Use Of Continuous Glucose Monitoring Research Articles

SAT666 Feasibility, Acceptability And Preliminary Efficacy Of Continuous Glucose Monitoring In Adolescents With Obesity

Abstract Disclosure: S. Chimatapu: None. S. Mittelman: None. M. Habib: None. L. Wisk: None. A. Klomhaus: None. A.P. Vidmar: None. Background: Childhood obesity is a global health concern that presents as a multifaceted challenge requiring comprehensive interventions targeting nutritional, physical activity and behavioral domains. Despite this, treatment outcomes have been modest due to challenges in adherence and individual variability in response. Wearable technologies, such as Continuous Glucose Monitors(CGMs), offer a unique solution to promote consistent weight control in youth. These devices provide real-time biofeedback, allowing youth to make timely and informed decisions about their lifestyle choices. To date, no trial has explored the feasibility and efficacy of CGM use as a standalone intervention for adolescents with obesity. Hypothesis: We hypothesize that this study will demonstrate feasibility, acceptability and preliminary efficacy of CGMs in facilitating weight management among adolescents with obesity. Furthermore, we postulate that the unblinded CGM use will lead to greater changes in diet and physical activity compared to blinded use; emphasizing the use of biofeedback as a motivator for behavior change in this population. Methods: Adolescents with obesity have been recruited into a six-week cross-over trial. All participants wear the CGM daily for six weeks. For three weeks subjects will wear the CGM in a blinded manner, and for the other three weeks they will have access to the real-time CGM data, with blocks assigned in a random, cross-over manner. Outcomes will include recruitment and retention rate, adherence, CGM metrics, sleep, dietary intake, physical activity, eating behaviors and change in weight compared between study arms. Results: We have so far recruited 16 of a goal of 30 adolescents (15.3± 2.4 years old, 68% female, 75% Hispanic). Baseline A1c was 5.6 ± 0.3%. Four participants completed the study; one was lost to follow up, and 11 are currently enrolled in the study. Data logs from weekly telephone calls revealed high continuous engagement throughout the six weeks of the study. Our qualitative analysis of participant feedback suggest that they engaged with their real-time device data during the unblinded window. Device itself was deemed comfortable to wear, fit properly, without adverse effects or negative impacts on daily functioning. One participant reported 2 lbs. weight loss in 2 weeks after wearing the CGM by modifying their behaviors based on the glucose readings. Conclusions: Our preliminary findings suggest that CGM use in youth with obesity is a feasible, acceptable and well-tolerated tool. CGMs also have the potential to bring forth sustainable changes in youth behavior and could be a powerful intervention to enhance lifestyle changes in pediatric weight management programs. Further analyses will be pursued to help understand effect of continuous glucose monitoring on glycemic variability, body composition and self-reported health behaviors in youth with obesity. Presentation: Saturday, June 17, 2023

THU130 Long Term Tracking Of HbA1c Levels Across The Life Span In Type 1 Diabetes: From Infants To Young Adults

Abstract Disclosure: S. Kim: None. K. Song: None. M. Lee: None. J. Seo: None. H. Chae: None. H. Kim: None. A. Kwon: None. Objectives HbA1c is the most important monitoring value and generally used in diabetes. However, HbA1c may change across the life span according to growth and puberty. This study explores the long-term tracking of HbA1c from infants to young adults diagnosed with Type 1 Diabetes mellitus (T1DM) and analyzes the effects of HbA1c according to life span on complications. Method This retrospective study, included 289 patients (M, 43.0%; mean first visit age, 7.39±3.94 years old; mean followed up periods, 4.32±3.15 years) diagnosed with T1DM. The total of 6368 HbA1c values were analyzed. The distribution of HbA1c values according to age and life period was evaluated. In addition, the differences in mean HbA1c values according to sex and the use of continuous glucose monitoring (CGM) were analyzed. Furthermore, it was analyzed which HbA1c of life period has the most influence on occurrence of complications. Result The level of HbA1c was relatively high at the age of 1- to 2-years, and then decreased between 4 to 5-years. After 5 years of age, HbA1C gradually escalated and peaked at the age of 12- to 15-years, during puberty. Especially for girls, HbA1c increased dramatically during puberty between the age of 10- to 13-years, which was consistent with the physiologic insulin resistance. During in childhood to young adulthood, the mean HbA1c of CGM users was lower than that of non-users. The higher mean HbA1c during all ages affected the occurrence of complications. Intriguingly, the HbA1c level during adolescence was important for the occurrence of diabetic retinopathy. Conclusion HbA1c level change across life span, and peaked at pubertal stage, which consistent with physiologic insulin resistance during puberty. In addition, good glycemic control in adolescence may reduce the occurrence of diabetic retinopathy. Therefore, using CGM in adolescence may be helpful for glycemic control and prevention of diabetic complications. Presentation: Thursday, June 15, 2023

