Population-Level Personalized Diabetes Management Facilitated by Analyses of Continuous Glucose Monitor Data and Telehealth Visits (Preprint)

2021 ◽  
Author(s):  
David Scheinker ◽  
Angela Gu ◽  
Josh Grossman ◽  
Andrew Ward ◽  
Oseas Ayerdi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Population Level ◽  
Care Providers ◽  
Continuous Glucose Monitor ◽  
Diabetes Clinic ◽  
Time Required ◽  
Glucose Management ◽  
Automated Tool

BACKGROUND Continuous glucose monitors (CGM) are recommended as standard of care by the American Diabetes Association for individuals with type 1 diabetes on insulin. These devices generate glucose readings every 5-15 minutes and use cloud-based platforms to share data. This remotely reviewed data can be used by members of diabetes care team to provide remote care. OBJECTIVE To design an automated tool that facilitates timely, personalized, population-level guidance for glucose management through asynchronous telehealth. METHODS Using CGM data from six clinical trials and two observational datasets, we developed manufacturer-agnostic algorithms to generate generic (e.g., mean glucose (MG) > 170mg/dL) and personalized (e.g., MG increased by >10mg/dL) flags. We developed and deployed an automated tool in a pediatric type 1 diabetes clinic, measured sensitivity for identifying who may benefit from telehealth, and measured the time saved reviewing data with the use of the tool. RESULTS The eight cohorts contained 1,365 patients with 30,017 weeks of data collected by seven types of CGMs. In the cohort with the highest MG, 81.3% (26 of 32) and 3.1% (1/32) of people had a generic and personalized flag every week, respectively. In the clinic, on average, 57.2% of patients were flagged per week, corresponding to a sensitivity of 98.6% and a 42.8% reduction in the time required to review data. CONCLUSIONS The automated analysis of CGM data may help identify people requiring guidance on glucose management while reducing the workload for care providers. The rules-based approach provided fully interpretable representations of patient status relative to the latest guidelines. When deployed in a clinic, an automated tool to generate flags identified 98.6% of patients who would benefit from asynchronous telehealth contact while reducing the time required to review patient data by 42.8%. Guideline-based population health management may become more accessible through the use of automated tools.

scholarly journals Type 1 diabetes management and hospitalisation in the over 25’s at an Australian outer urban diabetes clinic

2021 ◽  
Author(s):  
Shivani Patel ◽  
Celine Farkash ◽  
David Simmons
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Complication Rates ◽  
Specialist Care ◽  
Model Of Care ◽  
Specialist Service ◽  
Diabetes Clinic ◽  
Clinic Management ◽  
Acute Infarction

Abstract AimsTo describe clinic management and referral pathways among adults with type 1 diabetes (T1D) aged >25 years attending a public outpatient diabetes service. MethodsRetrospective cohort study of people with T1D aged >25 years seen by endocrinologists in one Australian urban public outpatient in 2017. Electronic and paper medical records were reviewed using a dataset adapted from the UK National Institute for Health and Care Excellence 2015 guidelines. ResultsAmong the 111 people with T1D (mean age 41 ± 13 years, 55% men, mean body mass index 27.1 ± 5.6 kg/m2), mean HbA1c was 8.1 ± 1.9% (66 ± 19 mmol/mol) (lower than the Australian National Diabetes Audit: 8.5%/69 mmol/mol) with 25.5% meeting the guideline target of <53 mmol/mol (7.0%). Most people had seen a diabetes educator (80.2%) or dietitian (73.0%) and had complication screening. Complication rates were high (nephropathy 20.4%, retinopathy 27.4%, peripheral neuropathy 30.1%, ischaemic heart disease/acute infarction 10.5%). Overall, 27% of referrals occurred following an acute inpatient admission or emergency department presentation and 13% for management of diabetes in pregnancy. ConclusionsA high proportion of people with T1D accessed public specialist care either during pregnancy or after a largely avoidable acute glycaemia-related hospital presentation. Subsequent care was in line with national specialist standards. This area has a “wait for acute event” rather than “complication prevention” model of care, associated with under-referral to the local multidisciplinary specialist service. Understanding how widespread this model of care is, and ways to reduce its prevalence, are urgently required.

Working Toward an mHealth Platform for Adolescents with Type 1 Diabetes: Focus Groups With Teens, Parents, and Providers

2020 ◽  
Vol 46 (5) ◽  
pp. 444-454
Author(s):  
Manuela Sinisterra ◽  
Katherine Patterson Kelly ◽  
Caitlin Shneider ◽  
Ashley El-Zein ◽  
Ellen Swartwout ◽  
...  
Keyword(s):  
Health Care ◽  
Type 1 Diabetes ◽  
Focus Groups ◽  
Health Care Providers ◽  
Diabetes Management ◽  
Self Management ◽  
Care Providers ◽  
Open Communication ◽  
Management Behaviors

