Diabetes technology & therapeutics最新文献

{"title":"Effect of Interrupting Prolonged Sitting with Frequent Activity Breaks on Postprandial Glycemia and Insulin Sensitivity in Adults with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion Therapy: A Randomized Crossover Pilot Trial.","authors":"Robyn Larsen, Frances Taylor, Paddy C Dempsey, Melitta McNarry, Kym Rickards, Parneet Sethi, Ashleigh Homer, Neale Cohen, Neville Owen, Kavita Kumareswaran, Richard MacIsaac, Sybil A McAuley, David O'Neal, David W Dunstan","doi":"10.1089/dia.2024.0146","DOIUrl":"10.1089/dia.2024.0146","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This study examined acute effects of interrupting prolonged sitting with short activity breaks on postprandial glucose/insulin responses and estimations of insulin sensitivity in adults with type 1 diabetes (T1D). <b><i>Method:</i></b> In a randomized crossover trial, eight adults (age = 46 ± 14 years [mean ± SD], body mass index [BMI] = 27.2 ± 3.8 kg/m²) receiving continuous subcutaneous insulin infusion (CSII) therapy completed two 6-h conditions as follows: uninterrupted sitting (SIT) and sitting interrupted with 3-min bouts of simple resistance activities (SRAs) every 30 min. Basal and bolus insulin were standardized across conditions except in cases of hypoglycemia. Postprandial responses were assessed using incremental area-under-the-curve (iAUC) and total AUC (tAUC) from half-hourly venous sampling. Meal-based insulin sensitivity determined from glucose sensor and insulin pump (S<i>_i</i>^SP) was assessed from flash continuous glucose monitor and insulin pump data. Outcomes were analyzed using mixed models adjusted for sex, BMI, treatment order, and preprandial values. <b><i>Results:</i></b> Glucose iAUC did not differ by condition (SIT: 19.8 ± 3.0 [estimated marginal means ± standard error] vs. SRA: 14.4 ± 3.0 mmol.6 h.L^-1; <i>P</i> = 0.086). Despite CSII being standardized between conditions, insulin iAUC was higher in SRA compared to SIT (137.1 ± 22.7 vs. 170.9 ± 22.7 mU.6 h.L^-1; <i>P</i> < 0.001). This resulted in a lower glucose response relative to the change in plasma insulin in SRA (tAUCglu/tAUCins: 0.32 ± 0.02 vs. 0.40 ± 0.02 mmol.mU^-1; <i>P</i> = 0.03). Si^SP was also higher at dinner following the SRA condition, with no between-condition differences at breakfast or lunch. <b><i>Conclusion:</i></b> Regularly interrupting prolonged sitting in T1D may increase plasma insulin and improve insulin sensitivity when meals and CSII are standardized. Future studies should explore underlying mechanistic determinants and the applicability of findings to those on multiple daily injections. <b><i>Trial Registration:</i></b> Australian and New Zealand Clinical Trial Registry Identifier-ACTRN12618000126213 (www.anzctr.org.au).</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe Options for the Treatment of Mothers and Babies with Pregestational Diabetes.","authors":"Katrien Benhalima, Chantal Mathieu, Angela Napoli, Yogish C Kudva, Katarzyna Cypryk, Peter Hammond, Tali Cukierman-Yaffe, Katarzyna Cyganek, Hema Divakar, Moshe Hod","doi":"10.1089/dia.2024.0499","DOIUrl":"https://doi.org/10.1089/dia.2024.0499","url":null,"abstract":"","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of an Automated Priming Bolus for Improving Prandial Glucose Control in Full Closed Loop Delivery.","authors":"Marcela Moscoso-Vasquez, Patricio Colmegna, Charlotte Barnett, Morgan Fuller, Chaitanya L K Koravi, Sue A Brown, Mark D DeBoer, Marc D Breton","doi":"10.1089/dia.2024.0315","DOIUrl":"https://doi.org/10.1089/dia.2024.0315","url":null,"abstract":"<p><p><b><i>Background:</i></b> Automated insulin delivery (AID) is widely available to people with type 1 diabetes (T1D), providing superior glycemic control versus traditional methods. The next generation of AID devices focus on minimizing user/device interactions, especially around meals (\"full closed loop,\" [FCL]). Our goal was to assess the postprandial glycemic impact of the bolus priming system (BPS), an algorithm delivering fixed insulin doses based on the likelihood of a meal having occurred, in conjunction with UVA's latest AID. <b><i>Method:</i></b> Eleven adults with T1D participated in a supervised randomized-crossover trial assessing glycemic control during two 24-h sessions with identical meals and activity-with and without