Daily Diabetes Management Research Articles

Transitioning from Self-Monitoring of Blood Glucose to Continuous Glucose Monitoring in Combination with a mHealth App Improves Glycemic Control in People with Type 1 and Type 2 Diabetes.

Introduction: Integrating mobile health (mHealth) apps into daily diabetes management allows users to monitor and track their health data, creating a comprehensive system for managing daily diabetes activities and generating valuable real-world data. This analysis investigates the impact of transitioning from traditional self-monitoring of blood glucose (SMBG) to real-time continuous glucose monitoring (rtCGM), alongside the use of a mHealth app, on users' glycemic control. Methods: Data were collected from 1271 diabetes type 1 and type 2 users of the mySugr® app who made a minimum of 50 SMBG logs 1 month before transitioning to rtCGM and then used rtCGM for at least 6 months. The mean and coefficient of variation of glucose, along with the proportions of glycemic measurements in and out of range, were compared between baseline and 1, 2, 3, and 6 months of rtCGM use. A mixed-effects linear regression model was built to quantify the specific effects of transitioning to a rtCGM sensor in different subsamples. A novel validation analysis ensured that the aggregated metrics from SMBG and rtCGM were comparable. Results: Transitioning to a rtCGM sensor significantly improved glycemic control in the entire cohort, particularly among new users of the mySugr app. Additionally, the sustainability of the change in glucose in the entire cohort was confirmed throughout the observation period. People with type 1 and type 2 diabetes exhibited distinct variations, with type 1 experiencing a greater reduction in glycemic variance, while type 2 displayed a relatively larger decrease in monthly averages.

Feeding and Eating Disorders in Young People with Type 1 Diabetes: A Systematic Review

Eating disorders (ED) are a growing concern among young individuals with type 1 diabetes (T1D), with a prevalence significantly higher than that observed in the general adolescent population. Studies indicate that adolescents with diabetes are 2 to 3 times more likely to develop ED compared to their non-diabetic peers. This increased prevalence is partly attributed to several risk factors unique to this population. Adolescence itself is a major risk factor for ED, characterized by hormonal fluctuations, rising concerns about body image, and experimental eating behaviors. However, for young people with T1D, these risks are exacerbated by additional challenges. Daily diabetes management, which involves rigorous monitoring of blood glucose levels and precise control of dietary intake, can contribute to increased stress and excessive preoccupation with weight and body shape. Furthermore, social expectations and pressures related to glycemic control can reinforce problematic eating behaviors. ED in young diabetics can have severe consequences on diabetes management and overall health. Restrictive eating or purging behaviors can lead to glycemic imbalances, poor diabetes control, and increased risk of associated complications. This can also worsen psychological difficulties, such as anxiety and depression, thereby amplifying the cycle of deteriorating mental and physical health. Effective management of ED in young diabetics requires a multidisciplinary approach. It is crucial to integrate interventions that address not only nutritional and psychological aspects but also the specific challenges related to managing T1D. Early detection and treatment of ED can improve clinical outcomes and promote a better balance between diabetes management and the mental health of patients.

Unveiling the interplay between rational, psychological and functional factors in continuous glucose monitoring early adoption: Novel evidence from the Dexcom ONE case in Italy

BackgroundThe escalating prevalence of diabetes, with its multifaceted complications, poses a pressing challenge for healthcare systems globally. In response, the advent of continuous glucose monitoring (CGM) systems, offering technological solutions for daily diabetes management, presents significant opportunities. However, the widespread adoption faces several barriers, linked both to the technological configuration of the devices and to the psychological dimension of patients. Therefore, this study aims to apply and test a theoretical model that investigates the antecedents of the intention to use Continuous Glucose Monitoring systems.MethodsThe research model was built to unveil the impacts of psychological factors, functional components and rational constructs derived from the Technology Acceptance Model (TAM) on CGM systems sustained adoption. To ensure the comparability of results, we have collected data from people who had used Dexcom ONE Dexcom (San Diego, CA) for the first time for at least one month. Employing Structural Equation Modelling (SEM) techniques, the hypothesized relationships among constructs were assessed.ResultsThe analyses confirmed the positive correlation of rational factors to the Intention to Use. Subjective Norm, intended as the physicians’ influence, is positively correlated with the Perceived Usefulness. Trend Arrows, albeit being negatively correlated with Perceived Usefulness, have a positive correlation on Perceived Ease Of Use, reinforcing its mediating effect towards Perceived Usefulness. Among psychological factors, Trust in the CGM technology positively correlates with Intention to Use. Health Literacy is negatively correlated to the Intention to Use.ConclusionsThese findings contribute to theoretical and managerial understanding, providing recommendations to enhance the adoption of CGM systems like Dexcom ONE.

