Diabetes technology & therapeutics最新文献

{"title":"Seeing the Road Ahead-The Need to Address Accessibility of Diabetes Technology.","authors":"Rishika Kartik, Halis Kaan Akturk, Michael W Stewart, Gregory P Forlenza","doi":"10.1089/dia.2024.0412","DOIUrl":"https://doi.org/10.1089/dia.2024.0412","url":null,"abstract":"","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881491","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":"The Cost of Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Type 1 Diabetes Pregnancies in the United States: A Cost-Consequences Analysis Using Real-World Evidence.","authors":"Michael J DiStefano, R Brett McQueen, Valerie Gao, Matthew P Klein, Janet K Snell-Bergeon, Sarit Polsky","doi":"10.1089/dia.2024.0478","DOIUrl":"https://doi.org/10.1089/dia.2024.0478","url":null,"abstract":"<p><p>Data on the cost implications of continuous glucose monitoring (CGM) use in type 1 diabetes (T1D) pregnancies in the United States are sparse. Drawing on associations identified in real-world evidence from a retrospective chart review at the Barbara Davis Center for Diabetes, we conducted a cost-consequences analysis of CGM use versus self-monitoring of blood glucose (SMBG), inclusive of neonatal intensive care unit (NICU) spending. In the base-case analysis assuming per-label CGM use and per-guideline finger-stick frequency, the per-person cost was $16,254 for CGM versus $15,182 for SMBG. In a real-world scenario analysis, the per-person cost was $13,708 for CGM versus $14,524 for SMBG. In both analyses, there was a cost savings for NICU admissions of $2,903 with CGM use. In the probabilistic sensitivity analysis, CGM was cost saving in 25% of base-case model iterations and 46% of real-world model iterations. This study adds to the growing evidence base that the increased costs of CGM use versus SMBG to manage T1D pregnancies are likely offset by better neonatal health outcomes.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853392","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":"Enhancing Type 1 Diabetes Immunological Risk Prediction with Continuous Glucose Monitoring and Genetic Profiling.","authors":"Eslam Montaser, Leon S Farhy, Stephen S Rich","doi":"10.1089/dia.2024.0496","DOIUrl":"https://doi.org/10.1089/dia.2024.0496","url":null,"abstract":"<p><p><b><i>Background:</i></b> Early identification of individuals at high risk for type 1 diabetes (T1D) is essential for timely intervention. Islet autoantibodies (AB) and continuous glucose monitoring (CGM) reveal early signs of glycemic dysregulation, while T1D genetic risk scores (GRS) further improve disease prediction. We use CGM data and T1D GRS to develop an AB classifier (1 AB vs. ≥2 AB) and predict early T1D risk. <b><i>Methods:</i></b> Thirty-nine AB-positive (18 with 1 and 21 with ≥2 AB) healthy relatives of T1D (mean age 22.1 ± 11.1 years, HbA1c 5.3 ± 0.3%, body mass index 24.1 ± 5.8 kg/m²) were enrolled in a National Institutes of Health's (NIH) TrialNet ancillary study. Participants wore CGMs for a week and consumed three standardized liquid mixed meals (SLMM). Post-SLMM CGM glycemic features and T1D GRS were used in a linear support vector machine (SVM) model with recursive feature elimination (RFE) for AB classification, evaluated via fivefold cross-validation using the receiver operating characteristic and precision-recall area under the curve (AUC-ROC/PR). <b><i>Results:</i></b> Significant differences between the AB groups were observed in the post-SLMM percent time of glucose >180 mg/dL and GRS (<i>P</i> = 0.020 and <i>P</i> = 0.001, respectively). An SVM model with two RFE-selected features (T1D GRS and incremental AUC) achieved the best performance, classifying 1 versus ≥2 AB individuals with an AUC-ROC of 0.93 (95% confidence interval [CI]: 0.83-1.00) and AUC-PR of 0.89 (95% CI: 0.71-0.99), compared with AUC-ROC of 0.80 (95% CI: 0.46-1.00) and AUC-PR of 0.82 (95% CI: 0.71-0.93) using all features. <b><i>Conclusions:</i></b> A machine learning approach combining a 1-week CGM home test and T1D GRS reliably assesses T1D immunological risk, enabling early intervention.