BPS. On the day in-between study sessions, participants underwent food and activity challenges to test BPS safety and robustness. Continuous glucose monitor (CGM) outcomes and total insulin doses were assessed overall and following meals with potential for BPS to dose additional insulin (CGM >90 mg/dL for 1 h prior). <b><i>Results:</i></b> Daytime CGM outcomes were similar with and without BPS: time-in-range (TIR) 70-180 mg/dL 70.6% [62.2-76.5] versus 65.7% [58.6%-80.6%]; time-below-range <70 mg/dL 0% [0-2.1] versus 0% [0-1.3]; respectively. Insulin delivery during 3 h postprandial was indistinguishable 33.5 U [26.4-47.0] versus 35.7 U [28.7-44.9]. Among 43 out of 66 meals with potential to trigger BPS (24/19 BPS/no-BPS), postprandial incremental area-under-the-curve (iAUC) was lower for BPS versus no-BPS (2530 ± 1934 versus 3228 ± 2029, <i>P</i> = 0.047), but CGM outcomes were inconclusive: 4-h-TIR 51.2% [19.8-83.3] versus 40.2% [20.8-56.3] (<i>P</i> = 0.24). There were no severe adverse events. <b><i>Conclusion:</i></b> While there was no difference in TIR, when BPS was active an improved postprandial AUC in FCL was obtained via earlier insulin injection.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring and Recreational Scuba Diving in Type 1 Diabetes: Head-to-Head Comparison Between Free Style Libre 3 and Dexcom G7 Performance.","authors":"Elena Gamarra, Giovanni Careddu, Andrea Fazi, Valentina Turra, Ambra Morelli, Chiara Camponovo, Pierpaolo Trimboli","doi":"10.1089/dia.2024.0126","DOIUrl":"10.1089/dia.2024.0126","url":null,"abstract":"<p><p><b><i>Background:</i></b> Scuba diving was previously excluded because of hypoglycemic risks for patients with type 1 diabetes mellitus(T1DM). Specific eligibility criteria and a safety protocol have been defined, whereas continuous glucose monitoring (CGM) systems have enhanced diabetes management. This study aims to assess the feasibility and accuracy of CGM Dexcom G7 and Free Style Libre 3 in a setting of repetitive scuba diving in T1DM, exploring the possibility of nonadjunctive use. <b><i>Material and Methods:</i></b> The study was conducted during an event of <i>Diabete Sommerso^®</i> association in 2023. Participants followed a safety protocol, with capillary glucose as reference standard (Beurer GL50Evo). Sensors' accuracy was evaluated through median and mean absolute relative difference (MeARD, MARD) and surveillance error grid (SEG). Data distribution and correlation were estimated by Spearman test and Bland-Altman plots. The ability of sensors to identify hypoglycemia was assessed by contingency tables. <b><i>Results:</i></b> Data from 202 dives of 13 patients were collected. The overall MARD was 31% (Dexcom G7) and 14.2% (Free Style Libre 3) and MeARD was 19.7% and 11.6%, respectively. Free Style Libre 3 exhibited better accuracy in normoglycemic and hyperglycemic ranges. SEG analysis showed 82.1% (Dexcom G7) and 97.4% (Free Style Libre 3) data on no-risk zone. Free Style Libre 3 better performed on hypoglycemia identification (diagnostic odds ratio of 254.10 vs. 58.95). Neither of the sensors reached the MARD for nonadjunctive use. <b><i>Conclusions:</i></b> The study reveals Free Style Libre 3 superior accuracy compared with Dexcom G7 in a setting of repetitive scuba diving in T1DM, except for hypoglycemic range. Both sensors fail to achieve accuracy for nonadjunctive use. Capillary tests remain crucial for safe dive planning, and sensor data should be interpreted cautiously. We suggest exploring additional factors potentially influencing sensor performance.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring Prediction of Gestational Diabetes Mellitus and Perinatal Complications.","authors":"Zoey Li, Roy Beck, Celeste Durnwald, Anders Carlson, Elizabeth Norton, Richard Bergenstal, Mary Johnson, Sean Dunnigan, Matthew Banfield, Katie Krumwiede, Judy Sibayan, Peter Calhoun","doi":"10.1089/dia.2024.0080","DOIUrl":"10.1089/dia.2024.0080","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To assess the performance of continuous glucose monitoring (CGM)-measured glycemic metrics in predicting development of gestational diabetes mellitus (GDM) and select perinatal complications. <b><i>Research Methods:</i></b> In a prospective observational study, CGM data were collected from 760 pregnant females throughout gestation after study