Diabetes Team Research Articles

Diabetes Education In Children With Type 1 Diabetes and Their Families

Tip 1 diyabetli çocuk ve gençlerin sağlıklı bir birey olarak yaşamını sürdürmesi, diyabetli bireyin merkezi rol oynadığı, multidisipliner çocuk diyabet ekibi tarafından verilen diyabet eğitimine bağlıdır. Başarılı eğitim ile Tip 1 diyabetli bireyler ve aileleri problem çözebilmelidir. Kan şekerlerini kendi kendine yönetebilmelidir. Bilgi ve pratik becerileri kullanma konusunda güçlenmeli, motive olmalıdır. Çocuk ve ailenin diyabet eğitimine başlanmadan önce; sağlık inanç ve tutumları, temel diyabet bilgisi, kültürel durumu, özyönetim becerileri, öğrenmeye hazır olma durumu, genel ve sağlık okuryazarlığı, öğrenme stili, yeteneği, mali durumu, aile ve sosyal destek gibi bileşenleri değerlendirilmelidir. Diyabet eğitimi, diyabetli tüm bireylere ve ailelerine ilk tanı anında başlanmalıdır. Düzenli bir şekilde, yaş ve gelişimsel özelliklerine uygun olarak verilmelidir. Yılda bir kez veya daha sıklıkla tekrar edilmelidir. Başarılı eğitim sadece bilgi vermekle kalmamalı, yaşam kalitesini de iyileştirmelidir. Tanı anından başlayarak yaşam boyu devam etmelidir. Çocuklar ve aileleri yaşamlarının tüm noktalarında bağımsız, güçlü, fiziksel ve ruhsal açıdan iyilik halinde olabilmelidirler.

795-P: Significance and Future Trends of AID Systems from the Perspective of Physicians

Aims: How do physicians assess AID-Systems in terms of their current and future importance for diabetes care? Methods: In 2021 3diabetologists in Germany (48% female, average age 53.7 years) were asked via online surveys about their current and future assessment of AID-Systems.The results were compared with the 20survey, in which 337 diabetologists (43% female, mean age 53.2 years) participated. Results: Currently, 58.6% (2020: 51.4%) of diabetologists consider AID-Systems to be important for diabetes care, in 5 years 89.3% (2020: 86.4%) . Diabetologists estimate that in approx. 9 years one in two PwD TD1 in Germany will be a user of an AID-System, and in approx. 17 years 90% will use an AID-System. Currently, they estimate that 57.6% of all PwD-TD1 are suitable for an AID-System. Diabetologists see the clearest impact of AID-Systems in an increased need for diabetes selfmangement education (78.9%) , but also in PwD becoming much more autonomous and empowered (62.8%) . Regarding possible negative effects of AID-Systems, diabetologists see only few risks: 20% fear that PWD will have less contact with the diabetes team, 16.9% are concerned that PWD will not be able to cope with the technological change. Only 7.9% fear that PWD will become riskier with AID-Systems, only 1.7% have fears that the diabetes team will become superfluous. Conclusions: Overall, diabetologists assess AID-Systems as a important innovation for diabetes care and that this will soon become the standard therapy for T1D. The effort for Diabetes self-management education and support is estimated to be relatively high, possible disadvantages relatively low. Disclosure L.Heinemann: Board Member; Lifecare, Inc., Consultant; Becton, Dickinson and Company, Roche Diabetes Care, Stock/Shareholder; Profil Institut für Stoffwechselforschung GmbH, Science Consulting in Diabetes GmbH. N.Hermanns: Advisory Panel; Abbott Diabetes, Research Support; Becton, Dickinson and Company, Roche Diagnostics, Speaker's Bureau; Berlin-Chemie AG, Novo Nordisk, Sanofi. D.Ehrmann: Advisory Panel; Dexcom, Inc., Consultant; mySugr, Roche Diabetes Care, Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Roos: None. B.Kulzer: Advisory Panel; Bayer AG, Bayer AG, Becton, Dickinson and Company, Becton, Dickinson and Company, Berlin-Chemie AG, Berlin-Chemie AG, Dexcom, Inc., Dexcom, Inc., Insulet Corporation, Novo Nordisk, Roche Diabetes Care, Sanofi, Sanofi-Aventis Deutschland GmbH, Research Support; Novo Nordisk, Roche Diabetes Care.

