Improved Time-in-Range (TIR) on Continuous Glucose Monitor (CGM) with Technosphere Inhaled Insulin (TI) Compared with Insulin Aspart in T1D Patients—STAT Study

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1017-P ◽  
Author(s):  
JANET K. SNELL-BERGEON ◽  
HALIS K. AKTURK ◽  
AMANDA REWERS ◽  
BRUCE W. BODE ◽  
LESLIE J. KLAFF ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Continuous Glucose Monitor ◽  
Inhaled Insulin ◽  
Time In Range

Neue Entwicklungen bei Diabetes mellitus Typ 1

2021 ◽  
Vol 146 (11) ◽  
pp. 710-713
Author(s):  
Linus Haberbosch ◽  
Joachim Spranger
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Aspart ◽  
Closed Loop ◽  
Glucose Monitoring ◽  
Loop System ◽  
Diabetes Mellitus Typ 1 ◽  
Closed Loop System ◽  
Neue Entwicklungen ◽  
Time In Range ◽  
Fast Acting

Was ist neu? Monitoring Mit der zunehmenden Prävalenz von Continuous-Glucose-Monitoring (CGM) -Systemen gewinnt die Time in Range (TIR) als Parameter zur Optimierung der Blutzuckereinstellung bei Patienten mit Diabetes mellitus Typ 1 an Bedeutung. Zuletzt erfolgte der Nachweis einer verbesserten Prävention von kardiovaskulären Ereignissen und Schwangerschaftskomplikationen bei Patienten mit optimierter TIR. Zusätzlich zur TIR wird empfohlen, die Time below Range (TBR) zu erheben, um Hypoglykämien als klinisch relevante Ereignisse ebenfalls zu erfassen. Hypoglykämien Hypoglykämien bleiben eine klinisch relevante Komplikation der Therapie des Diabetes mellitus Typ 1. Mit der Zulassung von nasalem Glukagon besteht nun gegenüber der klassischen Injektion eine Option als einfach anzuwendende Notfalltherapie. Mit der Entwicklung des im flüssigen Zustand stabilen Glukagon-Analogons Dasiglukagon steht potenziell in naher Zukunft darüber hinaus ein klassischer Notfall-Pen mit Fertiglösung zur Verfügung. Insulintherapie Das neue schnellwirksame Insulin aspart (fast-acting Insulin aspart, FIASP) bietet neue Chancen für die Blutzuckeroptimierung von Typ-1-Diabetespatienten. 2019 wurde darüber hinaus das erste Hybrid-Closed-Loop-System zur Behandlung des Diabetes mellitus Typ 1 in Deutschland zugelassen. Bei diesem System erfolgt eine automatische Anpassung der Basalrate anhand des per CGM gemessenen Blutzuckers. Aufgrund der weiterhin notwendigen Bolusgaben und der Komplexität der Technologie bleibt eine sorgfältige Auswahl und adäquate Schulung der mit einem solchen System therapierten Patienten essenziell. Bei adäquater Anwendung ermöglicht ein Hybrid-Closed-Loop-System eine verbesserte Einstellung insbesondere des nächtlichen Blutzuckers. Ergänzende Therapien Seit 2019 sind der SGLT-2-Inhibitor Dapagliflozin und der kombinierte SGLT-1/2-Inhibitor Sotagliflozin für die Therapie von unzureichend eingestellten Typ-1-Diabetikern mit einem BMI über 27 kg/m² und ohne Risikokonstellation für diabetische Ketoazidosen zugelassen. Die relevanteste Nebenwirkung ist die atypische normoglykäme Ketoazidose, weshalb eine initiale Risikoeinschätzung sowie eine angemessene Schulung des Patienten zur Durchführung und Interpretation von Ketonkörper- und pH-Messungen unter der Therapie von zentraler Bedeutung sind.  

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.

