Improved Time in Range Over 1 Year Is Associated With Reduced Albuminuria in Individuals With Sensor-Augmented Insulin Pump–Treated Type 1 Diabetes

Ajenthen G. Ranjan; Signe V. Rosenlund; Tine W. Hansen; Peter Rossing; Steen Andersen; Kirsten Nørgaard

doi:10.2337/dc20-0909

Improved Time-in-Range over 1 year is Associated with Reduced Albuminuria in Individuals with Sensor-Augmented Insulin Pump-Treated Type 1 Diabetes

10.2337/figshare.12777122 ◽

2020 ◽

Author(s):

Ajenthen G. Ranjan ◽

Signe V. Rosenlund ◽

Tine W. Hansen ◽

Peter Rossing ◽

Steen Andersen ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Pump ◽

Controlled Trial ◽

Daily Injection ◽

Albumin Creatinine Ratio ◽

Multiple Daily Injection ◽

Blood And Urine Samples ◽

Time In Range ◽

One Year

Aim: To investigate the association between treatment-induced change in continuous glucose monitored (CGM) time-in-range (TIR) and albuminuria in persons with type 1 diabetes (T1D) treated with sensor-augmented-pumps (SAP). Methods: <a></a><a>Twenty-six of fifty-five participants with albuminuria and multiple daily injection-therapy (25% females, 51 (46-63) years, HbA1c 75 (68-88) mmol/mol [9.0 (8.4-10.4)%], UACR 89 (37-250) mg/g) were in a randomized-controlled trial assigned to SAP-therapy for one year</a>. Anthropometrics, CGM-data, blood and urine samples were collected every three months. Results: Mean change (95%-CI) in %TIR was +13.2 (6.2;20.2)%, HbA1C was -14.4 (-17.4;-10.5) mmol/mol [-1.3 (-1.6;-1.0)%] and urinary albumin-creatinine-ratio (UACR) was -15 (-38;17)%, all p<0.05. UACR decreased with 19 (10;28)% per 10% increase in %TIR (p=0.04), 18 (1;30)% per 10 mmol/mol decrease in HbA1C (p=0.07), and 31% per 10 mmHg decrease in mean arterial pressure (p<0.001). Conclusion: In this longitudinal study, treatment-induced increase in %TIR was significantly associated with decrease in albuminuria in T1D.

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

Journal of Diabetes Science and Technology ◽

10.1177/1932296820906214 ◽

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.

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Safety and glycemic outcomes of do-it-yourself AndroidAPS hybrid closed-loop system in adults with type 1 diabetes

PLoS ONE ◽

10.1371/journal.pone.0248965 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0248965

Author(s):

Andrzej Gawrecki ◽

Dorota Zozulinska-Ziolkiewicz ◽

Magdalena A. Michalak ◽

Anna Adamska ◽

Michal Michalak ◽

...

Keyword(s):

Type 1 Diabetes ◽

Body Weight ◽

Closed Loop ◽

Insulin Pump ◽

Severe Hypoglycemia ◽

Insulin Requirement ◽

Time In Range ◽

Do It Yourself ◽

Glycemic Outcomes

Background The aim of the study was to assess the safety and glycemic outcomes with the use of a Do-It-Yourself (DIY) Hybrid Closed-Loop (HCL) system based on the AndroidAPS application in type 1 diabetes (T1D). Methods Single-center clinical trial, with 3-week run-in and 12-week study period. DIY HCL system consisted of the Dana Diabecare RS insulin pump, Dexcom G5 continuous glucose monitoring system and AndroidAPS application. Primary outcome was safety: incidences of severe hypoglycemia, diabetic ketoacidosis, time spent in glycemia <54 mg/dl. Secondary endpoints included percentage of time in range (TIR) 70–180 mg/dl, time below 70 mg/dl, HbA1c, insulin requirements, and body weight. Results In total 12 subjects (5 men, 7 women) were enrolled, mean age 31.3±6.7, 95%CI(27.7–34.9) years, mean diabetes duration 16.1±5.7, 95%CI(13.0–19.2) years. No episodes of severe hypoglycemia or ketoacidosis were observed. Percentage of time spent in glycemia below 54mg/dl was not increased. Average sensor glycemia was lower in the study period than baseline (141.1 ± 8.4, 95%CI(136.3–145.9) vs. 153.3 ± 17.9, 95%CI(143.2–163.4), mg/dl p<0.001). TIR 70–180 mg/dl was improved by 11.3%, 95%CI(2.8%-19.8%) (from 68.0 ± 12.7 to 79.3 ± 6.4%, p<0.001), without increasing hypoglycemia time. The HbA1c level decreased by -0.5%, 95%CI(-0.9%–-0.1%) (from 6.8 ± 0.5 to 6.3 ± 0.4%, p<0.001). Additionally, in the last 4 weeks of the study period participants significantly improved and showed TIR 70–180 mg/dl 82.1 ± 5.6%, 95%CI(78.9–85.3), time <54 mg/dl 0.30 (0.20–0.55)%, median 95%CI(0.1–0.7) and <70 mg/dl 1.90 (1.10–3.05)%, median 95%CI(0.7–3.2). The insulin requirement and body weight did not change in the study. Conclusions The study revealed safety of the Do-It-Yourself HCL system AndroidAPS in adults with T1D, limited to well-controlled, highly selected and closely monitored patients. The use of AndroidAPS significantly improved HbA1c, time in range and average sensor glycemia without increasing hypoglycemia. As both patients and their medical team are gaining experience using the system over time, they improve glycemic control. Trial registration German Clinical Trials Register: no. DRKS00015439; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015439.