957-P: A Community–Academic Practice Partnership to Optimize Outcomes in High-Risk Underserved Patients with Diabetes

Background: The project aims to establish an interprofessional diabetes team within a Federally Qualified Health Center (FQHC) to increase patient access and improve the health of underserved patients with diabetes. Methods: The program is a community-academic practice partnership implemented in a FQHC in the Southeastern United States. The program utilizes an interprofessional diabetes care model (in-person and telehealth) with a nurse practitioner, pharmacist, population health specialist, certified medical assistant, dietician, and primary care team to provide comprehensive diabetes care focused on treatment optimization, self-management, and identification of medical and community resources. Results: A total of 175 patients were seen from November 2020 to October 2021. The median (IQR) A1C at baseline was 9.6% (8.4-11.5%) versus 8.6% (7.0-10.0%) at follow-up (p<0.001) . The median BMI decreased by 0.4 kg/m3. Improvements were noted in diabetes quality metrics (Table 1) . Patient, primary care provider, and student surveys demonstrate 100% satisfaction with the diabetes team. Conclusions: A community-academic practice partnership supports comprehensive diabetes management and improved health outcomes. Next steps include expansion of the program to additional practice sites and continued data analysis on patient outcomes, cost, and satisfaction. Disclosure T.O.Fowler: None. J.Sterrett: None. L.T.Collins: None. A.D.Poole: None. E.Weeda: None. R.A.Dubose-morris: None. K.Roever: None. Funding The Duke Endowment (6878-SP)

150-LB: Diabetes and School Health (DASH) Program—An Innovative School-Based Health Model to Optimize Care for Youth with Type 1 Diabetes

Objectives: Pediatric type 1 diabetes (T1D) care requires collaboration of families, diabetes team and caregivers. Youth spend most of the time in school so care optimization in school is crucial. There are no evidence-based guidelines for school-based care, and management varies based on local legislation, school district, and staffing. An innovative school-based program provides an opportunity to standardize care, improve outcomes, reduce inequities, and inform guidelines for school T1D care. Methods: The Nationwide Children's Hospital (NCH) Diabetes and School Health (DASH) program is a novel school-based intervention. The intradisciplinary DASH team provides on-site education to students/staff, addresses medical/psychosocial concerns, coordinates delivery of medications/supplies, and facilitates communication. The pilot aimed to enroll 50 students identified as high risk based on their Diabetes Composite Score, a risk assessment tool developed by NCH. Qualitative and quantitative data was obtained for students, caregivers, and staff, including A1C, acute care utilization, educational mastery, quality of life, psychosocial, and health equity measures. Results: 50 students over 35 schools enrolled in the pilot. The majority used injections, 50% never used a continuous glucose monitor, and the average baseline A1C was 12%. More than 60% identified as an ethnic minority. Survey data showed over 50% of students felt others did not appreciate the burden of T1D care and endorsed T1D "burn out." Over 50% of caregivers endorsed feeling defeated/discouraged by T1D care, and worry about T1D related complications. Conclusions: DASH is a novel school-based program that provides support, education, and oversight to students at high risk of T1D complications. The program aims to standardize school-based care, empower school staff, improve self-efficacy, address inequities, decrease T1D complications and provide a framework for school based care. Disclosure A. C. H. Wood: None. A. M. Moffett: None. K. Simms: None. M. Moore: None. E. Suli: None. M. K. Irwin: None. E. Edwards: None. K. Gandhi: None.