Purpose The purpose of the study was to explore facilitators and barriers to self-management behaviors in adolescents with type 1 diabetes (T1D) to inform the development of an mHealth platform. Methods Eight adolescents with T1D, 9 parents, and 13 health care providers participated in separate focus groups that explored teen self-management behaviors. Results Adolescents and their parents have distinct preferences for handling diabetes management and use of mHealth technologies. Health care providers support the use of new technologies yet acknowledge concern meeting the potential increased volume of communication requests from teens and families. Conclusion Stakeholders agreed that an ideal mHealth platform would facilitate open communication between teens and their care network and easily integrate with other diabetes technologies. Future directions include incorporating additional feedback from stakeholders to build and modify the mHealth platform. The use of mHealth platforms could be integrated into clinical practice to optimize self-management and support communication between educators, providers, and families in between clinic visits.

scholarly journals Substance Use Among Adolescents and Young Adults With Type 1 Diabetes: Discussions in Routine Diabetes Care

2020 ◽  
Vol 59 (4-5) ◽  
pp. 388-395
Author(s):  
Samantha P. Bento ◽  
MaryJane S. Campbell ◽  
Olivia Soutullo ◽  
Fran R. Cogen ◽  
Maureen Monaghan
Keyword(s):  
Health Care ◽  
Substance Use ◽  
Type 1 Diabetes ◽  
Young Adults ◽  
Health Care Providers ◽  
Adolescents And Young Adults ◽  
Care Providers ◽  
Diabetes Clinic ◽  
Pediatric Health Care

Pediatric health care providers are in a unique position to discuss the health implications of alcohol, tobacco, and drug use with adolescents and young adults (AYAs) with type 1 diabetes (T1D). This study evaluated the frequency of self-reported substance use and associated demographic and clinical characteristics in a sample of AYAs with T1D and patient-provider discussions of substance use in T1D care. Sixty-four AYAs completed questions about substance use from the Youth Risk Behavior Survey (YRBS). Corresponding diabetes clinic visits were audio-recorded, transcribed, and reviewed to examine substance use discussions. A total of 56.3% of AYAs reported ever engaging in substance use; 40.6% reported substance use within the past 30 days. Five AYAs had discussions about substance use during their most recent diabetes clinic visit. Substance use should be proactively addressed by pediatric health care providers and AYAs should be encouraged to raise questions related to substance use during clinic visits.

scholarly journals Population-level management of Type 1 diabetes via continuous glucose monitoring and algorithm-enabled patient prioritization: Precision health meets population health

2021 ◽  
Author(s):  
Johannes O Ferstad ◽  
Jacqueline Jil Vallon ◽  
Daniel Jun ◽  
Angela Gu ◽  
Anastasiya Vitko ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Monitoring ◽  
Population Level ◽  
Continuous Glucose Monitor ◽  
Team Members ◽  
Clinical Criteria ◽  
Number Of Patients ◽  
Patient Prioritization ◽  
Time In Range

Objective: To develop and scale algorithm-enabled patient prioritization to improve population-level management of type 1 diabetes (T1D) in a pediatric clinic with fixed resources, using telemedicine and remote monitoring of patients via continuous glucose monitor (CGM) data review. Research Design and Methods: We adapted consensus glucose targets for T1D patients using CGM to identify interpretable clinical criteria to prioritize patients for weekly provider review. The criteria were constructed to manage the number of patients reviewed weekly and identify patients who most needed provider contact. We developed an interactive dashboard to display CGM data relevant for the patients prioritized for review. Results: The introduction of the new criteria and interactive dashboard was associated with a 60% reduction in the mean time spent by diabetes team members who remotely and asynchronously reviewed patient data and contacted patients, from 3.2 +/- 0.20 to 1.3 +/- 0.24 minutes per patient per week. Given fixed resources for review, this corresponded to an estimated 147% increase in weekly clinic capacity. Patients who qualified for and received remote review (n=58) have associated 8.8 percentage points (pp) (95% CI = 0.6-16.9pp) greater time-in-range (70-180 mg/dL) glucoses compared to 25 control patients who did not qualify at twelve months after T1D onset. Conclusions: An algorithm-enabled prioritization of T1D patients with CGM for asynchronous remote review reduced provider time spent per patient and was associated with improved time-in-range.

scholarly journals Assessment of Ramadan Education and Knowledge Among Diabetic Patients

2018 ◽  
Vol 11 ◽  
pp. 117955141775161 ◽  
Author(s):  
Mussa Hussain Almalki ◽  
Ibtihal Hussen ◽  
Shawana A. Khan ◽  
Abdulrahman Almaghamsi ◽  
Fahad Alshahrani
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Health Care Providers ◽  
Diabetes Management ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Care Providers ◽  
Cross Sectional