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834419","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":"Addressing Factors to Reduce Interruption of Continuous Glucose Monitor Use During Radiologic Procedures.","authors":"Nicholas Saad, Druti Shukla, Michael Rickson, Megan O'Neill","doi":"10.1089/dia.2024.0550","DOIUrl":"https://doi.org/10.1089/dia.2024.0550","url":null,"abstract":"","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812675","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":"Toward Automation: The Road Traveled and Road Ahead for Integrating Automated Insulin Delivery into Inpatient Care.","authors":"Michael S Hughes, Francisco J Pasquel, Georgia M Davis, Rayhan A Lal, Bruce A Buckingham, Charlotte K Boughton, Sue A Brown, Lia Bally","doi":"10.1089/dia.2024.0343","DOIUrl":"https://doi.org/10.1089/dia.2024.0343","url":null,"abstract":"<p><p>The introduction of automated insulin delivery (AID) systems represents a significant advancement in diabetes care, offering substantial benefits in outpatient settings. Although clinical studies suggest that these systems can also help improve glycemic control in acutely ill patients, several barriers remain for the actual implementation and use of these technologies in clinical practice. Three main contexts for inpatient use are addressed, including: (a) continuation of personal AID systems, (b) initiation of AID during hospitalization, and (c) initiation of AID systems at discharge. A research road map with immediate to long-term actions is presented. Initially, it calls for clinical studies assessing in-hospital efficacy, safety, and utility, addressing specific patient needs and health care operational impacts. Midterm, it focuses on practical integration, simplifying AID use, ensuring electronic health record compatibility, clarifying regulatory uncertainties, and supporting health care professionals and patients. Long-term goals include system optimizations and policy advocacy for in-hospital AID use.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767054","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":"Automated Insulin Delivery Effects During Driving Among Older Adults with Type 1 Diabetes in a Randomized Trial.","authors":"Steven Trawley, Hye Jin Kwon, Sara Vogrin, Peter G Colman, Spiros Fourlanos, Melissa H Lee, Richard J MacIsaac, David N O'Neal, Niamh A O'Regan, Vijaya Sundararajan, Glenn M Ward, Sybil A McAuley","doi":"10.1089/dia.2024.0303","DOIUrl":"https://doi.org/10.1089/dia.2024.0303","url":null,"abstract":"<p><p>Dysglycemia among drivers with type 1 diabetes (T1D) is associated with impaired driving performance, and glucose levels \"above 5 to drive\" are often recommended for insulin-treated drivers. Evidence for diabetes treatments that support euglycemia while driving is minimal, particularly for older drivers. In this randomized, crossover trial involving adults aged ≥60 years with T1D, we used continuous glucose monitoring (CGM) during driving to compare the first-generation closed-loop automated insulin delivery (AID) versus a sensor-augmented pump therapy. There were 1894 trips undertaken by 8 drivers (median age 68 years [IQR: 64-70]). During AID versus sensor-augmented pump, time in range >5.0-10.0 mmol/L was greater (100% [0-100] vs. 81% [0-100]; <i>P</i> = 0.033) and fewer trips had any CGM >16.7 mmol/L (3.5% vs. 6.4%; <i>P</i> = 0.006). Three percent of all trips included CGM <3.9 mmol/L, with no between-stage difference (3.0% vs. 3.5%; <i>P</i> = 0.52). System alerts occurred in 10% of all trips, with no between-stage difference (9% vs. 11%; <i>P</i> = 0.078). First-generation AID reduces hyperglycemic driving among older drivers with T1D, without increasing hypoglycemia. Developing dedicated \"driving-mode\" settings could prioritize safety while minimizing distraction. Trial Registration: ACTRN12619000515190.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766892","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":"Long-Term Health Economic Evaluation of Intermittently Scanned Glucose Monitoring Compared with Self-Monitoring Blood Glucose in a Real-World Setting in Finnish Adult Individuals with Type 1 Diabetes.","authors":"Jyrki Mustonen, Päivi Rautiainen, Marja-Leena Lamidi, Piia Lavikainen, Janne Martikainen, Tiina Laatikainen","doi":"10.1089/dia.2024.0102","DOIUrl":"10.1089/dia.2024.0102","url":null,"abstract":"<p><p><i>B</i><b><i>ackground and Aims:</i></b> There has been an evolving trend in the use of intermittently scanned continuous glucose monitoring (isCGM) among individuals with type 1 diabetes. Although isCGM is proven to be beneficial in the treatment of individuals with type 1 diabetes, its use leads to increasing device costs. This study aimed to