1032-P: Improving CGM Uptake in Minority Youth and Youth with Poorly Controlled T1D

Background: Continuous glucose monitoring (CGM) improves glycemic control for youth with type 1 diabetes (T1D) . Despite these benefits, less than half of youth with T1D use CGM. Objective: To determine if trial CGM use (10-days) increases CGM uptake and is associated with improved glycemic control among minority youth and youth with poorly controlled T1D. We also examined barriers to CGM use. Methods: This prospective study was conducted at an academic Pediatric Diabetes Center. Youth with T1D for more than 3 months, with no previous CGM usage, or no CGM usage in the last year were enrolled. Diabetes staff placed CGM at the point of care (POC) and provided CGM education. Barriers to prior CGM use, hemoglobin A1c (HbA1c) , and demographic information were recorded. Participants received 5 and 10-day follow up calls from the diabetes team to review glycemic trends. At 3 months, participants' use of CGM and HbA1c were recorded. Results: Youth with T1D (n=22) were enrolled (13 first time CGM users, 9 past users) , mean age 14.1years (SD 3.1) , 41% non-Hispanic black, 68% female, mean diabetes duration 6.3 ± 4.4years, and baseline mean HbA1c of 10.8%. Patient-cited barriers to prior CGM use included technical difficulties (n=5) , unawareness of CGM (n=4) , difficulty obtaining CGM (n=4) , general apprehension (n=3) , not wanting devices (n=3) , and pain, fear of needles, and new diabetes diagnosis (n=1 each) . Of participants, 20 completed some follow-up, and 18/20 (90%) cited wanting to use CGM long-term. Of 13 participants who completed 3 and/or 6-month follow-up visits, only 9 were actively using CGM. Further barriers to use included insurance issues (n=2) and CGM falling off (n=1) . There was no change in mean HbA1c from baseline to follow-up (10.8 ±2.4% vs. 10.3 ±2.3%, p=0.46) . Conclusion: There are many barriers to CGM uptake in youth. Providing a trial use of CGM at the POC may increase uptake of CGM use in at-risk diabetes populations, but further investigation of additional barriers that impact long-term adherence to CGM is needed. Disclosure T.L.Lin: None. J.A.Manfredo: None. N.Illesca: None. K.Abiola: None. N.Hwang: None. M.Seel: None. E.A.Brown: None. R.M.Wolf: Consultant; NEMA Research, Research Support; Dexcom, Inc. Funding Johns Hopkins Children's Center Innovation Award, and Dexcom

Tackling diabetes as a team: co-designing healthcare interventions to engage couples living with type 1 diabetes

AimsCouples living with Type 1 diabetes: co-designing interventions to support them.MethodsThis is a qualitative study comprising two phases. Phase I represents the exploratory phase, consisting of semi-structured interviews with persons with Type 1 diabetes (N = 16) and partners (N = 6). In the second phase, co-design principles guided workshops with healthcare professionals, persons with Type 1 diabetes, and partners (N = 7) to facilitate discussion of the key themes identified and solutions to engage couples living with Type 1 diabetes in diabetes care.ResultThe key themes identified from phase I as priorities to target in future interventions were: (i) Emotional impact of diabetes and (ii) Partners’ involvement. Priority (i) captures the impact the emotional burden of diabetes management produces within couples’ relationship. Priority (ii) captures the request from partners to be more involved in diabetes management. Characteristics of the interventions suggested during the co-design phase II focused on engaging patients and partners via a counseling point in healthcare settings and tailored help for couples’ psychological support needs.ConclusionsCouples value pro-active intervention and support from their diabetes team or primary care for both the partners to live well with Type 1 diabetes.

The dangerous coexistence of type 1 diabetes and eating disorders: a call for action

Eating disorders are more common among adolescents with type 1 diabetes than in the general peer-group population. This coexistence is often associated with poor glycaemic control and an increased risk of developing severe medical complications. In turn, type 1 diabetes may contribute to the maintenance of eating-disorder psychopathology, and in some cases hinder its treatment. Unfortunately, eating disorders are often not detected by health professionals involved in the management of type 1 diabetes, with negative repercussions on the outcomes of the respective conditions. The increase in the incidence of eating disorders among adolescents during the COVID-19 pandemic, likely also in people with type 1 diabetes, highlights the need to allocate resources for training health professionals involved in the management of type 1 diabetes to detect the early signs of eating disorders with the help of new, specific screening tools. It is also necessary to improve the rapid referral of patients to clinical services that implement the evidence-based treatments recommended for eating disorders, which must work in close contact with the diabetes team. Finally, future research should focus on better identifying the factors that increase the risk of eating disorders in people with type 1 diabetes to prevent the onset of this dangerous, and often undetected, comorbidity.