Background: During Ramadan, Muslims fast from dawn until dusk for one lunar month every year. Most of the Muslim patients with diabetes are unaware of the potential complications that can occur while fasting, such as hypoglycemia. The aim of this study is to assess the the patient education level and patients’ overall awareness of any possible complications that could occur while fasting during Ramadan and to determine how these patients deal with these complications. Methods: We conducted a cross-sectional study and surveyed diabetic patients about their diabetes-related knowledge over a period of 4 months from the outpatient clinic at the Obesity, Endocrine, and Metabolism Center at King Fahad Medical City. Patients were included if they were ≥16 years and if they had been receiving treatment for at least 1 year before the study, irrespective of the medications used; patients were also asked about the presence or absence of complications. Results: This study included 477 patients (325 women and 152 men). Most patients (297; 62.3%) had type 2 diabetes. The patients’ mean age was 39.72 ± 15.29 years, and the mean duration of diabetes was 10.80 ± 5.88 years. During the preceding Ramadan, 76% of patients reported fasting, whereas 58% said that they monitored their blood glucose levels once per day. Hypoglycemic episodes were reported in 60.3% of cases with type 2 diabetes and in 8.3% of cases with type 1 diabetes. Among those who had hypoglycemia, 2.8% of patients with type 1 diabetes and 17.8% with type 2 diabetes broke their fast. Finally, 54% of patients reported that their health care providers offered them instructions on diabetes management during Ramadan. Conclusions: Ramadan health education in diabetes can encourage, improve, and guide patients to change their lifestyles during Ramadan while minimizing the risk of acute complications.

scholarly journals Use of a Smartphone Application to Reduce Hypoglycemia in Type 1 Diabetes: A Pilot Study

2018 ◽  
Vol 12 (6) ◽  
pp. 1192-1199 ◽  
Author(s):  
Carly Feuerstein-Simon ◽  
Suzan Bzdick ◽  
Amitha Padmanabhuni ◽  
Puneetpal Bains ◽  
Cheryl Roe ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Pilot Study ◽  
Smartphone Application ◽  
Mobile App ◽  
Continuous Glucose Monitor ◽  
Hypoglycemia Unawareness ◽  
Glucose Meter ◽  
Time Required

Background: Hypoglycemia and hypoglycemia unawareness are common in long-standing type 1 diabetes (T1D). This pilot study examined the real-world use of a smartphone application (app), which receives meter readings and logs hypoglycemic symptoms, causes, and treatments to reduce hypoglycemia. Methods: Adults with T1D and recent hypoglycemia synchronized their glucose meter to their smartphone and used the Joslin HypoMap™ app powered by Glooko to track hypoglycemic events. At baseline, and after 6 and 12 weeks of using the app, a blinded continuous glucose monitor (CGM; Dexcom G4) was used for 2 weeks and surveys administered. Results: Participants (n = 22) at baseline had mean (SD) age 43 (14) years, duration of diabetes 26 (13) years, A1c 8.0% (0.87) and 21/22 had reduced hypoglycemia awareness per Clarke Hypoglycemia Unawareness survey scores; 13 (59%) were “CGM completers” (CGM data available at baseline and follow-up). Most noncompletion related to time required/difficulties using the mobile app. After 6 weeks, 8/13 completers (62% of CGM completers, 36% of total participants) had reduced daytime minutes with glucose <54 mg/dL (mean ↓331 minutes) and 10/13 (77% of CGM completers; 45% of total participants) had reduced time ≤ 70 mg/dL (mean ↓449 minutes). This was not sustained at 12 weeks, at which time half of the completers had less time (“improved”). Five participants reported improved hypoglycemia awareness; 9 stated the app helped them better recognize hypoglycemia. Conclusions: Use of this phone app has the potential to help reduce daytime hypoglycemia in a subset of T1D adults with reduce hypoglycemia awareness; larger studies are needed.

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

2021 ◽  
pp. 193229682110213
Author(s):  
Stuart Chalew ◽  
Alan M. Delamater ◽  
Sonja Washington ◽  
Jayalakshmi Bhat ◽  
Diane Franz ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Racial Disparity ◽  
Diabetes Management ◽  
New Technology ◽  
African American Youth ◽  
Glucose Monitoring ◽  
Supportive Role

Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.

scholarly journals A global perspective on the issue of access to insulin

Diabetologia ◽  
2021 ◽  
Author(s):  
David Beran ◽  
Maria Lazo-Porras ◽  
Camille M. Mba ◽  
Jean Claude Mbanya
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Multinational Companies ◽  
Global Perspective ◽  
Patient Access ◽  
Middle Income ◽  
Middle Income Countries ◽  
Wide Range ◽  
Pricing And Reimbursement

AbstractThe discovery of insulin in 1921 changed the prognosis for people with type 1 diabetes. A century later, availability and affordability of insulin remain a challenge in many parts of the globe. Using the WHO’s framework on understanding the life cycle of medicines, this review details the global and national challenges that affect patients’ abilities to access and afford insulin. Current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95% of global insulin supply. The inclusion of insulin on the WHO’s Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer. Whilst expenses related to diabetes are mostly covered by insurance in high-income countries, many patients from low- and middle-income countries have to pay out of their own pockets. The organisation of diabetes management within the healthcare system also affects patient access to insulin. The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all individuals living with diabetes. Graphical abstract

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