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Generation of Virtual Patient Populations That Represent Real Type 1 Diabetes Cohorts

Mathematics ◽

10.3390/math9111200 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1200

Author(s):

Sayyar Ahmad ◽

Charrise M. Ramkissoon ◽

Aleix Beneyto ◽

Ignacio Conget ◽

Marga Giménez ◽

...

Keyword(s):

Type 1 Diabetes ◽

Clinical Data ◽

Insulin Pump ◽

Real Life ◽

Model Parameters ◽

Preclinical Testing ◽

Time In Range ◽

Therapy Strategies ◽

Hospital Clinic

Preclinical testing and validation of therapeutic strategies developed for patients with type 1 diabetes (T1D) require a cohort of virtual patients (VPs). However, current simulators provide a limited number of VPs, lack real-life scenarios, and inadequately represent intra- and inter-day variability in insulin sensitivity and blood glucose (BG) profile. The generation of a realistic scenario was achieved by using the meal patterns, insulin profiles (basal and bolus), and exercise sessions estimated as disturbances using clinical data from a cohort of 14 T1D patients using the Medtronic 640G insulin pump provided by the Hospital Clínic de Barcelona. The UVa/Padova’s cohort of adult patients was used for the generation of a new cohort of VPs. Insulin model parameters were optimized and adjusted in a day-by-day fashion to replicate the clinical data to create a cohort of 75 VPs. All primary and secondary outcomes reflecting the BG profile of a T1D patient were analyzed and compared to the clinical data. The mean BG 166.3 versus 162.2 mg/dL ( = 0.19), coefficient of variation 32% versus 33% ( = 0.54), and percent of time in range (70 to 180 mg/dL) 59.6% versus 66.8% ( = 0.35) were achieved. The proposed methodology for generating a cohort of VPs is capable of mimicking the BG metrics of a real cohort of T1D patients from the Hospital Clínic de Barcelona. It can adopt the inter-day variations in the BG profile, similar to the observed clinical data, and thus provide a benchmark for preclinical testing of control techniques and therapy strategies for T1D patients.

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Improved Time-in-Range over 1 year is Associated with Reduced Albuminuria in Individuals with Sensor-Augmented Insulin Pump-Treated Type 1 Diabetes

10.2337/figshare.12777122.v1 ◽

2020 ◽

Author(s):

Ajenthen G. Ranjan ◽

Signe V. Rosenlund ◽

Tine W. Hansen ◽

Peter Rossing ◽

Steen Andersen ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Pump ◽

Controlled Trial ◽

Daily Injection ◽

Albumin Creatinine Ratio ◽

Multiple Daily Injection ◽

Blood And Urine Samples ◽

Time In Range ◽

One Year

Aim: To investigate the association between treatment-induced change in continuous glucose monitored (CGM) time-in-range (TIR) and albuminuria in persons with type 1 diabetes (T1D) treated with sensor-augmented-pumps (SAP). Methods: <a></a><a>Twenty-six of fifty-five participants with albuminuria and multiple daily injection-therapy (25% females, 51 (46-63) years, HbA1c 75 (68-88) mmol/mol [9.0 (8.4-10.4)%], UACR 89 (37-250) mg/g) were in a randomized-controlled trial assigned to SAP-therapy for one year</a>. Anthropometrics, CGM-data, blood and urine samples were collected every three months. Results: Mean change (95%-CI) in %TIR was +13.2 (6.2;20.2)%, HbA1C was -14.4 (-17.4;-10.5) mmol/mol [-1.3 (-1.6;-1.0)%] and urinary albumin-creatinine-ratio (UACR) was -15 (-38;17)%, all p<0.05. UACR decreased with 19 (10;28)% per 10% increase in %TIR (p=0.04), 18 (1;30)% per 10 mmol/mol decrease in HbA1C (p=0.07), and 31% per 10 mmHg decrease in mean arterial pressure (p<0.001). Conclusion: In this longitudinal study, treatment-induced increase in %TIR was significantly associated with decrease in albuminuria in T1D.

