Moving the Goalposts: Do Adults With Type 1 Diabetes Want Time in Tight Range?

IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Molly L Tanenbaum, Mabelle B Pasmooij, Rachel Tam, Marina Basina, Michael S Hughes, Franziska K Bishop, David M Maahs
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Abstract

Objectives: Our objective was to understand attitudes toward time in tight range (TITR: 70-140 mg/dL) among adults with type 1 diabetes. The perspectives of people with type 1 diabetes on TITR can inform educational approaches to introducing potential new continuous glucose monitoring (CGM) metrics in a way that optimizes glycemic and quality of life outcomes for people with type 1 diabetes.

Methods: Focus groups with adult CGM users with type 1 diabetes elicited feedback on a potential shift to TITR. Groups were audio-recorded, transcribed, and analyzed using content analysis.

Results: Participants were 33 adults (age 42.7 ± 16.7 years, 55% female, 91% non-Hispanic White, 23 ± 16 years living with diabetes, HbA1c 6.5 ± 0.6% (48 ± 6 mmol/mol)). Most (88%) used automated insulin delivery. Some approved of TITR for the potential to improve their long-term health. Concerns about TITR included increased management burden; risk of anxiety, hypoglycemia, disordered eating; and feelings of failure. Participants advocated for flexible, personalized clinical targets and better technologies, insulins, and access, to make TITR achievable for more people with type 1 diabetes.

Conclusions: Results indicate that TITR may be a welcome shift for some who are already using the tighter metric but may add risks and psychosocial and self-management burden even in a group of adults predominantly using automated insulin delivery and achieving current HbA1c goals. Including the perspectives of people with type 1 diabetes in decision-making around CGM metrics will be important for the implementation of new clinical targets to improve patient care.

移动门柱:成人1型糖尿病患者需要严格控制时间吗?
目的:我们的目的是了解成人1型糖尿病患者对小范围时间(TITR: 70-140 mg/dL)的态度。1型糖尿病患者对TITR的看法可以为教育方法提供信息,以引入潜在的新的连续血糖监测(CGM)指标,以优化1型糖尿病患者的血糖和生活质量。方法:与患有1型糖尿病的成人CGM使用者进行焦点小组讨论,以获得关于可能转向TITR的反馈。各组录音,转录,并使用内容分析进行分析。结果:参与者为33名成年人(年龄42.7±16.7岁,55%为女性,91%为非西班牙裔白人,23±16岁患有糖尿病,HbA1c 6.5±0.6%(48±6 mmol/mol))。大多数(88%)使用自动胰岛素输送。一些人认为TITR有可能改善他们的长期健康。对TITR的关注包括增加管理负担;有焦虑、低血糖、饮食紊乱的风险;还有失败的感觉。与会者倡导灵活、个性化的临床目标和更好的技术、胰岛素和可及性,使更多的1型糖尿病患者可以实现TITR。结论:结果表明,对于一些已经使用更严格指标的人来说,TITR可能是一个受欢迎的转变,但即使在主要使用自动化胰岛素输送并达到当前HbA1c目标的成年人群体中,TITR也可能增加风险、社会心理和自我管理负担。将1型糖尿病患者的观点纳入围绕CGM指标的决策中,对于实施新的临床目标以改善患者护理非常重要。
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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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