Optimal Diabetes Control Research Articles

A Long-Term Retrospective Real-World Evidence to Understand the Pattern of Insulin Prescription in Patients with Type 2 Diabetes Mellitus: Evaluating the Role of Insulin Initiation

Abstract Aims and Objective: To evaluate the prescription pattern of insulin and oral antidiabetic drugs (OADs) and the trend of glycemic control in people with diabetes (PwD) with type 2 diabetes mellitus attending a tertiary care center in India. Materials and Methods: This retrospective, cross-sectional observational study included clinic records of 647 PwD collected at three different time points (2011, 2015, and 2019). Population characteristics, patterns of glycemic parameters, and trends of antidiabetic medication were analyzed. Results: PwD population was similar in terms of anthropometric and clinical variables. Dysglycemia was observably higher in the 2015 population (mean HbA1C = 8.37 ± 1.8%) compared with the 2011 population (6.4 ± 0.4%) and stabilized in the 2019 population (8.35 ± 1.9%) compared with the 2015 population. This correlated with the trend of increase in basal and bolus insulin prescriptions as more subjects were initiated on insulin to address the higher dysglycemia in 2015 than in 2011 and were later titrated in 2019. The proportion of subjects with uncontrolled diabetes increased marginally in 2015 (50.9%) compared with 2011 (45.6%) and decreased significantly in 2019 (34.1%) compared with 2015. This correlated with the additive increases of premix insulin, sodium-glucose transport protein 2 inhibitors (SGLT2i), and dipeptidyl peptidase 4 inhibitors (DPP4i) prescriptions. Conclusion: We observed a judicious usage of insulin prescriptions correlating with the higher need for PwD to be initiated with basal insulin to counter the increasing trend of dysglycemia, followed by more premix insulin prescriptions to address stabilized dysglycemia. Optimal diabetes control can be partly attributed to dysglycemia stabilization by insulin initiation and usage of newer OADs, such as SGLT2i and DPP4i.

Knowledge and attitude regarding insulin therapy among patients treated with insulin for diabetes attending a tertiary care hospital in Sri Lanka

Introduction: The incidence of diabetes is rising in the South Asian region including Sri Lanka. Insulin is one of the therapeutic options which has a significant impact in optimal control of diabetes but lack of knowledge and negative attitudes among patients pose a significant barrier to proper adherence to insulin therapy. This study aims to assess the knowledge and attitudes towards insulin therapy among patients treated with insulin for diabetes attending National Hospital, Kandy and to assess the association of demographic parameters with knowledge and attitude scores.Methods: An institution-based, descriptive, cross-sectional study was conducted which included 298 randomly selected patients with diabetes who are on insulin attending National Hospital, Kandy. They were assessed with a structured interviewer-administered questionnaire. The data was analysed using SPSS version 22.Results: The knowledge scores of participants were 70%, 26.8% and 3% for good, moderate and inadequate, respectively. The majority (74%) had a favourable attitude towards insulin therapy. The mean knowledge and attitudes scores were 81.9% (95% CI: 79.5% to 84.3%) and 78.3% (95% CI: 73.5% to 83.1%), respectively. Being retired (p= .012) and being on insulin for more than 5 years (p = .028) were associated with a good knowledge score. Conclusions: Majority of the patients with diabetes assessed in the study had good knowledge and a favourable attitude regarding insulin therapy. It is therefore essential to maintain and reinforce the educational and training modalities made available for patients with diabetes.

HbA1c control in type 2 diabetes mellitus patients with coronary artery disease: a retrospective study in a tertiary hospital in South Africa.

