Glycemic Control in Transition‐Aged Versus Early Adults with Type 1 Diabetes and the Effect of a Government‐Funded Insulin Pump Program

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.

Download Full-text

Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes

JAMA ◽

10.1001/jama.2017.13994 ◽

2017 ◽

Vol 318 (14) ◽

pp. 1358 ◽

Cited By ~ 111

Author(s):

Beate Karges ◽

Anke Schwandt ◽

Bettina Heidtmann ◽

Olga Kordonouri ◽

Elisabeth Binder ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Glycemic Control ◽

Insulin Pump ◽

Severe Hypoglycemia ◽

Insulin Injection ◽

Injection Therapy ◽

Insulin Pump Therapy ◽

Pump Therapy

Download Full-text

Initiation of insulin pump therapy in children at diagnosis of type 1 diabetes resulted in improved long-term glycemic control

Pediatric Diabetes ◽

10.1111/pedi.12357 ◽

2016 ◽

Vol 18 (1) ◽

pp. 26-32 ◽

Cited By ~ 8

Author(s):

Eunice G. Lang ◽

Bruce R. King ◽

Malcolm N. Miller ◽

Sandra V. Dunn ◽

Darrell A. Price ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Insulin Pump ◽

Insulin Pump Therapy ◽

Pump Therapy

Download Full-text

Level of Internet use among Greek adolescents with type 1 diabetes

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2016-0140 ◽

2017 ◽

Vol 31 (1) ◽

Author(s):

Katerina Daniilidou ◽

Panagiota Triantafyllou ◽

Maria Resta ◽

Meropi Dimitriadou ◽

Athanasios Christoforidis

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Internet Use ◽

Insulin Pump ◽

Addictive Behavior ◽

The Internet ◽

Control Group ◽

Healthy Children ◽

Diabetes Clinic

Abstract Background Compulsive Internet use has emerged as a contemporary addictive behavior. Our aim was to investigate the reasons for Greek adolescents with type 1 diabetes mellitus (T1DM) and their families to use the Internet and additionally to investigate the level of Internet use and its associations to demographic, socio-economic parameters and glycemic control. Methods Patients with T1DM, aged >12 years and their parents were recruited during their regular visits to the Pediatric Diabetes Clinic. A similar group of healthy children, age- and sex-matched served as a control group. All participants were asked to fill out the Greek translated version of the Internet Addiction Test (IAT). Caregivers of patients with T1DM were asked to complete a second questionnaire consisting of questions regarding demographic and socio-economic data of the family and data concerning disease management. Results Thirty-five patients with T1DM (mean decimal age of 14.95 ± 1.90 years) and 35 controls participated in the study. Nine patients were on an insulin pump whereas the rest were on multiple daily injections. The mean total score of the patients’ IAT questionnaires was significantly lower compared to the controls (26.26 ± 12.67 vs. 39.91 ± 18.55, p = 0.003). Controls were characterized as exhibiting moderate addictive behavior at a significantly higher percentage than patients (31.43% vs. 2.86%, p = 0.002). All patients on insulin pumps demonstrated normal Internet use. Mild addictive behavior was associated with a lower parental educational level. Finally, level of Internet use (IAT score) was positively associated to glycemic control (HbA1c value) with a correlation that was approaching significance (r = 0.315, p = 0.065). Conclusions Adolescents with T1DM and especially those on an insulin pump exhibit normal Internet use compared to their healthy peers. Time consumed on Internet correlates reversibly with glycemic control.

Download Full-text