IDF21-0054 Education on Correct Injection Practice: The Missing Link between Technology Advances and Optimal Diabetes Management

Background: The therapeutic availability of insulin in 1921 and its first use in humans in 1922 changed the course of type 1 diabetes from a death sentence into a manageable condition, making it one of the most outstanding achievements of medical sciences to this day. In the centenary of insulin’s discovery, however, two fundamental problems still stand: (a) barriers to access to insulin, which are due to: (i) affordability and availability, especially in low-income settings, and (ii) geopolitical situations and national healthcare organizations; and (b) misuse of insulin due to incorrect injection techniques, which have severe economic and health consequences. According to the IDF Atlas 2019 a staggering 463 million adults (20-79 years) worldwide live with diabetes; a further 1.1 million children and adolescents (aged under 20) live with type 1 diabetes; 232 million people are estimated to be undiagnosed. By 2030 it is expected that some 578 million adults will live with diabetes and 700 million by 2045. A large proportion of people with diabetes (PwD) inject insulin in an incorrect manner, with considerable and needless health – mostly cardiovascular – and economic consequences. Aim: One hundred years after the discovery of insulin, correct injection techniques should be practiced by PwD supported by trained healthcare personnel (HCP) who follow periodic refresher courses. The aim is the reduction of insulin misuse, with immediate positive consequences on the health of PwD in terms of avoidance of skin lesions, mostly lipohypertrophy (LH) and reduced health costs. Method: Correct injection techniques have been known since the discovery of insulin. Despite practical injection guidelines and recommendations which have been available for about a decade, LH rate still averages 38% (range 2-70%) worldwide, indicating a lack of aptitude/interest/organization for practical and fully effective educational efforts. Results: The authors recently provided evidence that continuous reinforcement of the initial educational training addresses the need to keep alive the memory of the skills and abilities underlying appropriate insulin injection in PwD and HCP. How long the initial knowledge lasts after initial education is still to be determined. From a practical perspective, the diabetes team should have the competence and time needed to instruct people with diabetes periodically. Discussion: We have been struggling with injection-induced skin lesions for one hundred years, ever since insulin production, as LHs was described for the first time in 1922. It is high time to take action to improve well-being in PwD all over the world by encouraging diabetes-related volunteer associations, scientific societies, governments, and insulin manufacturers to promote specific information and training campaigns on correct injection techniques and engage health care teams and PwD in a fully effective fight against injection technique errors.

IDF21-0235 Averting Complications and Improving Quality of Life (QOL) in T2D Adhering to a Telemedicine Program for 15 Years

Background: Pros and cons of telemedicine (TM) in different specialties, haves been highly debated during the COVID pandemic. With Diabetes Tele Management System (DTMS®), TM-based treatment follow-up and integrated EMR in our centre since 1997, changes in dosages, diet and exercise are carried out via telephone/email by a multidisciplinary diabetes team 24*7, based on reported structured glucose values and remote monitoring.

IDF21-0521 Peer Support for Diabetes Management in the Shanghai Integration Model Developed Community Capacity to Combat COVID-19