SAT106 Use Of Data Sharing Feature Of Dexcom G6 Sensor Is Associated With Improved Glycemic Control: A Comparative Analysis

Abstract Disclosure: B. Sadek: None. Introduction: The use of Continuous Glucose Monitoring (CGM) sensors has significantly increased in part due to the seamless integration with smartphones. The Dexcom G6 CGM automatically sends real-time glucose readings to a compatible smart device. Moreover, the Dexcom Clarity app provides analytic tools and allows users to continuously share glucose data with their healthcare professionals, enabling remote monitoring of patients' glycemic control. Although multiple studies have shown better glucose control in patients who use CGM systems, what remains unexplored is if glucose metrics are further improved in those who share CGM data with healthcare providers. In this study, we compared glycemic outcomes among patients who use the sharing feature of the Dexcom G6 sensor to share their data with their healthcare providers to those who do not. Method: We conducted a single-center cross-sectional study in a community hospital with patients who use the Dexcom G6 CGM (n=201). Data was obtained from Dexcom Clarity for Healthcare Professionals, an online platform for clinicians to review patients' glucose patterns and statistics through interactive reports. The following data was collected for each patient: date of the last upload, data sharing status, average glucose, standard deviation, glucose management indicator (GMI) (%), glucose ranges (categorized as very high, high, in range, low, very low), sensor usage, and coefficient of variation (%). Two-tailed unpaired Student's t-tests were used to analyze the CGM metrics based on data sharing status. Significance was defined as a p-value less than 0.05. Results: 123 (61.19%) of the study participants shared data with healthcare providers. Participants with sharing data 'on' were significantly younger (49±15 years, p-value = 0.0007) and had increased sensor usage (90±21%, p-value = 0.0012), compared to those with sharing off. Participants who shared data spent more time in range (57±24 %, p-value = 0.0435), indicating a higher percentage of readings with glucose levels in a healthy range (70-180 mg/dL). Lastly, average glucose was lower in participants who shared data, although not statistically significant (179 ±44 mg/dL, p=0.08). Conclusion: The data-sharing feature on Dexcom G6 was utilized more frequently by younger people and was associated with a higher percentage of sensor usage. In addition, using the data-sharing feature of the Dexcom G6 could lead to a clinically meaningful improvement in glycemic control. Presentation: Saturday, June 17, 2023

THU350 Rapid Decrease Of Glycemic Levels In Three Patients With Severe Insulin Resistance Associated With Bell’s Palsy.