Disordered eating in adolescents with type 1 diabetes: risk factors and screening recommendations.

Adolescents with Type 1 diabetes (T1D) are at significantly greater risk for disordered eating behaviors compared to their peers without T1D. Given that this is a dangerous and potentially lethal combination, this review aims to support pediatric medical providers in increasing competence in identification, assessment, and prevention of disordered eating behaviors in adolescents with T1D. This review provides an up-to-date synthesis of unique risk factors for disordered eating behaviors in adolescents with T1D, including the daily diabetes management tasks, effects of insulin on weight and hunger, family conflict, and reinforcement from their environment for disordered behaviors. This review recommends two brief screening tools, the Diabetes Eating Problems Survey-Revised (DEPS-R) and Modified SCOFF (mSCOFF), to be used in busy practices; it also provides practical strategies for providersto use with patients in the form of effective, nonjudgmental language. A clear understanding of unique experiences impacting adolescents with T1D may increase use of evidence-based screening tools and identification of disordered eating behaviors among a high-risk population in clinic/practice. In addition, providers' intentional use of nonjudgmental and de-stigmatizing language may lead to more positive interactions for adolescents and willingness to engage in further treatment.

Separable Microneedle for Integrated Hyperglycemia Sensing and Photothermal Responsive Metformin Release.

Microdevices that offer hyperglycemia monitoring and controllable drug delivery are urgently needed for daily diabetes management. Herein, a theranostic separable double-layer microneedle (DLMN) patch consisting of a swellable GelMA supporting base layer for glycemia sensing and a phase-change material (PCM) arrowhead layer for hyperglycemia regulation has been fabricated. The Cu-TCPP(Fe)/glucose oxidase composite and 3,3',5,5'-tetramethylbenzidine coembedded in the supporting base layer permit a visible color shift at the base surface in the presence of glucose via a cascade reaction, allowing for the in situ detection of glucose in interstitial fluid. The PCM arrowhead layer is encapsulated with water monodispersity melanin nanoparticles from Sepia officinalis and metformin that is imparted with a near-infrared ray photothermal response feature, which is beneficial to the controllable release of metformin for suppression of hyperglycemia. By applying the DLMN patch to the streptozotocin-induced type 2 diabetic Sprague-Dawley rat model, the results demonstrated that it can effectively extract dermal interstitial fluid, read out glucose levels, and regulate hyperglycemia. This DLMN-integrated portable colorimetric sensor and self-regulated glucose level hold great promise for daily diabetes management.

Virtual Laboratories for Diabetes Education on Artificial Pancreas

A crucial aspect of diabetes management is the comprehensive education of clinical staff, patients, and caretakers. The introduction of advanced technologies in artificial pancreas devices heightens this need, as patients must learn to manage their condition and navigate the evolving technological components of their treatment. A series of self-guided virtual laboratories has been developed to aid this process. These laboratories are designed to introduce diabetes management agents to the control engineering concepts used in artificial pancreas systems, as well as to the fundamental clinical and physiological aspects of daily diabetes management.

Power and Sensitivity Management of Carbon Nanotube Transistor Glucose Biosensors.