Type 2 diabetes mellitus (T2DM) patients with coronary artery disease (CAD) have an increased risk of recurrent cardiovascular events. These patients require optimal glucose control to prevent the progression of atherosclerotic cardiovascular disease (ASCVD). Contemporary guidelines recommend an HbA1c ≤7% to mitigate this risk. The aim of this study was to evaluate HbA1c control in T2DM patients with angiographically proven ASCVD. We conducted a cross-sectional, retrospective study on consecutive T2DM patients with acute and chronic coronary syndromes managed in a tertiary academic hospital in South Africa. Glycaemic control was assessed by evaluating the glycated haemoglobin (HbA1c) level measured at index presentation with acute and chronic coronary syndromes and during the most recent follow-up visit. The study population comprised 262 T2DM patients with a mean age of 61.3 ± 10.4 years. At index presentation, 110 (42.0%) T2DM patients presented with ST-segment elevation myocardial infarction, 69 (26.3%) had non-ST-segment elevation myocardial infarction, 43 (16.4%) had unstable angina, and 40 (15.3%) had stable angina. After a median duration of 16.5 months (IQR: 7-29), 28.7% of the study participants had an HbA1c ≤7%. On multivariable logistic regression analysis, females were less likely to have poor glycaemic control (HbA1c above 7%) [odds ratio (OR): 0.42, 95% confidence interval (CI): 0.19-0.95, p=0.038]. Also, T2DM patients prescribed metformin monotherapy (OR: 0.34, 95% CI: 0.14-0.82, p=0.017) and patients with ST-segment depression on the electrocardiogram (OR: 0.39, 95% CI: 0.16-0.96, p=0.041) were less likely to have poor glycaemic control. After a median duration of 16.5 months, only 28.7% of T2DM patients with CAD had an HbA1c ≤7%. This finding underscores the substantial unmet need for optimal diabetes control in this very high-risk group.

The Influence of Natural, Preformed Physical Factors in Patients with Type 2 Diabetes Mellitus with the Metabolic Syndrome on the Compensation of Carbohydrate Metabolism According to the Results of Continuous Glucose Level Monitoring

In recent years, rehabilitative and preventive areas of medicine have become relevant. Restorative treatment and rehabilitation with the use of complex resort therapy in patients with type 2 diabetes have been relevant in recent years. The purpose of our study was to investigate the variability of glycemia in patients with type 2 diabetes mellitus with MS under the influence of natural and preformed physical factors at the sanatorium of SPK "Morshinkurort" in Morshin. Continuous glucose monitoring (CGM) was performed using the Metronic Guardian Connect system in 48 patients with type 2 diabetes and MS for an average of 14 days before and after treatment. Daily monitoring of blood glucose was carried out using the "Metronic" device. We used traditional indicators of glycemia variability according to the recommendations of the American Diabetes Association. All patients with type 2 diabetes and MS had signs of abdominal obesity, which was evidenced by an increase not only in BMI, but also in OT. Their waist circumference was 112.06±5.59 in men and 107.64±2.46 in women. After the course of treatment, the NOMA IR index decreased by 3 times (p<0.05). The content of fasting insulin in the blood after 3 months of treatment probably decreased by 45%, which indicates a significant contribution of sanatorium-spa therapy in overcoming hyperinsulinemia and insulin resistance in general. For optimal diabetes control, in addition to HbA1c, we must consider CGM and % Time in range (TIR) ​​(time in target range). TIR: (3.9–10.0 mmol/l) in the studied patients before treatment was 53.30±5.90% and significantly differed from patients after treatment - 72.53±7.41% (p < 0.05 ) (with a norm of >70%). TIR should be used as a target point as an indicator of glycemic control in routine clinical practice. Under the influence of natural and preformed physical factors in the conditions of the "Morshinkurort" medical center in Morshyn, in patients with type 2 diabetes with MS, the variability of glycemia according to CGM data is likely to decrease, which makes it possible to achieve strategic goals and criteria for the effectiveness of treatment of diabetes. CGM plays an important role in evaluating the effectiveness and safety of treatment, including the prevention of hypoglycemia.

Factors Influencing the Control of Diabetes Measured via Glycated Hemoglobin Concentrations in Adults with Type 1 Diabetes.

Numerous complications of type 1 diabetes (T1D) may be prevented through suitable glycemic control. Glycated hemoglobin (HbA1c) may be one of the markers for the early detection of the metabolic imbalance characteristic of the disease. However, optimal control of diabetes is not achieved in a large group of patients. It was demonstrated that numerous factors (sociodemographic, psychological, and clinical) contributed to this condition. The aim of the study was to identify factors influencing the control of diabetes measured via glycated hemoglobin concentrations in people with T1D. Independent factors influencing better diabetes control measured via HbA1c in the study group included higher disease acceptance, higher nutritional adherence, lower BMI, and a lower risk of eating disorders. Describing the determinants will allow for the improvement of the system of care provided to people with T1D and for it to comprise important psychological variables related to self-care and acceptance of the disease.