Abstract Disclosure: E. Chuki: None. M. Lightbourne: None. B. Abel: None. R.J. Brown: None. Bell’s palsy (BP) is associated with diabetic angiopathy and facial nerve ischemia and may be the first sign of diabetic mononeuropathy. Specific risk factors for diabetic mononeuropathy have not been well established. Rapid tightening of glycemic control has been associated with worsening diabetic retinopathy. However, this association has not been reported previously in the development of diabetic mononeuropathy or BP. We describe three patients with extreme insulin resistance, in whom rapid correction of hyperglycemia was temporally associated with development of BP. Case 1: A 63 year-old African American male with history of type 2 diabetes (T2D) and peripheral neuropathy was admitted with sudden onset severe insulin resistance and DKA, leading to a diagnosis of type B insulin resistance. Serum glucose was >600 mg/dl and A1c was 13.4%. He was treated with an insulin drip, then transitioned to subcutaneous insulin U-500 at a total daily dose of ∼3000 units, resulting in blood glucose between 140 and 180 mg/dl. On Day 5 after initiating U-500 and achieving tight control of glycemia, the patient developed bilateral Bell’s Palsy, which resolved after 4 years. Case 2: A 25 year-old African American female with history of T2D was admitted with sudden onset severe insulin resistance and DKA requiring an insulin drip of ∼3,000 units per day, leading to a diagnosis of type B insulin resistance. A1c on admission was 14%. After ∼5 days, she transitioned to U-500 that was titrated over 2 weeks to a total daily dose of 3,000 units with blood glucose between 98 and 177 mg/dL. She developed bilateral BP approximately 43 days from onset of DKA and 36 days after starting U-500 insulin with improved glycemic control. At last follow up 5 years later she still had residual facial weakness. Case 3: A 25 year-old Caucasian male with history of diabetes due to type A insulin resistance (Rabson-Mendenhall Syndrome) and recurrent ketosis on U500 insulin >1,000 units daily had poor adherence to insulin and diet with A1c of 14.3%. 3 weeks after A1c measurement he was started on a Continuous Glucose Monitor (CGM), leading to dramatic change in diet and medication adherence, with reduction in the estimated A1c based on glucose management indictor (GMI) to 7.7% within 3 weeks. 3 weeks after starting CGM use with improved compliance and glycemic control, he developed unilateral BP, which fully recovered after 1 month.We report 3 cases in which onset of BP was observed in rapid temporal correlation with massive increases in insulin dose and/or improvement in glycemia. Severe insulin resistance and rapid decrease of glycemic levels may lower intravascular volume and narrow vessels, leading to microvascular disruption of the vasa nervorum, ultimately causing mononeuropathy. A more gradual approach to glycemia management in patients with severe insulin resistance may be warranted to mitigate this risk. Presentation: Thursday, June 15, 2023

SAT126 Relationship Between Type I Diabetes And Depression In The Pediatric Population

Abstract Disclosure: L.B. Greenblatt: None. M. Epelman: None. S. Demissie: None. Introduction: Type 1 diabetes mellitus (T1DM) is one of the most common chronic illnesses in children. Depression in children and adolescents with T1DM has been associated with negative diabetes related health outcomes, such as recurrent diabetes ketoacidosis. These associations can be bidirectional, where poor glycemic control can worsen symptoms of depression. Adolescents with T1DM and depression pose additional challenges to health care providers due to non-adherence to diabetes management. Objective: The aim of this study is to investigate the relationship between depression and age of onset, duration and T1DM control. We hypothesized that duration of diabetes mellitus positively correlates with depression symptoms. Patients diagnosed with T1DM in adolescence have higher depression scores compared to individuals diagnosed at a younger age. Methods: Individuals with T1DM 11 to 21 years old enrolled in the study. Patients with known psychiatric illnesses and intellectual disabilities were excluded. After obtaining informed consent and assent, participants were asked to complete age specific depression screening form PHQ-9. Forms were immediately scored by the investigator. Patients with moderate symptoms (score of 10 to 14) are provided a list of local mental health resources and individuals with severe depressive symptoms (score > 15) were referred to a pediatric psychiatrist for evaluation. Data on age, sex, ethnicity, age at diagnosis, diabetes duration, recent glycosylated hemoglobin (HbA1C), treatment methods (insulin pump vs injections) and continuous glucose monitor use were collected from patients’ electronic health records. Results: 34 patients, 61.7% female, were screened thus far. The mean age was 16 years and average age at diagnosis was 8 years. 22% of patients were on multiple daily injections and 78% on insulin pump therapy. Most patients (88%) were using continuous glucose monitors. Despite long term care, the average HbA1c was 8%. Girls had higher average PHQ-9 score (7.24) compared to boys (3.69). As expected, high PHQ-9 score was associated with poor diabetes control (r=0.35, p=0.044). There was a positive correlation between PHQ-9 score and duration of T1DM and negative correlation between PHQ-9 score and age at onset (p>0.05). Conclusion: Children and adolescents with T1DM are at risk of depression. Younger age of onset and longer duration of T1DM was associated with higher severity of depression symptoms as evident by PQH-9 score. Poor control, defined by high HbA1C, is positively correlated with depression score. Screening for depression and proper referral should be integrated into routine care for children and adolescents with T1DM. Presentation: Saturday, June 17, 2023

SAT107 Assessing Continuous Glucose Monitor Alarm Use By Families Of Children With Diabetes