enrollment. GDM was diagnosed using the oral glucose tolerance test (OGTT) at 24-34 weeks of gestation. Predictive models were built using logistic and elastic net regression. Predictive performance was assessed by the area under the receiver-operating characteristic (AUROC) curve. <b><i>Results:</i></b> The AUROCs of using second trimester percent time >140 mg/dL (TA140) and week 13-14 TA140 in predicting GDM were 0.81 and 0.74, respectively. The AUROCs for predicting large-for-gestational-age (LGA) births and hypertensive disorders of pregnancy (HDP) using second trimester TA140 were both 0.58. When matching the specificity of OGTT, a model using TA140 in weeks 13-14 achieved similar sensitivity to OGTT in predicting HDP (13% vs. 10%, respectively) and LGA (6% for both methods). Elastic net also demonstrated similar AUROC and diagnostic performance with no meaningful improvement by using multiple predictors. <b><i>Conclusion:</i></b> CGM-measured hyperglycemic metrics such as TA140 predicted GDM with high AUROCs as early as 13-14 weeks of gestation. These metrics were also similar statistically to the OGTT at 24-34 weeks in predicting perinatal complications, although sensitivity was low for both. CGM could potentially be used as an early screening tool for elevated hyperglycemia during gestation, which could be used in addition to or instead of the OGTT.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring Metrics and Hemoglobin A1c Relationship in Patients with Type 2 Diabetes Treated by Hemodialysis.","authors":"Rodolfo J Galindo, Bobak Moazzami, Katherine R Tuttle, Richard M Bergenstal, Limin Peng, Guillermo E Umpierrez","doi":"10.1089/dia.2024.0145","DOIUrl":"10.1089/dia.2024.0145","url":null,"abstract":"<p><p><b><i>Background:</i></b> There is a need for accurate glycemic control metrics in patients with diabetes and end-stage kidney disease (ESKD). Hence, we assessed the relationship of continuous glucose monitoring (CGM) metrics and laboratory-measured hemoglobin A1c (HbA1c) in patients with type 2 diabetes (T2D) treated by hemodialysis. <b><i>Methods:</i></b> This prospective observational study included adults (age 18-80 years) with T2D (HbA1c 5%-12%), treated by hemodialysis (for at least 90 days). Participants used a Dexcom G6 Pro CGM for 10 days. Correlation analyses between CGM metrics [mean glucose, glucose management indicator (GMI), and time-in-range (TIR 70-180 mg/dL)] and HbA1c were performed. <b><i>Results:</i></b> Among 59 participants (mean age was 57.7 ± 9.3 years, 58% were female, 86% were non-Hispanic blacks), the CGM mean glucose level was 188.9 ± 45 mg/dL (95% CI: 177.2, 200.7), the mean HbA1c and GMI were 7.1% ± 1.3% and 7.8% ± 1.1%, respectively (difference 0.74% ± 0.95). GMI had a strong negative correlation with TIR 70-180 mg/dL (r = -0.96). The correlation between GMI and HbA1c (r = 0.68) was moderate. Up to 29% of participants had a discordance between HbA1c and GMI of <0.5%, with 22% having a discordance between 0.5% and 1%, and 49% having a discordance of >1%. <b><i>Conclusions:</i></b> In patients with diabetes and ESKD treated by hemodialysis, the GMI has a strong correlation with TIR, while HbA1c underestimated the average glucose and GMI. Given the limitations of HbA1c in this population, GMI or mean glucose and TIR may be considered as more appropriate glucose control markers.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert Panel Recommendations for a Standardized Ambulatory Glucose Profile Report for Connected Insulin Pens.","authors":"Gregg D Simonson, Amy B Criego, Tadej Battelino, Anders L Carlson, Pratik Choudhary, Sylvia Franc, Dana Gershenoff, George Grunberger, Irl B Hirsch, Diana Isaacs, Mary L Johnson, David Kerr, Davida F Kruger, Chantal Mathieu, Thomas W Martens, Revital Nimri, Sean M Oser, Anne L Peters, Ruth S Weinstock, Eugene E Wright, Carol H Wysham, Richard M Bergenstal","doi":"10.1089/dia.2024.0107","DOIUrl":"10.1089/dia.2024.0107","url":null,"abstract":"<p><p><b><i>Background</i></b>: Connected insulin pens capture data on insulin dosing/timing and can integrate with continuous glucose monitoring (CGM) devices with essential insulin and glucose metrics combined into a single platform. Standardization of connected insulin pen reports is desirable to enhance clinical utility with a single report. <b><i>Methods</i></b>: An international expert