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Increased Time-in-Range with Sotagliflozin as Adjunct Therapy to Insulin in Adults with Type 1 Diabetes as Demonstrated by 24-Week Continuous Glucose Monitoring (inTandem1, inTandem2)

Diabetes ◽

10.2337/db18-1179-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1179-P ◽

Cited By ~ 2

Author(s):

THOMAS DANNE ◽

BERTRAND CARIOU ◽

JOHN B. BUSE ◽

SATISH K. GARG ◽

JULIO ROSENSTOCK ◽

...

Keyword(s):

Type 1 Diabetes ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Adjunct Therapy ◽

Time In Range

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1066-P: Improvement in Time-in-Range (TIR) with Real-Life Use of Hybrid Closed-Loop System in Patients with Type 1 Diabetes (T1D)

Diabetes ◽

10.2337/db19-1066-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1066-P

Author(s):

HALIS K. AKTURK ◽

DOMINIQUE A. GIORDANO ◽

HAL JOSEPH ◽

SATISH K. GARG ◽

JANET K. SNELL-BERGEON

Keyword(s):

Type 1 Diabetes ◽

Closed Loop ◽

Real Life ◽

Loop System ◽

Closed Loop System ◽

Time In Range

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871-P: Baseline Time-in-Range Association with Glycemic Improvement in Adults with Type 1 Diabetes (T1D)

Diabetes ◽

10.2337/db20-871-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 871-P

Author(s):

PETER CALHOUN ◽

DAVID A. PRICE ◽

ROY BECK

Keyword(s):

Type 1 Diabetes ◽

Time In Range

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693-P: Oxidative–Antioxidant Balance after Maximum Intensity Exercise in Men with Type 1 Diabetes Treated with a Personal Insulin Pump vs. Healthy Control

Diabetes ◽

10.2337/db20-693-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 693-P

Author(s):

BARTłOMIEJ MATEJKO ◽

ŁUKASZ TOTA ◽

MAłGORZATA MORAWSKA ◽

SANDRA MROZINSKA ◽

WANDA PILCH ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Pump ◽

Maximum Intensity ◽

Healthy Control

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Time in range for multiple technologies in type 1 diabetes: a systematic review and network meta-analysis

10.2337/figshare.12116691 ◽

2020 ◽

Author(s):

Anthony Pease ◽

Clement Lo ◽

Arul Earnest ◽

Velislava Kiriakova ◽

Danny Liew ◽

...

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Closed Loop ◽

Meta Analysis ◽

Management Strategies ◽

Glucose Testing ◽

Closed Loop Systems ◽

Percent Time ◽

Time In Range

Background: Time-in-range is a key glycaemic metric, and comparisons of management technologies for this outcome are critical to guide device selection. Purpose: We conducted a systematic review and network meta-analysis to compare and rank technologies for time in glycaemic ranges. Data sources: We searched All Evidenced Based Medicine Reviews, CINAHL, EMBASE, MEDLINE, MEDLINE In-Process and other non-indexed citations, PROSPERO, PsycINFO, PubMed, and Web of Science until 24 April, 2019. Study selection: We included randomised controlled trials >2 weeks duration comparing technologies for management of type 1 diabetes in adults (>18 years of age), excluding pregnant women. Data extraction: Data were extracted using a predefined template. Outcomes were percent time with sensor glucose levels 3.9–10.0mmol/l (70–180mg/dL), >10.0mmol/L (180mg/dL), and <3.9mmol/L (70mg/dL). Data synthesis: We identified 16,772 publications, of which 14 eligible studies compared eight technologies comprising 1,043 participants. Closed loop systems lead to greater percent time-in-range than any other management strategy and was 17.85 (95% predictive interval [PrI] 7.56–28.14) higher than usual care of multiple daily injections with capillary glucose testing. Closed loop systems ranked best for percent time-in-range or above range utilising surface under the cumulative ranking curve (SUCRA–98.5 and 93.5 respectively). Closed loop systems also ranked highly for time below range (SUCRA–62.2). Limitations: Overall risk of bias ratings were moderate for all outcomes. Certainty of evidence was very low. Conclusions: In the first integrated comparison of multiple management strategies considering time-in-range, we found that the efficacy of closed loop systems appeared better than all other approaches.

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