Abstract Disclosure: V.S. Ochs: None. S.E. Woerner: Employee; Self; Lilly USA, LLC. A. Ustyol: None. L.A. DiMeglio: Advisory Board Member; Self; Merck, Abata. Consulting Fee; Self; Vertex. Background: Continuous glucose monitors (CGM) offer customizable alarms which alert persons with diabetes and their caregivers of current or pending glycemic changes. However, there has been little work studying real-world CGM alert setting use in large clinical populations. We sought to understand CGM alarm use through report analyses. Methods: After IRB approval we analyzed data from two-week CGM reports obtained clinically to determine common settings and compared those to target guidelines. Results: CGM download data from 150 children using a Dexcom® G6 were analyzed (median age 14y, (range: 1-19), 89% white, 9.5% black, and 1.5% Asian, 47% female, 51% pump users). Median A1c was 7.8% (range: 5.4-15). Median CGM glucose was 190 (range: 56-374). Average time in range was 47.7% (range: 3.4-99.1).A Low Alarm alert was set for 131 participants (87%) with a median sensor glucose alert threshold of 74 mg/dL (range: 60-100). The High Alarm was used by 109 children (73%) with a median threshold of 272 mg/dL (range: 120-400). The Signal Loss alarm was used by 103 (69%) participants with a median time until notification of 20 min (range: 20-240). Low Repeat and High Repeat alarms were used by only 50 (33%) and 36 (24%) of children, respectively. Rise Rate and Fall Rate alarms were used by 18 (12%) and 34 (23%). There was a significant difference between the median High alarm cutoff of 272 mg/dL and a recommended standard (e.g. PantherProgram.org) of 250 mg/dL (p=0.0016). The same was true with the median Low alarm cutoff of 74 mg/dL and a recommended 70 mg/dL (p<0.0001). There was significant difference between the median High Repeat notification time of 1 hour and the recommended 2 hours (p<0.0001). Pump users were 2.2x more likely to use High Repeat alarms compared to injection users (95% CI: 1.18-4.15, p<0.01). The same was true with the Low Repeat alarm being 1.8x more likely to be used by pumpers compared to injection users (95% CI: 1.12-2.99, p=0.01). There were no significant differences in Low, High, Rise Rate, Fall Rate, Urgent Low Soon, Urgent Low Soon Repeat, or Signal Loss alarms.When the group was divided based on age, above 12 and <=12, younger CGM users were 1.2 times more likely to use the Low alarm compared to older users (95% CI: 1.03-1.30). Also, younger CGM users were more likely to use the Rise Rate (RR=3.6, 95% CI:1.37-9.67), Low Repeat (RR=1.7, 95% CI:1.09-2.71), Signal Loss (RR=1.3, 95% CI:1.04-1.60), Urgent Low Soon (RR=1.2, 95% CI:1.07-1.41), and Urgent Low Soon Repeat (RR=1.2, 95% CI:1.05-1.38) alarms. There were no significant differences in High, High Repeat, or Fall Rate alarm settings. Conclusions: The wide variability of alarm settings used by patients indicates likely educational gaps in CGM onboarding and use. Ensuring CGM alarm best practices will help children with diabetes and their caregivers get needed real-time glycemic data while minimizing alarm fatigue. Presentation: Saturday, June 17, 2023