Continuous glucose monitoring (CGM), which is significant for the daily management of diabetes, requires a low-power-consumption sensor system that can track low nanomolar levels of glucose in physiological fluids, such as sweat and tears. However, traditional electrochemical methods are limited to analytes in micromolar to millimolar ranges and entail high power consumption. Carbon nanotube (CNT) film field-effect transistors (FETs) are promising for constructing extremely sensitive biosensors, but their wide applications in CGM are limited by the strong screening effect of physiological fluids and the zero charge of glucose molecules. In this study, we demonstrate a glucose aptamer-modified CNT FET biosensor to realize a highly sensitive CGM system with sub-nW power consumption by applying a suitable gate voltage. A positive gate voltage can enlarge the effective Debye screening length at the double layer to reduce the local ion population nearby and then improve the sensitivity of the FET-based biosensors by 5 times. We construct CNT FET sensors for CGM with a limit of detection of 0.5 fM, a record dynamic range up to 109, and a power consumption down to ∼100 pW. The proposed field-modulated sensing performance scheme is applicable to other aptamer-based FET biosensors for detecting neutral or less charged molecules and opens opportunities to develop facilely modulated, highly sensitive, low-power, and noninvasive CGM systems.

1100-P: Real-World Use of GLP-1 Agonists in Youth with Type 2 Diabetes Is Associated with Improvements in Hemoglobin A1c—A Multicenter Analysis

Background: Despite the high risk of diabetes complications at an early age in youth with type 2 diabetes (T2D), there are limited pharmacologic options to manage T2D in youth. The first Glucagon-like-peptide-1 agonist (GLP-1a) was approved for pediatric T2D treatment in 2019. However, little is known on the real-world use and effectiveness of GLP-1a for management of T2D in the pediatric population. Objectives: To assess the real-world use and effectiveness of GLP-1a (exenatide, dulaglutide, liraglutide, semaglutide) in managing T2D in a diverse cohort of youth. Methods: This multicenter retrospective analysis included adolescents and young adults (ages 11-25y) from two academic pediatric diabetes centers who were prescribed a GLP-1a for management of T2D. Patient HbA1c, weight, and BMI within 12 months of follow-up after GLP-1a prescription were compared to baseline using Signed Rank tests. Secondary outcomes included insulin and metformin use after GLP-1a initiation and were compared using McNemar's test. Results: A total of 153 patients (median age 16.1 years (IQR 13.9-17.8), 57% female, 59% non-Hispanic Black, 23% Hispanic or Latino, 76% with public insurance) were prescribed GLP-1a and 36 patients discontinued the GLP-1a. At a median follow-up of 8.2 months, 117 patients were taking GLP-1a and were included in pre-post analyses. From baseline to follow-up, HbA1c decreased from 8.3% to 7.5% (p<0.007), while weight and BMI remained stable. At baseline, 48% of patients were taking prandial insulin, compared to 36% at follow-up (p=0.001), 71% were taking basal insulin compared to 62% at follow-up (p = 0.025), and 85% were prescribed metformin at baseline compared to 74% at follow-up (p=0.005). Conclusion: Real-world use of GLP-1a in youth with T2D is associated with decreased HbA1c levels. GLP-1a treatment may reduce doses of insulin and other medications for diabetes in youth, which can mitigate the burden of daily diabetes management. Disclosure S.Samuels: None. A.Chajecki: None. P.Hu: None. M.Kayser: None. K.Weyman: None. B.Pan: None. E.A.Brown: None. M.A.Van name: Research Support; Provention Bio, Inc. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. Funding American Diabetes Association (7-22-JDFN-03 to S.S.); National Institutes of Health (R01DK134955)

Sex differences in cardiovascular risk, lifestyle, and psychological factors in patients with type 2 diabetes: the Fukuoka Diabetes Registry

BackgroundThe excess risk of cardiovascular diseases associated with diabetes is greater in women than in men. The present study aimed to examine sex differences in the control of cardiovascular risk factors, as well as lifestyle and psychological factors, in patients with type 2 diabetes.MethodsA total of 4923 Japanese patients with type 2 diabetes were included in this cross-sectional study. Female/male differences in cardiovascular risk factor levels, and corresponding odds ratios for achieving recommended ranges for preventing cardiovascular diseases and having unhealthy lifestyle and psychological factors were computed by linear and logistic regression models.ResultsWomen were less likely than men to achieve recommended ranges for glycated hemoglobin, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and obesity-related anthropometric indices such as body mass index and waist circumference, but were more likely than men to be on target for high-density lipoprotein cholesterol and triglycerides. Women were also more likely than men to have an unhealthy lifestyle and psychological factors, including less dietary fiber intake, less leisure-time physical activity, shorter sleep duration, more constipation, and more depressive symptoms. Similar findings were observed when the participants were subgrouped by age (< 65 and ≥ 65 years) and past history of cardiovascular disease.ConclusionsWe observed significant sex differences for a range of cardiovascular risk factors, as well as lifestyle and psychological factors, suggesting the importance of adopting a sex-specific approach for the daily clinical management of diabetes.