investigate the long-term cost-effectiveness of isCGM. <b><i>Methods:</i></b> Long-term clinical outcomes and costs were projected using the IQVIA Core Diabetes Model (v10.0) based on the observed real-world outcomes of isCGM. The clinical input data for the analysis were sourced from a real-world patient cohort from Eastern Finland, including 877 adult individuals with type 1 diabetes with isCGM (i.e., Freestyle Libre 1 and 2). At the baseline, the patients' mean age was 48 years, and the mean duration of diabetes was 25.8 years. The mean baseline HbA1c was 8.6%, and the mean 12-month change from baseline in HbA1c was -0.37% after the initiation of isCGM. The cost-effectiveness analysis was performed over a lifetime time horizon. A discount rate of 3% was used for the future costs and health outcomes. <b><i>Results:</i></b> The projected use of isCGM was associated with improved quality-adjusted life year (QALY) expectancy of 0.84 QALYs after the start of isCGM. The direct lifetime costs were 7861 EUR higher with the use of isCGM, which resulted in an incremental cost-effectiveness ratio of 9396 EUR per QALY gained. <b><i>Conclusions:</i></b> According to the present analysis, the use of isCGM is considered cost-effective in adult individuals with type 1 diabetes in a real-world setting in Finland.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"918-924"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261004","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":"Reduced Rate of Hospitalizations for Acute Diabetes Events Before and After FreeStyle Libre^® System Initiation in Some People With Type 2 Diabetes on Insulin-Secretagogue Oral Drug Therapy Without Insulin in France.","authors":"Jean-Pierre Riveline, Fleur Levrat-Guillen, Bruno Detournay, Eric Vicaut, Gérard De Pouvourville, Corinne Emery, Bruno Guerci","doi":"10.1089/dia.2024.0171","DOIUrl":"10.1089/dia.2024.0171","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Glycemic management in people with type 2 diabetes mellitus (T2DM) on insulin-secretagogue regimens without insulin is of importance, as this group still represents a significant proportion of patients. Risks for acute diabetes events (ADEs), including diabetic ketoacidosis (DKA) or hypoglycemia, using insulin-secretagogue drugs are well established. Few studies have suggested that continuous glucose monitoring (CGM) could be useful for monitoring glucose dynamics associated with the use of such therapies. To document this point an exploratory analysis was conducted in a group of individuals with noninsulin treated T2DM in France who are managed with oral insulin-secretagogues and initiating the FreeStyle Libre^® system (FSL). <b><i>Methods:</i></b> A retrospective study of the French national SNDS reimbursement claims database (≈66 million French people) was conducted to identify people with T2DM on oral insulin-secretagogues and receiving a first reimbursement of FSL between August 1, 2017 and December 31, 2018. The analysis included data for the 12 months before and up to 24 months after FSL initiation. Hospitalizations for diabetes-related acute events were identified using ICD-10 codes as main or related diagnosis, for: hypoglycemic events; DKA events; comas; and hyperglycemia-related admissions. <b><i>Results:</i></b> A total of 1272 people with T2DM on insulin-secretagogues without insulin initiated FSL during the selection period. Of these, 7.15% had at least one hospitalization for any ADE in the year before FSL initiation, compared with 2.52% at 12 months and 2.83% at 24 months following FSL initiation. Reductions in ADEs were driven by -73% fewer admissions for ADEs related to diabetic ketoacidosis (DKA) or other hyperglycemia-related events. These patterns of reduced ADEs persisted after 2 years. <b><i>Conclusions:</i></b> This study suggests the value of the FSL system in reducing ADEs in some people with T2DM in France being treated with insulin-secretagogues without insulin. Characteristics of these patients remain to be documented.