Comprehensive Telehealth Model to Support Diabetes Self-Management

As the number of patients with diabetes continues to increase in the United States, novel approaches to clinical care access should be considered to meet the care needs for this population, including support for diabetes-related technology. To evaluate a virtual clinic to facilitate comprehensive diabetes care, support continuous glucose monitoring (CGM) integration into diabetes self-management, and provide behavioral health support for diabetes-related issues. This cohort study was a prospective, single-arm, remote study involving adult participants with type 1 or type 2 diabetes who were referred through community resources. The study was conducted virtually from August 24, 2020, to May 26, 2022; analysis was conducted at the clinical coordinating center. Training and education led by a Certified Diabetes Care and Education Specialist for CGM use through a virtual endocrinology clinic structure, which included endocrinologists and behavioral health team members. Main outcomes included CGM-measured mean glucose level, coefficient of variation, and time in range (TIR) of 70 to 180 mg/dL, time with values greater than 180 mg/dL or 250 mg/dL, and time with values less than 70 mg/dL or 54 mg/dL. Hemoglobin A1c was measured at baseline and at 12 and 24 weeks. Among the 234 participants, 160 had type 1 diabetes and 74 had type 2 diabetes. The mean (SD) age was 47 (14) years, 123 (53%) were female, and median diabetes duration was 20 years. Median (IQR) CGM use over 6 months was 96% (91%-98%) for participants with type 1 diabetes and 94% (85%-97%) for those with type 2 diabetes. Mean (SD) hemoglobin A1c (HbA1c) in those with type 1 diabetes decreased from 7.8% (1.6%) at baseline to 7.1% (1.0%) at 3 months and 7.1% (1.0%) at 6 months (mean change from baseline to 6 months, -0.6%, 95% CI, -0.8% to -0.5%; P < .001), with an 11% mean TIR increase over 6 months (95% CI, 9% to 14%; P < .001). Mean HbA1c in participants with type 2 diabetes decreased from 8.1% (1.7%) at baseline to 7.1% (1.0%) at 3 months and 7.1% (0.9%) at 6 months (mean change from baseline to 6 months, -1.0%; 95% CI, -1.4% to -0.7%; P < .001), with an 18% TIR increase over 6 months (95% CI, 13% to 24%; P < .001). In participants with type 1 diabetes, mean percentage of time with values less than 70 mg/dL and less than 54 mg/dL decreased over 6 months by 0.8% (95% CI, -1.2% to -0.4%; P = .001) and by 0.3% (95% CI, -0.5% to -0.2%, P < .001), respectively. In the type 2 diabetes group, hypoglycemia was rare (mean [SD] percentage of time <70 mg/dL, 0.5% [0.6%]; and <54 mg/dL, 0.07% [0.14%], over 6 months). Results from this cohort study demonstrated clinical benefits associated with implementation of a comprehensive care model that included diabetes education. This model of care has potential to reach a large portion of patients with diabetes, facilitate diabetes technology adoption, and improve glucose control.

2023 Clinical Practice Guidelines for Diabetes: Continuous Glucose Monitoring and Insulin Pumps

With the expanding use of continuous glucose monitoring (CGM) and insulin pumps worldwide, several international guidelines dedicated to diabetes technology have been developed. Recently, the Korean Diabetes Association released a new version of their clinical practice guidelines including substantial changes in recommendations on the use of CGM and insulin pumps. Of note, continuous use of real-time CGM is now recommended to all people with diabetes using insulin, including people with type 2 diabetes using once daily basal insulin. Convincing evidence from recent automated insulin delivery (AID) trials supports the recommendation of AID as standard therapy in type 1 diabetes. This review summarizes the results of recent clinical studies on CGM and AID and their influence on the new clinical recommendations.

The role of continuous glucose monitoring in physical activity and nutrition management: perspectives on present and possible uses

[Purpose] Continuous glucose monitoring (CGM) is on the rise as the prevalence of obesity and diabetes increases. This review aimed to explore the use of CGM and its potential novel applications in physical activity and nutrition management.[Methods] We searched PubMed, Web of Science, and Wiley Online Library databases using the keywords ‘continuous glucose monitor,’ ‘nutrition,’ ‘physical activity,’ and ‘numerical modeling.’[Results] Continuous blood glucose measurement is useful for individuals with obesity and diabetes. Long-term blood glucose data allow for personalized planning of nutritional composition, meal timing, and physical activity type and intensity, as well as help prevent hypoglycemia and hyperglycemia. Thus, understanding the limitations of CGM is important for its effective use.[Conclusion] CGM systems are being increasingly used to monitor and identify appropriate blood glucose controlling interventions. Blood glucose level is influenced by various factors such as nutrient composition, meal timing, physical activity, circadian rhythm, and cortisol levels. Numerical modeling can be used to analyze the complex relationship between stress, sleep, nutrition, and physical activity, which affect blood glucose levels. In future, blood glucose, sleep, and stress data will be integrated to predict appropriate lifestyle levels for blood glucose management. This integrated approach improves glucose control and overall wellbeing, potentially reducing societal costs.

2023 Clinical Practice Guidelines for Diabetes

The Committee on Clinical Practice Guidelines of the Korean Diabetes Association updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the eighth edition in May 2023. We performed a comprehensive systematic review of recent clinical trials and evidence suitable for the Korean population that could be applicable to real-world practice. These guidelines were developed to enable all healthcare providers including physicians, diabetes experts, and certified diabetes educators nationwide to best care for individuals with diabetes in a clinical practice setting. The recommendations for screening, medical nutrition therapy, pharmacologic therapy for adults with type 2 diabetes, and obesity, hypertension, and lipid management were revised and updated. The use of real-time continuous glucose monitoring (CGM) devices was recommended for adults with type 1 diabetes and adults with type 2 diabetes treated with multiple insulin injections, and additional CGM metrics were added to the blood glucose control target.