Background: The Shanghai Integration Model linking primary, specialty, and hospital care includes peer support to help individuals carry out daily management of their diabetes. Initial results from 9 Community Health Centers (CHCs) in Shanghai documented improvements in glycated hemoglobin and other clinical and quality-of-life measures. Expansion to 12 additional communities enlisted neighborhood committees and Community Self Management Groups as well as CHCs to host and promote PS activities. Planned implementation from May 2019 to May 2020 was, however, interrupted by COVID. During the pandemic, peer support for diabetes management was reduced but maintained through WeChat groups and individual contacts while peer leaders also emerged as dependable community partners in responding to COVID-19. Aim: Characterize how the pandemic revealed a broader benefit of the Shanghai Integration Model and peer support in the capacity they provided CHCs and communities to respond to COVID-19. Method: Descriptive and qualitative study of program developments and observed benefits based on structured interviews with key informants among CHC staff, and community and district-level public health officers. Routine documentation of program activities. Results: As part of the proactive, highly coordinated responses of the Chinese government and citizens and the people’s shared sense of duty, peer supporters took an important role in their communities in Shanghai. In initial months of strict lockdowns, peer support pivoted from in-person activities to digital and telephone support. In 9 of 12 communities, peer leaders formed online WeChat groups that became valuable sources both for sustaining diabetes management and responding to COVID. These WeChat groups facilitated clinic-to-patient communication, community peer support, healthy lifestyles, and disseminated credible information about COVID as well as about obtaining medications and clinical services for diabetes. Respondents to structured interviews indicated that peer leaders assisted in their communities in various ways, such as distributing publicity materials, bringing groceries and supplies to older adults who could not leave their buildings, and distributing face masks. Illustrative comments included “Our diabetes team members are not just an audience during the entire epidemic prevention process…they actually give full play to their power as volunteers” and, “The cohesion, the coordination, the willingness to help, and the activity are important factors of a group leader. Those group leaders have put incredible efforts into the prevention and control of the COVID-19 epidemic.” A district level public health officer added, “These group leaders also help in society…they were basically active in all types of social welfare activities.” In addition to serving others, the collaborative relationships cultivated with other organizations created a basis for supporting each other when “everyone was under great pressure. Both leaders and colleagues cared for and encouraged each other, which was consistent with the emotional support content in the peer support program.” Discussion: Beyond direct benefits with diabetes, integration of care such as through the Shanghai Integration Model, peer support, and collaboration with community groups as well as CHCs enhance community capacity to address other health challenges, including even the unprecedented threats provided by COVID-19 in China and worldwide.

The attitudes, experiences, and self-competencies of pediatric endocrinology fellows and attending physicians regarding diabetes technology: the Turkey experience.

Unlike in Western countries, the use of diabetes technologies has been limited in Turkey, or at least until the last few years. This low adoption frequency may be attributed to the lack of experience of pediatric diabetes teams in working with new technologies. The aim of this study is to evaluate the attitudes, experiences and self-efficacies of pediatric endocrinology fellows and attending physicians in terms of use of continuous subcutaneous insulin infusion (CSII) therapy and continuous glucose monitoring (CGM) systems. The questionnaire used in this study consisted of 63 questions including 10 questions evaluating the demographic characteristics and experience of the participants, 33 Likert-type questions related to self-competency, 17 yes/no questions and 3 open-ended questions which evaluated attitudes towards our study area. This questionnaire was e-mailed to pediatric endocrinology fellows and attending physicians working in Turkey. A total of 24 fellows and 28 attending physicians working in the field of pediatric endocrinology participated in the survey. Of the respondents, 61% reported that there was no formal training curriculum regarding diabetes technology at their institutions. The mean scores obtained from the Likert scale questions measuring self-competency in using CSII and CGM were 3.8 and 3.3 out of 5, respectively. Of the respondents, 55% judged themselves to be under-skilled in interpreting pump reports while 39% of the respondents reported themselves as being under-skilled in interpreting CGM reports. While it is true that training programs for using diabetes technology have been established by the National Pediatric Endocrinology Association in Turkey, the development of a specific curriculum for institutions that provide pediatric endocrinology fellowship training in this framework will increase the self-confidence of pediatric endocrinologists in this matter and this will ultimately contribute to the improvement of the metabolic control of children with diabetes.

The Diabetes Team Dynamics Unraveled: A Qualitative Study

Background: Diabetes is a complex disease requiring a multidisciplinary approach. However, the dynamics of this collaboration and the involvement of healthcare providers remain unclear. Aim(s): To explore the composition, the division of roles/tasks, and the collaboration in a diabetes team. Methods: A qualitative, explorative study with six focus groups was conducted, of which four focus groups were with healthcare providers (n = 34) and two with informal caregivers and persons with diabetes (n = 13). In addition, two in-depth interviews with doctors were performed. An iterative process of data analysis took place, guided by the Qualitative Analysis Guide of Leuven (QUAGOL). Results: All participants confirm the importance of patient empowerment and the fact that the person with diabetes should have a central role within the team. However, this has not been achieved yet. This research gives a clear insight into the dynamics of a diabetes team. Roles and tasks are allocated according to the specific expertise and knowledge of the different healthcare providers. Interprofessional collaboration is the ultimate goal. However, the diabetes team is often formed ad hoc depending on the needs of the person with diabetes and the preferences for collaboration of the healthcare providers. Furthermore, this study revealed some important bottlenecks with regard to the knowledge of healthcare providers, persons with diabetes and their informal caregivers, the regulation and reimbursement. Discussion: Our study uncovers the dynamics of a diabetes team and its members. Healthcare providers work mainly alone, except in hospitals, where they can consult other healthcare providers briefly if necessary. Although collaboration proves to be difficult, all healthcare providers ask for a more intensive interprofessional collaboration. Conclusion: In order to improve quality of diabetes care, patient-centered care and the satisfaction of patients, informal caregivers, and healthcare providers, efforts have to be made to facilitate interprofessional collaboration. This can be achieved by sharing information via electronic shared patient records, coordination, overview, local task agreements, simplified legal regulations, and an adjusted financing system.