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"932-938"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418297","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":"Beyond Glucose Monitoring: Multianalyte Sensor Use in Diabetes.","authors":"Kathy Zhou, Steven James, Michele Gaca, Ashani Lecamwasam, Muamer Dervisevic, David O'Neal, Nicolas H Voelcker, Elif I Ekinci","doi":"10.1089/dia.2024.0250","DOIUrl":"10.1089/dia.2024.0250","url":null,"abstract":"<p><p>The incidence, prevalence, mortality, and health expenditure associated with diabetes continue to grow, despite efforts. The use of multianalyte sensors, which detect glucose as well as key analytes such as ketones, lactate, insulin, uric acid, and electrolytes, may provide additional information to guide earlier identification and management of diabetes and its complications. We undertook a narrative review using a systematic approach in May 2023, with a bridge search undertaken in April 2024. Four biomedical databases were searched: MEDLINE (Ovid), Embase, Emcare, and Cochrane Library. Searches for gray literature were conducted on ClinicalTrials.gov, Google Scholar, and websites of relevant organizations. Included studies incorporated articles on multianalyte sensors in diabetes and single-analyte sensors proposing integration into multianalyte diabetes management, with no limits placed on publication date and study design. Data were screened and extracted using Covidence^TM software. Overall, 11 articles were included, of which 7 involved multianalyte sensors (involving glucose and other analytes) and 4 single-analyte sensors (measuring non-glucose substances for proposed future integration into multianalyte systems). Analytes examined were ketones (<i>n</i> = 3), lactate (<i>n</i> = 4), uric acid (<i>n</i> = 3), insulin (<i>n</i> = 1), and potassium (<i>n</i> = 1). Results demonstrated that <i>in vitro</i> and <i>in vivo</i> measurements of multi- and single-analyte sensors accurately and reliably corresponded with human capillary and serum samples. While the literature on this topic is sparse, our review demonstrated that measurement of glucose and other analytes can be feasibly undertaken using multi- and single-analyte sensors. More studies in humans are needed to establish clinical utility in diabetes self-management and assist with technological improvements.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"885-896"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757740","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":"Population-Based Study on the Implementation of Flash Glucose Monitoring and Severe Hypoglycemia in Adults With Type 1 Diabetes.","authors":"Pablo Rodríguez de Vera Gómez, Eduardo Mayoral Sánchez, Ángel Vilches Arenas, Reyes Ravé García, Manuel de la Cal Ramírez, Guillermo Umpierrez, María Asunción Martínez-Brocca","doi":"10.1089/dia.2024.0201","DOIUrl":"10.1089/dia.2024.0201","url":null,"abstract":"<p><p><b><i>Objective:</i></b> We analyzed the effect of implementing a flash glucose monitoring (FGM) technology in a public health care system with universal coverage on the rate of severe hypoglycemia requiring urgent care in adults with type 1 diabetes mellitus (T1DM). <b><i>Methods:</i></b> Using a comprehensive regional dataset, we extracted emergency care codes with hypoglycemia in individuals with T1DM who initiated the use of FGM in Andalucia, Spain, from January 1, 2020, to December 31, 2021. Severe hypoglycemia was defined as a confirmed blood glucose <70 mg/dL, which required the urgent dispatch of an emergency medical service (EMS) for onsite management. We compared hypoglycemic events reported in the 12 months before and after the initiation of FGM to determine the population incidence rates. <b><i>Results:</i></b> A total of 13,616 participants with a mean age of 43.7 ± 13.5 years were included. The follow-up periods were 23.4 and 24.8 months before and after FGM. There were 969 and 737 cases of hypoglycemia before and after the initiation of FGM. The baseline incidence rate was 358.58 episodes per 10,000 person-years, which decreased to 260.9 at the end of the follow-up (rate-ratio 0.72 [0.66; 0.80]). The reduction in hypoglycemia was significant in individuals aged ≥60 years (rate-ratio 0.40 [0.28; 0.55]) and males (0.64 [0.56; 0.72]). In addition, there was a reduction in the overall median HbA1c of -0.35% (95% CI [-0.38; -0.33], <i>P</i> < 0.001). <b><i>Conclusion:</i></b> The implementation of FGM systems in a public health care system as a provision for adults with T1DM was associated with significant reductions in the rate of severe hypoglycemic events that required urgent EMS care.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"951-959"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418296","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}