panel was convened to develop a standardized connected insulin pen report incorporating insulin and glucose metrics into a single report containing clinically useful information. An extensive literature review and identification of examples of current connected insulin pen reports were performed serving as the basis for creation of a draft of a standardized connected insulin pen report. The expert panel participated in three virtual standardization meetings and online surveys. <b><i>Results</i></b>: The <i>Ambulatory Glucose Profile (AGP) Report: Connected Insulin Pen</i> brings all clinically relevant CGM-derived glucose and connected insulin pen metrics into a single simplified two-page report. The first page contains the time in ranges bar, summary of key insulin and glucose metrics, the AGP curve, and detailed basal (long-acting) insulin assessment. The second page contains the bolus (mealtime and correction) insulin assessment periods with information on meal timing, insulin-to-carbohydrate ratio, average bolus insulin dose, and number of days with bolus doses recorded. The report's second page contains daily glucose profiles with an overlay of the timing and amount of basal and bolus insulin administered. <b><i>Conclusion</i></b>: The <i>AGP Report: Connected Insulin Pen</i> is a standardized clinically useful report that should be considered by companies developing connected pen technology as part of their system reporting/output.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporary Target Versus Suspended Insulin Infusion in Patients with Type 1 Diabetes Using the MiniMed 780G Advanced Closed-Loop Hybrid System During Aerobic Exercise: A Randomized Crossover Clinical Trial.","authors":"Ana María Gómez, Diana Cristina Henao, Oscar Mauricio Muñoz, Diana Marcela Romero, Julio David Silva León, Pablo Esteban Jaramillo, Evelyn Moscoso, Darío A Parra Prieto, Sofía Robledo, Maira García Jaramillo, Martin Rondón Sepúlveda","doi":"10.1089/dia.2023.0589","DOIUrl":"10.1089/dia.2023.0589","url":null,"abstract":"<p><p><b><i>Aim:</i></b> To compare the safety in terms of hypoglycemic events and continuous glucose monitoring (CGM) metrics during aerobic exercise (AE) of using temporary target (TT) versus suspension of insulin infusion (SII) in adults with type 1 diabetes (T1D) using advanced hybrid closed-loop systems. <b><i>Methods:</i></b> This was a randomized crossover clinical trial. Two moderate-intensity AE sessions were performed, one with TT and one with SII. Hypoglycemic events and CGM metrics were analyzed during the immediate (baseline to 59 min), early (60 min to 6 h), and late (6 to 36 h) post-exercise phases. <b><i>Results:</i></b> In total, 33 patients were analyzed (44.6 ± 13.8 years), basal time in range (%TIR 70-180 mg/dL) was 79.4 ± 12%, and time below range (%TBR) <70 mg/dL was 1.8 ± 1.7% and %TBR <54 mg/dL was 0.5 ± 0.9%. No difference was found in the number of hypoglycemic events, %TBR <70 mg/dL and %TBR <54 mg/dL between TT and SII. Differences were found in the early phase, with better values when using TT for %TIR 70-180 mg/dL (83.0 vs. 65.3, <i>P</i> = 0.005), time in tight range (%TITR 70-140 mg/dL) (56.3 vs. 41.5, <i>P</i> = 0.04), and time above range (%TAR >180 mg/dL) (15.3 vs. 31.8, <i>P</i> = 0.01). In the diurnal period, again %TIR was better for TT use (82.1 vs. 73.1, <i>P</i> = 0.02) and %TAR (15.0 vs. 22.96, <i>P</i> = 0.04). No significant differences were found in the CGM metrics during the different phases of AE. <b><i>Conclusion:</i></b> Our data appear to show that the use of TT compared with SII is equally safe in all phases of AE. However, the use of TT allows for a better glycemic profile in the early phase of exercise.