Accuracy and impact on quality of life of real-time continuous glucose monitoring in children with hyperinsulinaemic hypoglycaemia.

Continuous glucose monitoring (CGM) is the standard of care for glucose monitoring in children with diabetes, however there are limited data reporting their use in hyperinsulinaemic hypoglycaemia (HH). Here, we evaluate CGM accuracy and its impact on quality of life in children with HH. Real-time CGM (Dexcom G5 and G6) was used in children with HH aged 0-16years. Data from self-monitoring capillary blood glucose (CBG) and CGM were collected over a period of up to 28days and analysed. Quality of life was assessed by the PedsQL4.0 general module and PedsQL2.0 family impact module, completed by children and their parents/carers before and after CGM insertion. Analysis of accuracy metrics included mean absolute relative difference (MARD) and proportion of CGM values within 15, 20, and 30% or 15, 20, and 30 mg/dL of reference glucose values >100 mg/dL or ≤100 mg/dL, respectively (% 15/15, % 20/20, % 30/30). Clinical reliability was assessed with Clarke error grid (CEG) analyses. Prospective longitudinal study with data analysed from 40 children. The overall MARD between reference glucose and paired CGM values (n=4,928) was 13.0% (Dexcom G5 12.8%, Dexcom G6 13.1%). The proportion of readings meeting %15/15 and %20/20 were 77.3% and 86.4%, respectively, with CEG analysis demonstrating 97.4% of all values in zones A and B. Within the hypoglycaemia range (<70 mg/dL), the median ARD was 11.4% with a sensitivity and specificity of 64.2% and 91.3%, respectively. Overall PedsQL child report at baseline and endpoint were 57.6 (50.5 - 75.8) and 87.0 (82.9 - 91.2), and for parents were 60.3 (44.8 - 66.0) and 85.3 (83.7 - 91.3), respectively (both p<0.001). Use of CGM for children with HH is feasible, with clinically acceptable accuracy, particularly in the hypoglycaemic range. Quality of life measures demonstrate significant improvement after CGM use. These data are important to explore use of CGM in disease indications, including neonatal and paediatric diabetes, cystic fibrosis and glycogen storage disorders.

Minimum Sampling Duration for Continuous Glucose Monitoring Metrics to Achieve Representative Glycemic Outcomes in Suboptimal Continuous Glucose Monitor Use.

Two weeks of continuous glucose monitoring (CGM) sampling with >70% CGM use is recommended to accurately reflect 90 days of glycemic metrics. However, minimum sampling duration for CGM use <70% is not well studied. We investigated the minimum duration of CGM sampling required for each CGM metric to achieve representative glycemic outcomes for <70% CGM use over 90 days. Ninety days of CGM data were collected in 336 real-life CGM users with type 1 diabetes. CGM data were grouped in 5% increments of CGM use (45%-95%) over 90 days. For each CGM metric and each CGM use category, the correlation between the summary statistic calculated using each sampling period and all 90 days of data was determined using the squared value of the Spearmen correlation coefficient (R2). For CGM use 45% to 95% over 90 days, minimum sampling period is 14 days for mean glucose, time in range (70-180 mg/dL), time >180 mg/dL, and time >250 mg/dL; 28 days for coefficient of variation, and 35 days for time <54 mg/dL. For time <70 mg/dL, 28 days is sufficient between 45 and 80% CGM use, while 21 days is required >80% CGM use. We defined minimum sampling durations for all CGM metrics in suboptimal CGM use. CGM sampling of at least 14 days is required for >45% CGM use over 90 days to sufficiently reflect most of the CGM metrics. Assessment of hypoglycemia and coefficient of variation require a longer sampling period regardless of CGM use duration.

Expected Basal Insulin Requirement during CSII therapy by Age Group, Sex and BMI, based on 25,718 Young People with Type 1 Diabetes in the DPV Registry.