722-P: Inhaled Insulin Improves Daytime Time-in-Range in People with Type 2 Diabetes

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 722-P
Author(s):  
LANE DESBOROUGH ◽  
PHILIP LEVIN ◽  
LEE A. BROMBERGER
Keyword(s):  
Type 2 Diabetes ◽  
Inhaled Insulin ◽  
Time In Range

Time–Action Profile and Patient Assessment of Inhaled Insulin via the Exubera Device in Comparison with Subcutaneously Injected Insulin Aspart via the FlexPen Device

2009 ◽  
Vol 11 (2) ◽  
pp. 87-92 ◽  
Author(s):  
Thomas Forst ◽  
Cloth Hohberg ◽  
Thomas Schöndorf ◽  
Marcus Borchert ◽  
Senait Forst ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Patient Assessment ◽  
Inhaled Insulin ◽  
Action Profile

scholarly journals Use of Continuous Glucose Monitor in Critically Ill COVID-19 Patients Requiring Insulin Infusion: An Observational Study

2021 ◽  
Author(s):  
Eileen R Faulds ◽  
Andrew Boutsicaris ◽  
Lyndsey Sumner ◽  
Laureen Jones ◽  
Molly McNett ◽  
...  
Keyword(s):  
Insulin Infusion ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Median Number ◽  
Continuous Glucose Monitor ◽  
Academic Medical ◽  
Validation Criteria ◽  
Time In Range ◽  
Staff Workload

Abstract Context The coronavirus disease 2019 (COVID-19) pandemic has created a need for remote blood glucose (BG) monitoring in the intensive care unit (ICU). Objective To evaluate feasibility and patient safety of a hybrid monitoring strategy of point of care (POC) BG plus continuous glucose monitor (CGM) in the ICU. Design Retrospective analysis. Setting ICU of an academic medical center. Patients Patients with COVID-19 on intravenous (IV) insulin. Intervention After meeting initial validation criteria, CGM was used for IV insulin titration and POC BG was performed every 6 hours or as needed. Main Outcome Measures Outcomes included frequency of POC BG, workflow, safety, and accuracy measures. Results The study included 19 patients, 18 with CGM data, mean age 58 years, 89% on mechanical ventilation, 37% on vasopressors, and 42% on dialysis. The median time to CGM validation was 137 minutes (interquartile range [IQR] 114-206). During IV insulin, the median number of POC values was 7 (IQR 6-16) on day 1, and declined slightly thereafter ( 71% reduction compared to standard of 24 /day). The median number of CGM values used nonadjunctively to titrate IV insulin was 11.5 (IQR 0, 15) on day 1 and increased thereafter. Time in range 70-180mg/dl was 64+/-23% on day 1 and 72+/-16% on day 2-7 while time &lt;70 mg/dl was 1.5 +/-4.1% on day 1 and &lt;1% on days 2-7. Conclusions This study provides data to support that CGM using a hybrid protocol is feasible, accurate, safe, and has potential to reduce nursing and staff workload.

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 Automated Insulin Delivery in Real Life (AID-IRL): Real-World User Perspectives on Commercial AID

2020 ◽  
pp. 193229682095736
Author(s):  
Dana Lewis
Keyword(s):  
Clinical Outcomes ◽  
Real World ◽  
Real Life ◽  
Insulin Delivery ◽  
Continuous Glucose Monitor ◽  
Algorithm Performance ◽  
Training Materials ◽  
Time In Range ◽  
User Perspectives

Commercial automated insulin delivery (AID) systems are usually assessed based on clinical outcomes, ignoring uptake. A qualitative study evaluated user experiences when switching to currently available commercial AID. Interview feedback was coded on key themes including the adoption experience with regards to quality of life, clinical outcomes, and users’ expectations. Most felt their learning curve was easy. Most saw reduced hypoglycemia and increased time in range, although there were outliers. Many mentioned post-meal hyperglycemia as an improvement area for commercial AID. Users with one particular continuous glucose monitor (CGM) type reported sleep disruption. Companies should consider real-world user feedback with regards to improving training materials for new users with less CGM experience and by improving target flexibility and postprandial algorithm performance, plus reducing manual interventions required by users.

Higher derived time in range with insulin degludec/insulin aspart vs insulin glargine U100 in Japanese adults with T2D

2021 ◽  
Author(s):  
Athena Philis-Tsimikas ◽  
Balamurali Kalyanam ◽  
John Michael D'Cruz ◽  
Christophe De Block ◽  
Ramsathish Sivarathinasami ◽  
...  
Keyword(s):  
Insulin Glargine ◽  
Insulin Aspart ◽  
Insulin Degludec ◽  
Japanese Adults ◽  
Time In Range
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