Management of Type 1 Diabetes in Children in the Outpatient Setting.

Management of Type 1 Diabetes in Children in the Outpatient Setting.

Biosimilar insulins in international and domestic practice of pharmacist

In Ukraine, people with diabetes receive insulin, including insulin biosimilars in pharmacies, so pharmacists should increase their knowledge about biosimilar because they become more available in the coming years.
 The aim of the work was to summarize current information on insulin biosimilars.
 Research materials ‒ regulatory database information and scientific publications on biosimilars. Content analysis, bibliosemantic, analytical, generalizing analyzes were used.
 The terminology related to reproducible biological drugs (biosimilars) is difference and it depend on the regulatory agency or the country that controls the approve of drugs. Insulin was the first biopharmaceutical drug which was developed. For approving biosimilars, it is necessary to establish similarity with the reference drug in terms of safety, purity and efficacy. Regulatory of biosimilars and requirements for demonstration the biosimilarity are specified in regulatory of the EMA and WHO. The regulatory of the approving of biosimilar in Ukraine is harmonized with European regulatory. The rules on interchangeability are not determined by all regulatory agency. The International Diabetes Federation emphasizes the role of the pharmacist, stating that they should be well informed about the forms of insulin, includes biosimilars. In Ukraine, pharmacists must dispense insulin, including biosimilars, exactly in accordance to the prescription in which the trade name of insulin (or biosimilars) is indicated. Insulin biosimilars can be an alternative to original insulins that have lost patent protection by increasing the availability of drugs, which can lead to increased market competition and access insulin for patients.
 Based on the analysis of current information on biosimilars, generalizations about their terminology, aspects of manufecture, regulatory, interchangeability, prospects in the treatment of diabetes and their replacement of referens insulins are presented. The potential impact of biosimilar insulins to patients and the health care system was determinated. The importance of awareness of these drugs by pharmacists as part of the diabetic team are highlighted.

Development and Theoretical Underpinnings of the PRIORITY Intervention: A Parenting Intervention to Prevent Disordered Eating in Children and Young People With Type 1 Diabetes.

Children and young people (CYP) with type 1 diabetes (T1D) are twice as likely to develop disordered eating (T1DE) and clinical eating disorders than those without. This has significant implications for physical and mental health, with some eating disorders associated with repeated diabetic ketoacidosis and higher HbA1c levels, both of which are life threatening. There is currently limited psychological support for CYP and families with T1D but increasingly, policy and practice are suggesting disordered eating in T1D may be effectively prevented through psychological intervention. We describe the development and theoretical underpinnings of a preventative psychological intervention for parents of CYP aged 11-14, with T1D. The intervention was informed by psychological theory, notably the Information Motivation Behaviour Skills model and Behaviour Change Technique Taxonomy. The intervention was co-developed with an expert advisory group of clinicians, and families with T1D. The manualised intervention includes two online group workshops, and supplementary online materials. The intervention continues to evolve, and feasibility findings will inform how best to align the intervention with routine care in NHS diabetes teams. Early detection and intervention are crucial in preventing T1DE, and it is hoped that the current intervention can contribute to improving the psychological and physical wellbeing of young people and families managing T1D.