Current Trends and Strategies for Exercise in Diabetes.

From Research to Practice| May 15 2023 Current Trends and Strategies for Exercise in Diabetes Susana R. Patton 0000-0002-8902-6965 ; Susana R. Patton Diabetes Spectrum Associate Editor Search for other works by this author on: This Site PubMed Google Scholar Michael C. Riddell 0000-0001-6556-7559 Michael C. Riddell Guest Editor Corresponding author: Michael C. Riddell, mriddell@yorku.ca Search for other works by this author on: This Site PubMed Google Scholar Corresponding author: Michael C. Riddell, mriddell@yorku.ca Diabetes Spectr 2023;36(2):100–103 https://doi.org/10.2337/dsi22-0019 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Citation Susana R. Patton, Michael C. Riddell; Current Trends and Strategies for Exercise in Diabetes. Diabetes Spectr 1 May 2023; 36 (2): 100–103. https://doi.org/10.2337/dsi22-0019 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsDiabetes Spectrum Search Advanced Search Regular physical activity, which includes structured sessions of exercise for fitness, health, and/or enjoyment, plays an important role in the daily management of diabetes (1,2). Regular sessions of moderate-to-vigorous physical activity (MVPA) and the avoidance of prolonged sitting time are regarded as one of the Association of Diabetes Care & Education Specialists’ ADCES7 self-care behaviors for optimal diabetes self-management—specifically “being active” (3). The World Health Organization (WHO) defines “physical activity” as any physical movement supported by skeletal muscles that increases energy use (4). This can include activities performed as part of leisure time, traveling, or an individual’s job. By contrast, “exercise” represents a subset of physical activity. All forms of physical activity count toward the American Diabetes Association (ADA) and WHO goal of at least 150 minutes of MVPA per week (2,4). Regular physical activity and exercise yield... You do not currently have access to this content.

Virtual Clinics for Diabetes Care.

Virtual Clinics for Diabetes Care.

Global diabetes burden: analysis of regional differences to improve diabetes care

IntroductionThe current evaluation processes of the burden of diabetes are incomplete and subject to bias. This study aimed to identify regional differences in the diabetes burden on a universal level...

Age and sex-specific associations of visit-to-visit variability of glycated hemoglobin A1c with all-cause mortality in patients with diabetes.

Background:Visit-to-visit variability (VVV) of glycated hemoglobin (HbA1c) levels have been found to be associated with prognosis of diabetes. However, little is known about whether or to what extent sex and age may modify the effects of VVV.Methods:To investigate age- and sex-specific rates of mortality from all causes and relative hazards of mortality in association with VVV of HbA1c levels, 47,145 patients with diabetes and prescription of any antidiabetic agents >6 months were identified from outpatient visits of a tertiary medical center in northern Taiwan during 2003–2018. VVV of HbA1c was measured by quartiles of standard deviation (SD), coefficient of variation (CV), and average real variability (ARV), respectively. The study subjects were linked to Taiwan’s National Death Registry to identify all-cause mortality. The person-year approach with the Poisson assumption was used to assess the all-cause mortality rates, and Cox proportional hazard regression model was used to evaluate the relative hazards of all-cause mortality concerning various levels of VVV of HbA1c.Results:The lowest all-cause mortality rate was found in either the first or second quartile of various measures for VVV of HbA1c, but the highest mortality rate was consistently observed in the fourth quartile of VVV, regardless of SD, CV, or ARV across ages and sexes. Increased hazards of overall all-cause mortality were noticed from the second to fourth quartile of VVV of HbA1c. In detailed age- and sex-stratified analyses, elevated risk of mortality was seen in the fourth quartile of those aged <50 years while in those aged >69 years, increased risk of mortality was noticed in the third and fourth quartiles of any VVV of HbA1c irrespective of sex. In those aged 50–69 years, incremental increased hazards of mortality were consistently observed in the second to fourth quartiles of VVV of HbA1c.Conclusion:HbA1c variability whether it was SD, CV, or ARV could strongly predict the risks of all-cause mortality. The extent of the relationship between VVV of HbA1c and all-cause mortality in different age groups was comparable between both sexes. Given the importance of long-term glucose fluctuation, the inclusion of HbA1c variability calculated from the standardized method should be considered by clinical guideline policymakers as part of the biochemical panel in daily diabetes management.

