Fear of Hypoglycemia Scale (FOH), State-Trait Anxiety Inventory (STAI), Problem Areas in Diabetes Scale (PAID), and an investigator developed questionnaire assessing primary reason for starting CGM. Surveys were repeated 3-8 months after adding CGM. The results of the initial surveys reported elsewhere suggest that the most common reason for starting CGM is to improve glycemic control. Out of 32 participants who completed initial surveys and intended to start CGM on their child, only 43% (N=14) started using CGM during the 3-8 month follow up period. Reasons for not starting CGM included: not having the chance to start the process of having it approved by insurance in 64% (N=9), and difficulties getting insurance to approve CGM in 28% (N=4). One participant reported that despite insurance coverage, out of pocket expense was too much. Wilcoxon Rank Sum tests were used to compare demographic variables between those that started and those that did not start CGM. Medians were used to report the results. There were no statistically significant differences between children who did and did not start CGM in terms of age (9.3 vs. 11.4 yrs, P=0.3), baseline HbA1c (8.1% vs. 9.4%, P=0.1), and diabetes duration (3.0 vs. 4.3 yrs, P=0.6). In summary, despite parental interest in CGM initiation for their children with type 1 diabetes, there remains a significant barrier to implementation from delays in getting insurance approval. Revision of policies related to CGM coverage in youth need to be revised and systems in place to expedite approval.

scholarly journals The CGM Experience of Minority Adults With Type 1 Diabetes in the South Bronx

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A462-A463
Author(s):  
Faustina Alejandra Lozada Orquera ◽  
Vivien Leung ◽  
Susel Rodriguez Ortega
Keyword(s):  
Socioeconomic Status ◽  
Type 1 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Low Income ◽  
Glucose Monitoring ◽  
Recent Analysis ◽  
The South ◽  
South Bronx ◽  
Black Patients

Abstract Objective: To describe the state of type 1 diabetes (T1D) in minority adults in the South Bronx, and their experience with continuous glucose monitoring (CGM). Introduction: In a recent analysis of data from the Type 1 Diabetes Exchange Registry, one notable finding was the difference in metabolic control and use of diabetes technology in patients of different socioeconomic status and racial/ethnic backgrounds. With limited data available on Hispanic and Black patients, we sought to examine the use of and experience with continuous glucose monitoring (CGM) in our hospital system, which primarily serves a low-income, minority population in the South Bronx. Methods: 68 adults with T1D who attended the Endocrinology clinic at our hospital from 2017 to 2019 were identified. Patients were contacted by telephone to complete a questionnaire regarding CGM use and satisfaction. A retrospective chart review was conducted to obtain additional demographic and clinical information. Results: Out of 68 patients with T1D in the hospital database who were contacted, 47 patients completed the questionnaire. The age range was 23 to 63 years. 42.6% were male. 59.6% were Hispanic, 19.1% Black/African American (AA), 4.3% Caucasian, and 17% not specified. 87.2% had public insurance. Overall, 48.9% of patients were actively using CGM, 19.1% had discontinued use of CGM, and 31.9% had never used CGM. In Hispanic patients using CGM, mean HbA1C was 8.2% compared to 10.1% in Hispanic non-users. In Black/AA patients using CGM, mean HbA1C was 9.2% compared to 9.9% in Black/AA non-users. Hospitalizations for acute diabetes complications were lower in CGM users (4.3%) compared to non-CGM users (16.7%). Among active CGM users, 74% rated their satisfaction as “extremely satisfied” or “very satisfied.” Perceived benefits included the prevention of hypoglycemia and awareness of inappropriate food intake. Discussion: Our study population, mainly comprised of Hispanic and Black T1D adults, showed a higher CGM utilization rate than previously reported. After stratification by socioeconomic status, CGM utilization was reported to be as low as 16% in Hispanic and 10% in Black patients with household income &lt;$50,000/year in the T1D Exchange Registry. By comparison, 49% of our studied population possessing similar demographics was actively using CGM. This study demonstrated that CGM acceptance was high in this largely minority, low-income population in the South Bronx, and was associated with lower A1C levels, high degree of patient satisfaction and reduction in diabetes-related hospitalizations. However, glycemic control remained suboptimal overall despite CGM access. Additional strategies to optimize the utility of CGM are needed to improve clinical outcomes such as HbA1C levels in minority T1D patients.

scholarly journals Reproducibility of Glucose Fluctuations Induced by Moderate Intensity Cycling Exercise in Persons with Type 1 Diabetes

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Gabriel Tafdrup Notkin ◽  
Peter Lommer Kristensen ◽  
Ulrik Pedersen-Bjergaard ◽  
Andreas Kryger Jensen ◽  
Stig Molsted
Keyword(s):  
Heart Rate ◽  
Type 1 Diabetes ◽  
Moderate Intensity ◽  
Blood Pressure Monitor ◽  
Continuous Training ◽  
Pressure Monitor ◽  
Continuous Glucose Monitor ◽  
Individual Level ◽  
Exercise Induced

Aims. The purpose was to assess the reproducibility of glucose changes during three sessions of standardized moderate intensity continuous training of cycling on an individual level in people with type 1 diabetes. Methods. Twelve adults (six females) with type 1 diabetes performed three test sessions on an ergometer bicycle (30 min, 67% of predicted heart rate) on three different days. The participants were 36.5 (26.6-45.5) (median, IQR) years old, and their HbA1c was 65 ± 15   mmol/mol ( mean ± SD ). Two hours before the tests, the participants had a standard meal. Interstitial glucose (IG) and capillary glucose (CG) were measured using an iPro2 Medtronic continuous glucose monitor and the Bayer Contour XT-device, respectively. Prior to the test sessions, resting heart rate was measured using a digital blood pressure monitor to estimate the desired intensity of the exercise. Results. The average within-participant relationship between the average slope in glucose during sessions 2 and 1 was in IG -0.29 (95% CI -1.11; 0.58) and in CG -0.04 (-0.68; 0.77). Between sessions 3 and 2, IG is 0.18 (-0.27; 0.64) and in CG 0.13 (-0.25; 0.55). Between sessions 3 and 1, IG was 0.06 (-0.57; 0.71) and in CG 0.06 (-0.39; 0.52). The results indicate low reproducibility at participant levels and remained unchanged after adjustment for baseline glucose values. Conclusion. On an individual level, the glucose declines during three standardized sessions of PA were not associated with identical responses of the measured IG and CG levels. An overall anticipated decline of glucose concentrations was found in the moderate intensity cycling sessions. This highlights the importance of regular CG measurements during and after physical activity and awareness towards potential exercise-induced hypoglycemia in persons with type 1 diabetes.

Sign in / Sign up

Export Citation Format

Share Document