Background Since the introduction of insulin pumps into the therapy of paediatric subjects, different approaches have been taken to find optimal basal rates. Previously, the DPV registry provided circadian basal rate patterns for different age groups. As the number of pump users has increased recently and short-acting insulin analogues are now predominant, we performed a new analysis with a larger data pool. Methods We included all recent basal profiles from T1D patients between 1 and 25 years from the DPV 2021 data pool. We excluded night-time-only pump users, human regular insulin users, and daily basal rates < 0.05 U/kgBW/d and >1.0 U/kgBW/d. Results In the analysis of profiles from 25,718 young persons with T1D, differences in the daily pattern of basal rates were found between age groups. In addition, we saw significant (p<0.001) differences in total daily basal dose between genders in all age groups except adults. In addition, the shape of the expected basal-rate pattern differed by BMI, HbA1c and use of continuous glucose monitoring. Discussion This analysis demonstrates multiple factors influencing basal patterns and insulin requirement, including age group, gender, overweight, HbA1c, bolus frequency and sensor use. As circadian basal rates are still mandatory for initiating insulin pump therapy with or without automation, a multimodal approach is necessary to estimate optimal basal rates.

Adolescent- and Young Adult-Reported Outcomes and Use of Continuous Glucose Monitoring Features: A Report from the CITY Trial

Objective. To evaluate patterns of continuous glucose monitor (CGM) use and perceptions of quality of life in adolescents/young adults with type 1 diabetes (T1D) after using CGM for up to 52 weeks in the CGM Intervention in Teens and Young (CITY) Adults randomized clinical trial (RCT). Subjects and Methods. Participants with T1D were initially randomized 1 : 1 to use of CGM or blood glucose meter (BGM) for 26 weeks. Following the RCT, participants in the BGM group initiated CGM (BGM–CGM cohort) and participants in the CGM group continued CGM (CGM–CGM cohort) for another 26 weeks. Problem Areas in Diabetes Survey-Pediatric Version (PAID-peds), Glucose Monitoring Satisfaction Survey (GMSS), Hypoglycemia Confidence Scale (HCS), Diabetes Technology Attitudes (DTA), Pittsburgh Sleep Quality Index (PSQI), Benefits of CGM, and Burdens of CGM were completed at baseline, 26 and 52 weeks. Results. In both cohorts, &gt;70% of participants were wearing CGM &gt; 5 days/week at 52 weeks; 5% discontinued CGM. The majority used the mobile app to receive glucose data. Adolescents (14 to &lt;19 years) were more likely to use SHARE features than young adults (80% versus 41%). CGM–CGM participants had significantly higher scores on GMSS, DTA, and HCS at 52 weeks compared with baseline, and reported higher benefit and lower burden perceptions than at baseline. Similar results were observed for the BGM–CGM cohort. Conclusions. Improvements in self-reported measures were observed in adolescents and young adults using CGM. As CGM use is also associated with better glycemic control, utilizing CGM may contribute to improving both medical outcomes and emotional health.

Demographic Variables Associated With Diabetes Technology Awareness or Use in Adults With Type 2 Diabetes.

Studies in populations with type 1 diabetes highlight racial/ethnic disparities in the use of diabetes technology; however, little is known about disparities among those with type 2 diabetes. This project investigates the racial/ethnic and socioeconomic disparities in diabetes technology awareness and use in adults with type 2 diabetes in the ambulatory setting. Adults ≥40 years of age with type 2 diabetes in ambulatory care were invited to participate via an e-mail link to a de-identified REDCap (Research Electronic Data Capture) questionnaire. Variables, including awareness and use of continuous glucose monitoring (CGM) and insulin pumps, were summarized descriptively using frequencies and percentages and were compared across racial/ethnic groups, education level, and income using Pearson χ2 or Fisher exact tests. The study included 116 participants, most of whom (62%) were White, elderly Medicare recipients. Compared with White participants, those of racially/ethnically minoritized groups were less likely to be aware of CGM (P = 0.013) or insulin pumps (P = 0.001). Participants with a high school education or less were also less likely to be aware of insulin pumps (P = 0.041). Interestingly, neither awareness nor use of CGM or insulin pumps was found to be associated with income. This cross-sectional analysis suggests that racially/ethnically minoritized groups and individuals with lower education have less awareness of CGM or insulin pumps.