Momentary Partner Involvement in Diabetes Self-Care and Continuously Measured Glucose: A Dynamic Analysis.

This study examined the dynamic, real-time associations between partner involvement in diabetes self-care and continuous glucose monitor (CGM) metrics in adults with type 2 diabetes. For 1 week, 63 participants wore Dexcom G4 CGMs and provided momentary reports of partner involvement in diabetes self-care five times per day. Dynamic structural equation models were used to estimate the reciprocal lagged effects of partner involvement on next-hour CGM metrics (and vice versa). Partner involvement predicted improved next-hour glucose control for five of six CGM metrics in analyses adjusted for time-varying covariates. The hour after partner involvement, the model predicted a 26.34 mg/dl decrease in glucose level (standardized β = -0.19), 30% greater odds of meeting target time in target range ( β = 0.07), 48% higher odds of target time below target range (TBR; β = 0.04; the only nonsignificant effect), 47% greater odds of target time above target range (β = 0.11), a 4.20 unit decrease in glucose standard deviation ( β = -0.19), and a 0.01 unit decrease in glucose coefficient of variation ( β = -0.08; all p values < .05). There was less consistent support for the reverse pathway, with only two metrics significantly related to next-hour partner involvement: glucose level ( β = 0.15) and TBR ( β = 0.21), such that having higher levels and meeting target TBR were significantly predictive of next-hour partner involvement. This is the first study showing that partner involvement in daily diabetes management predicts short-term glucose control. More research is needed to understand how partners influence glycemic control and evaluate interventions that promote their involvement in diabetes care.

ASSESSMENT OF PSYCHOSOCIAL CONSEQUENCES OF COVID-19 IN DIABETES PATIENTS: A CROSS-SECTIONAL STUDY

Objective: The aim of the study was to assess the psychosocial health, to identify coronavirus disease 2019 (COVID-19) specific concerns in people with diabetes and to analyze the changes in the management of diabetes during the corona crisis. Methods: An online cross-sectional survey was conducted for a period of 6 months among the South Indian diabetes population. A validated questionnaire containing socio-demographics, general health status, the diabetes distress scale 17, and the 3-itemUCLA loneliness scale was sent to 600 people, out of which 226 participants were included in the study based on inclusion and exclusion criteria. Responses were analyzed using univariate and multivariate logistic regressions. Results: Among the participants, females had moderate to high diabetes distress (54.4%). The subjects in the age group of 40–59 years felt lonely and had more diabetes distress. The two major worries among the participants were that “they are labeled as a risk group” and that “they might be overly affected.” Participants with gestational diabetes mellitus (DM), DM duration of 7 months to 1 year, taking both medications (oral antidiabetic medication and insulin), HbA1c level of more than 8%, infected with coronavirus or having someone close to them infected with coronavirus, were more concerned about taking medication daily, and those who changed their meal plan during the corona period had the greatest concerns. Conclusion: People who participated in the survey were more worried about the COVID-19 situation and were very disturbed. Psychosocial consequences of COVID-19 were more prevalent in diabetes patients, including diabetes distress, loneliness, and changes in daily diabetes management.

Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70–180 mg/dL (3.9–10 mmol/L) increased across 19/27 cohorts with a median 3.3% (− 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.

Improved Methods for Mid-Term Blood Glucose Level Prediction Using Dietary and Insulin Logs.