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-Life Achievements of MiniMed 780G Advanced Closed-Loop System in Youth with Type 1 Diabetes: AWeSoMe Study Group Multicenter Prospective Trial.","authors":"Noah Gruber, Avigail Wittenberg, Avivit Brener, Shirli Abiri, Kineret Mazor-Aronovitch, Michal Yackobovitch-Gavan, Shay Averbuch, Tal Ben Ari, Noah Levek, Neriya Levran, Zohar Landau, Marianna Rachmiel, Orit Pinhas-Hamiel, Yael Lebenthal","doi":"10.1089/dia.2024.0148","DOIUrl":"10.1089/dia.2024.0148","url":null,"abstract":"<p><p><b><i>Background:</i></b> We assessed real-life glycemic outcomes and predictors of composite measures of optimal glycemic control in children and adolescents with type 1 diabetes (T1D) during their initial 12 months of the MiniMed™ 780G use. <b><i>Methods:</i></b> This prospective observational multicenter study collected demographic, clinical, and 2-week 780G system data at five time points. Optimal glycemic control was defined as a composite glycemic control (CGC) score requiring the attainment of four recommended continuous glucose monitoring (CGM) targets, as well as the glycemia risk index (GRI) of hypoglycemia and hyperglycemia and composite CGM index (COGI). Outcome measures included longitudinal changes in multiple glycemic parameters and CGC, GRI, and COGI scores, as well as predictors of these optimal measures. <b><i>Results:</i></b> The cohort included 93 children, 43% girls, with a median age of 15.1 years (interquartile range [IQR] 12.9,17.0). A longitudinal analysis adjusted for age and socioeconomic index yielded a significant improvement in glycemic control for the entire cohort (<i>p</i>_time < 0.001) after the transition to 780G. The mean hemoglobin A1c (HbA1c) (SE) was 8.65% (0.12) at baseline and dropped by >1% after 1 year to 7.54% (0.14) (<i>p</i>_time < 0.001). Optimal glycemic control measures improved at 12 months post 780G; CGC improved by 5.6-fold (<i>P</i> < 0.001) and was attained by 24% of the participants, the GRI score improved by 10-fold (<i>P</i> = 0.009) and was achieved by 10% of them, and the COGI improved by 7.6-fold (<i>P</i> < 0.001) and was attained by 20% of them. Lower baseline HbA1c levels and increased adherence to Advanced Hybrid Closed-Loop (AHCL) usage were predictors of achieving optimal glycemic control. <b><i>Conclusions:</i></b> The AHCL 780G system enhances glycemic control in children and adolescents with T1D, demonstrating improvements in HbA1c and CGM metrics, albeit most participants did not achieve optimal glycemic control. This highlights yet ongoing challenges in diabetes management, emphasizing the need for continued proactive efforts on the part of health care professionals, youth, and caregivers.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Patterns of Continuous Glucose Monitoring Use and Metrics of Glycemic Control in Type 1 Diabetes and Type 2 Diabetes Patients in the Veterans Health Care System: Integrating Continuous Glucose Monitoring Device Data with Electronic Health Records Data.","authors":"Tomoki Okuno, Sharon A Macwan, Donald Miller, Gregory J Norman, Peter Reaven, Jin J Zhou","doi":"10.1089/dia.2024.0083","DOIUrl":"10.1089/dia.2024.0083","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To integrate long-term daily continuous glucose monitoring (CGM) device data with electronic health records (EHR) for patients with type 1 and type 2 diabetes (T1D and T2D) in the national Veterans Affairs Healthcare System to assess real-world patterns of CGM use and the reliability of EHR-based CGM information. <b><i>Research Design and Methods:</i></b> This observational study used Dexcom CGM device data linked with EHR (from 2015 to 2020) for a large national cohort of patients with diabetes. We tracked the initiation and consistency of CGM use, assessed concordance of CGM use and measures of glucose control between CGM device data and EHR records, and examined results by age, ethnicity, and diabetes type. <b><i>Results:</i></b> The time from pharmacy release of CGM to patients to initiation of uploading CGM data to Dexcom servers averaged 3 weeks but demonstrated wide variation among individuals; importantly, this delay decreased markedly over the later years. The average daily wear time of CGM exceeded 22 h over nearly 3 years of follow-up. Patterns of CGM use were generally consistent across age, race/ethnicity groups, and diabetes type. There was strong concordance between EHR-based estimates of CGM use and Dexcom CGM wear time and between estimates of glucose control from both sources. <b><i>Conclusions:</i></b> The study demonstrates our ability to reliably integrate CGM devices and EHR data to provide valuable insights into CGM use patterns. The results indicate in the real-world environment that CGM is worn consistently over many years for both patients with T1D and T2D within the Veterans Affairs Healthcare System and is similar across major race/ethnic groups and age-groups.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}