Use of continuous glucose monitoring in pediatric gastroenterology allows for personalized nutrition support care – Potential for collaboration between pediatric endocrinologists and gastroenterologists

Continuous glucose monitoring (CGM) devices have been approved for the management of patients with diabetes mellitus. Some of the brands available almost completely eliminate the need for finger pricks. We aim to describe our experience with the use of CGM in two patients followed in the gastroenterology clinic due to diseases associated with hypoglycemia and how the information obtained from the devices improved care and outcomes. Data were continuously reviewed through the CGM device remote monitoring system and influenced clinical decisions related to nutrition support. CGMs are now part of standard care for patients with diabetes mellitus. The benefits of these devices and how they can improve the care of patients with disorders typically managed by the gastroenterologist need to be explored. In particular, patients with glycogen storage disorders, fatty acid oxidation defects, and ketotic hypoglycemia can benefit from GCM utilization, allowing for optimal and personalized nutritional care.

Parental diabetes distress is a stronger predictor of child HbA1c than diabetes device use in school-age children with type 1 diabetes

IntroductionDiabetes distress (DD) describes the unrelenting emotional and behavioral challenges of living with, and caring for someone living with, type 1 diabetes (T1D). We investigated associations between parent-reported and child-reported...

Legal issues of the use of continuous glucose monitoring in children with type 1 diabetes

Continuous glucose monitoring is an effective method of monitoring glycaemia, allowing to achieve optimal glycemic control and reduce the risk of complications of type 1 diabetes mellitus in children. After the approval of the new «Standard of medical care for children with type 1 diabetes (diagnosis and treatment)» (registered with the Ministry of Justice of Russia on 02/18/2021 No. 62543), hundreds of lawsuits were initiated in many regions of the country against regional public authorities in the field of healthcare and medical organizations demanding free supply of systems for continuous monitoring of blood glucose levels and/or sensors to them. This article analyzes the current legislation regarding the validity of the claims for free supply of disabled children with type 1 diabetes with continuous glucose monitoring.

Evaluating the Clinical Effect of Personal Continuous Glucose Monitoring in a Diverse Population With Type 2 Diabetes.

Objective: To determine the clinical effect of personal continuous glucose monitoring (CGM) in a diverse population with type 2 diabetes (T2D). Research Design and Methods: A report was created from the electronic health record identifying adults prescribed CGM at an urban family medicine clinic between January 1, 2019, and February 23, 2022. An "index date" was identified as the start of CGM. The closest hemoglobin A1c (A1c) 6 months or more after the index date was identified as the "follow-up date." The primary outcome of this study was to compare the percentage of individuals meeting the MN Community Measure (MNCM) D5 HbA1c goal of <8% at the follow-up date versus the index date. Results: Seventy-two patients were identified after the exclusion criteria were applied. Approximately one-third of patients required utilization of an interpreter and 76% of patients were of a racial or ethnic minority. The mean HbA1c prior to CGM use was 9.8%, with 16.7% of the population meeting the MNCM D5 A1c goal of <8%. At the follow-up date, the mean A1c was 8.4% (mean difference -1.4%; p < 0.001), with 41.7% of the population meeting goal (mean difference +25%; p < 0.001). Subgroup analyses affirm that the results of the primary outcome were sustained despite insulin use status. Conclusion: A diverse population with T2D had a significant reduction in A1c and was more likely to meet the MNCM D5 A1c goal of <8% after an average of 6 months using personal CGM.

Progress and indication for use of continuous glucose monitoring in patients with diabetes in pregnancy: a review.

Gestational diabetes mellitus is one of the most common endocrine diseases that occur during pregnancy. Disorders of blood glucose metabolism during pregnancy can increase the risk of adverse pregnancy outcomes, such as pregnancy-related hypertension, preeclampsia, eclampsia, miscarriage, macrosomia, and neonatal hypoglycemia. Continuous glucose monitoring (CGM) can safely and effectively monitor blood glucose changes in patients with gestational hyperglycemia, thereby reducing adverse pregnancy outcomes. Hence, this article aimed to provide a comprehensive review of the progress and indications for using CGM in pregnant patients with diabetes. CGM can reduce blood glucose fluctuations and the occurrence of serious hypoglycemia and hyperglycemia events and can provide time in range (TIR). TIR is an important indicator of blood glucose level. Patients with a higher TIR during pregnancy have better gestational outcomes.