Background and Objectives: The daily lifestyle management of diabetes requires accurate predictions of the blood glucose level between meals. The objective of this study was to improve the accuracy achieved by previous work, especially on the mid-term, i.e., 120 to 180 min prediction horizons, for insulin-dependent patients. Materials and Methods: An absorption model-based method is proposed to train an artificial neural network with the bolus and basal insulin dosing and timing, the baseline blood glucose level, the maximal glucose infusion rate, and the total carbohydrate content as parameters. The approach was implemented in various algorithmic setups, and it was validated on data from a small-scale clinical trial with continuous glucose monitoring. Results: Root mean square error results for the mid-term horizons are 1.72 mmol/L (120 min) and 1.95 mmol/L (180 min). The accuracy of the proposed model measured on the clinical data is better than the accuracy reported by any other currently available and comparable models. Conclusions: A relatively short (ca. two weeks) training sample of a continuous glucose monitor and dietary/insulin log is sufficient to provide accurate predictions. For the outpatient application in practice, a hybrid model is proposed that combines the present mid-term method with the authors’ previous work for short-term predictions.

509-P: Type 1 Diabetes Management and the Impact on Caregiver Quality of Life

After a child’s type 1 diabetes diagnosis, significant demands may be placed on the family. Families are thrust into a new routine focused on daily diabetes management that include continuous monitoring of their child’s blood glucose levels, nutritional needs, activity and sleep patterns, stress and emotional responses, and medication administration, among others. Additionally, the caregivers become inundated with time and financial strain for travel for new medical appointments, management of healthcare insurance policies, and medical bills, causing some caregivers to cease employment or secure a job that allows for increased time flexibility. The purpose of this mixed methods study was to examine how caring for a child living with type 1 diabetes impacts caregiver quality of life, burden, and roles. Through convenience sampling, caregivers (n=43) completed an electronic demographic survey, Burden Scale for Family Caregivers, WHOQoL, followed by an individual phenomenological interview (n=6). The majority of caregivers reported moderate burden (48%) or severe to very severe burden (20%). A significant large negative correlation was found between caregiver burden and quality of life (r = -0.73, p&amp;lt;0.01), indicating that as burden increased, quality of life decreased. Interview findings revealed three themes: relationship maintenance difficulties lead to decreased social support; declining productive occupations; and a strong desire for education and advocacy. Due to caregivers reporting difficulty with maintaining their own health and well-being while caring for a child living with type 1 diabetes, it is imperative for interprofessional diabetes health care teams to develop novel interventions aimed to improve family quality of life. Disclosure V. D. Jewell: Research Support; Self; Dexcom, Inc.

Telehealth in type 1 diabetes.

The role of telehealth in the care of people with type 1 diabetes (T1D) has expanded dramatically during the coronavirus pandemic, and is expected to remain a major care delivery modality going forward. This review explores the landscape of recent evidence for telehealth in T1D care. Telemedicine for routine T1D care has shown equivalence to standard in-person care, with respect to glycemic control, while also increasing access, convenience, and satisfaction. Telehealth use promotes increased engagement of adolescents with T1D. Telehealth platforms have successfully been used in the care of microvascular complications and to support mental health related to diabetes. Machine learning and advanced decision support will increasingly be used to augment T1D care, as recent evidence suggests increasing capabilities to improve glycemic control. A spectrum of digital connected care services are emerging to support people with diabetes with daily management of diabetes. Finally, policy and systems are required that promote data interoperability, telemedicine provision, and reimbursement to support the ongoing growth of telehealth in T1D. A developing field of evidence supports use of telehealth in T1D. As this care modality scales, it has the potential to increase access to high-quality diabetes care for many people with T1D.

AGP in daily clinical practice: a guide for use with the FreeStyle Libre flash glucose monitoring system

As real-time continuous glucose monitoring and flash glucose monitoring systems become more widely prescribed in the daily management of diabetes, it is important that the ambulatory glucose profile (AGP) methodology for reviewing and interpreting trends in glucose control is effectively applied. In this article we look at the essential features of the AGP and provide systematic and practical guidance on how the AGP can be interpreted in daily diabetes care with confidence. Using examples taken from glucose data captured by the FreeStyle Libre flash glucose monitoring system, we show how each aspect of the AGP can be used to understand daily patterns in glucose control for a person with diabetes, including the importance of time in range and adjunct use of individual daily logs. Using these elements collectively, we show how and why treatment adjustments can be made, with the goal of improving glycaemic control and diabetes outcomes.