Frequency of diabetes team contacts in children and adolescents using insulin pumps

Background: The purpose of this study is to assess if a relationship exists between A1c within target (£ 7.5%) and frequency of patient-initiated contact with diabetes team, in children with type 1 diabetes (T1DM) on an insulin pump. Additionally, to determine factors impacting frequency of contact. Methods: This was a retrospective study of children with T1DM on an insulin pump. Frequency of contact, type of contact, and A1c were collected. Study participants filled out a questionnaire at study entry. Results: One hundred and seventy-six participants were enrolled, with a mean age of 13 years. The median duration of T1DM was 6 years with a median duration of pump use, 3.6 years. One hundred and sixteen subjects (66%) contacted the diabetes team for insulin dose adjustments between clinic visits with a mean (standard deviation [SD]) of 1.2 (± 1.7) contacts, 90% of which were by e-mail. There was no significant relationship between achieving target A1c and frequency of contact. However, increasing age and longer duration of pump use were associated with decreased frequency of contact. Common barriers to contact included being too busy and technical problems with software. Conclusions: There was no significant relationship between the frequency of patient-initiated contact with diabetes team and A1c. Overall, there was low frequency of contact in the cohort. Older children and children with longer duration of pump use had fewer contacts with low rates of self-directed pump adjustments. These results raise the importance of defining strategies to increase patient engagement and empower diabetes data review.

Feasibility and Impact of Remote Glucose Monitoring Among Patients With Newly Diagnosed Type 1 Diabetes: Single-Center Pilot Study.

BackgroundCaregivers of children with newly diagnosed type 1 diabetes (T1D) maintain close contact with providers for several weeks to facilitate rapid adjustments in insulin dosing regimens. Traditionally, patient glucose values are relayed by telephone for provider feedback, but digital health technology can now enable the remote sharing of glucose data via mobile apps.ObjectiveThe aim of this study was to test the feasibility of remote glucose monitoring in a population of children and adolescents with newly diagnosed T1D and to explore whether remote monitoring alters habits for self-review of glucose data or perceived ease of provider contact in this population as compared to a nonrandomized control group.MethodsData were collected from families who chose to participate in remote monitoring (intervention group) as well as from patients receiving usual care (control group). The intervention group received Bluetooth-capable glucose meters and Apple iPod Touch devices. Patient-generated glucose data were passively relayed from the meter to the iPod Touch and then to both the electronic health record (EHR) and a third-party diabetes data platform, Tidepool. The principal investigator reviewed glucose data daily in the EHR and Tidepool and contacted the participants as needed for insulin dose adjustments during the time between hospital discharge and first clinic appointment. Families in the control group received usual care, which involved keeping written records of glucose values and contacting the diabetes team daily by telephone to relay data and receive treatment recommendations. A total of 40 families (20 for the intervention group and 20 for the control group) participated in the study. All families were surveyed at 1 month and 6 months regarding self-review of glucose data and ease of contacting the diabetes team.ResultsPatient-generated glucose data were remotely accessible for 100% of the participants via Tidepool and for 85% via the EHR. Survey data indicated that families in the intervention group were more likely than those in the control group to review their glucose data using mobile health apps after 1 month (P<.001), but by 6 months, this difference had disappeared. Perceived ease of contacting the clinical team for assistance was lower for the intervention group after 6 months (when receiving usual care) in comparison to during the intervention period (P=.48) and compared with a control group who did not have exposure to remote monitoring (P=.03).ConclusionsRemote glucose monitoring is feasible among pediatric patients with newly diagnosed T1D and may be associated with the earlier adoption of mobile health apps for self-management. The use of broadscale remote monitoring for T1D in the future will depend on improved access to Bluetooth-enabled mobile devices for all patients, improved interoperability of mobile health apps to enable data transfer on Android as well as Apple devices, and new provider workflows to handle large-scale panel management based on patient-generated health data.Trial RegistrationClinicalTrials.gov NCT04106440; https://clinicaltrials.gov/ct2/show/NCT04106440

A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) - Clinimetric Evidence From Five Studies.

Measurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practices in type 1 diabetes (T1D) and type 2 diabetes (T2D). The DSMQ-R is a multidimensional questionnaire with 27 items regarding essential self-management practices for T1D and T2D (including diabetes-adjusted eating, glucose testing/monitoring, medication taking, physical activity and cooperation with the diabetes team). For the revised form, the original items were partially amended and the wording was updated; eleven items were newly added. The tool was applied as part of health-related surveys in five clinical studies (two cross-sectional, three prospective) including a total of 1,447 people with T1D and T2D. Using this data base, clinimetric properties were rigorously tested. The analyses showed high internal and retest reliability coefficients for the total scale and moderate to high coefficients for the subscales. Reliability coefficients for scales including the new items were consistently higher. Correlations with convergent criteria and related variables supported validity. Responsiveness was supported by significant short to medium term changes in prospective studies. Significant associations with glycemic outcomes were observed for DSMQ-R-assessed medication taking, glucose monitoring and eating behaviors. The results support good clinimetric properties of the DSMQ-R. The tool can be useful for research and clinical practice and may facilitate the identification of improvable self-management practices in individuals.

Clinical Characteristics of COVID-19 Patients in a Regional Population With Diabetes Mellitus: The ACCREDIT Study.

ObjectiveTo identify clinical and biochemical characteristics associated with 7- & 30-day mortality and intensive care admission amongst diabetes patients admitted with COVID-19.Research Design and MethodsWe conducted a cohort study collecting data from medical notes of hospitalised people with diabetes and COVID-19 in 7 hospitals within the Mersey-Cheshire region from 1 January to 30 June 2020. We also explored the impact on inpatient diabetes team resources. Univariate and multivariate logistic regression analyses were performed and optimised by splitting the dataset into a training, test, and validation sets, developing a robust predictive model for the primary outcome.ResultsWe analyzed data from 1004 diabetes patients (mean age 74.1 (± 12.6) years, predominantly men 60.7%). 45% belonged to the most deprived population quintile in the UK. Median BMI was 27.6 (IQR 23.9-32.4) kg/m2. The primary outcome (7-day mortality) occurred in 24%, increasing to 33% by day 30. Approximately one in ten patients required insulin infusion (9.8%). In univariate analyses, patients with type 2 diabetes had a higher risk of 7-day mortality [p < 0.05, OR 2.52 (1.06, 5.98)]. Patients requiring insulin infusion had a lower risk of death [p = 0.02, OR 0.5 (0.28, 0.9)]. CKD in younger patients (<70 years) had a greater risk of death [OR 2.74 (1.31-5.76)]. BMI, microvascular and macrovascular complications, HbA1c, and random non-fasting blood glucose on admission were not associated with mortality. On multivariate analysis, CRP and age remained associated with the primary outcome [OR 3.44 (2.17, 5.44)] allowing for a validated predictive model for death by day 7.ConclusionsHigher CRP and advanced age were associated with and predictive of death by day 7. However, BMI, presence of diabetes complications, and glycaemic control were not. A high proportion of these patients required insulin infusion warranting increased input from the inpatient diabetes teams.

Lived Experiences of Diabetes Team and Patients about Diabetes Care System after Redesigning Delivery System and Supporting Self-Management in Iran: A Qualitative Research.

Background:Diabetes as a chronic disease requires a change in the paradigm of treatment and health care system based on acute illnesses to chronic conditions. Chronic Care Model has been designed to address this need. This study aimed to explore the lived experiences of the diabetes team and diabetic patients regarding the health care system after redesigning delivery system and supporting self-management based on the Chronic Care Model in Iran.Methods:Research was conducted with a qualitative descriptive approach in one of the Isfahan city clinics in 2018. The participants were diabetes team (composed of diabetes physician, nurse, assistant nurse and dean of the clinic) and 17 type- 2 diabetic patients who were selected through purposive sampling. Data collection was performed through semi-structured interviews and then were analyzed using content analysis with an inductive approach.Results:The findings of this study were composed of the following two main categories: (1) educational function change, including the sub-categories of evidence-based nurse education and patients’ demand to ongoing participation in the training classes; and (2) treatment and care method upgrade, including the sub-categories of nurse's role change in a team approach, continuity in cares and upgrading patients’ self-care behaviors.Conclusions:Delivery system redesign and diabetes self-management support based on Chronic Care Model changed organizational structure and performance of the diabetes care system. It also reformed the structure of treatment providers from a vertical and hierarchical form to a team arrangement. Nurse's educational function became evidence-based and patients’ self-care behaviors upgraded.