Perception of self-management and glycaemic control in people with type 2 diabetes receiving insulin injection therapy: A qualitative study

AimThe aim of this study was to explore the experience of self-management and glycaemic control in Chinese people with type 2 diabetes receiving insulin injection therapy. MethodsA qualitative descriptive design was adopted with individual, semi-structured interviews. Participants were selected by purposive sampling. All face-to-face interviews were conducted between December 2020 and January 2021. The interviews were audio recorded and transcribed verbatim. Content analysis was used to analyse the interview data. ResultsA total of 27 participants were recruited and individually interviewed. Three themes were generated: integrating insulin injection therapy into daily self-management; experiencing uncertainty when coping with suboptimal glycaemic control; and self-management programmes for optimal diabetes control. ConclusionAll of our findings increase the understanding of self-management and glycaemic control in people with T2D receiving insulin injection therapy. Healthcare professionals should recognise the unmet needs of this cohort to promote their diabetes management. Appropriate and effective self-management programmes should be developed and implemented to alleviate the negative impacts of insulin injection therapy on diabetes management with consideration of cultural and personal context.

SARS-CoV-2 vaccination in children and adolescents with and without type 1 diabetes mellitus.

Adults with Diabetes Mellitus (DM) have increased risk of severe clinical presentation during COVID-19 infection, while children and adolescents with type 1 diabetes (T1D) have the same mild clinical course as their healthy peers, especially those with optimal glycemic control. The present review focuses on the necessity of COVID-19 vaccination among children and adolescents with T1D, and also in their non-diabetic peers. The efficacy and safety of COVID-19 vaccines are also discussed, as well as their various side-effects, ranging from common mild to very rare and serious ones. Furthermore, the results of COVID-19 vaccination of adolescents with and without T1D are reported, as well as the efficacy and concerns about childhood vaccination. It is concluded that patients with DM of all age groups should maintain optimal diabetic control in order to avoid glycemic deterioration during COVID-19 infection. Furthermore, despite the very rare and serious complications of COVID-19 vaccines, vaccination against COVID-19 is recommended for children and adolescents with T1D to prevent glycemic deterioration and rare but serious complications of COVID-19 infection.

Impact of anemia on HbAC level in type 2 diabetes mellitus patients

HbA1c is one of the important laboratory markers of blood glucose levels monitoring over last 2-3 months. Studies have shown that many factors affect HbA1c levels, hence it is not the only investigation to diagnose diabetes mellitus. As both iron deficiency anaemia and diabetes mellitus are highly prevalent disorders, effect of iron deficiency anaemia on HbA1C need to be evaluated. Many factors such as haemolytic anaemia, vitamin deficiencies, pregnancy. Kidney disease, haemoglobin variants can affect HbA1C levels. This study had two groups of participants. Group 1 included diabetic patients with iron deficiency anaemia and group 2 included diabetic patients without iron deficiency anaemia. Significant correlation between HbA1C and iron deficiency anaemia has been found. PCV, MCH, MCHC, MCV are low in diabetics with Iron deficiency anaemia and high in diabetics without iron deficiency anaemia. Need for anaemia screening before treatment planning of diabetes based on HBA1C levels must be considered and for optimal diabetes control, treating anemia is necessary.

Evaluation of the nutrients in locally prepared soups for optimal diabetes control: Evidence from low income communities in Zaria, Nigeria

A changing pattern towards prevention and complete remission is greatly needed in type 2 diabetes (T2D) care through lifestyle medicine especially healthy diet. The nutritionally valuable macromolecules, minerals and functional properties of benniseed (Sesamum radiatum), Melon seed (Colocynthis citrullus) and Groundnut (Arachis hypogea) soups were studied. Locally prepared soups of theses seeds' were analysed based on moisture, ash, lipid, protein, fiber, carbohydrate and minerals using AOAC standard methods. Statistical analysis employed SPSS using frequency and chi-square tools. Manganese, copper, calcium, magnesium, iron and zinc were determined using Atomic Absorption Spectrophotometer (AAS). The results on dry/weight and wet/weight basis showed that protein ranged from 7.04-9.05% versus 22.00-24.13%; moisture 8.5 to 10.6%; ash 6.90-12.33% versus 2.21-3.90%; crude fibre 1.75-2.53% versus 4.66%-7.91%; lipid 19.07%-16.77% versus 50.86%-54.18%; and carbohydrate 1.76-4.34% versus 5.34-12.92% respectively. The predominant mineral was calcium which varied between 4.060 and 8.600 mg/100 g. The samples were low in manganese and copper with moderate concentrations of magnesium, zinc and iron. The proximate analyses of the soups showed optimum abundance to support the management of diabetes mellitus (DM). When intensified with dose adherence, remission may be achieved to reduce DM complications in the environment with challenges attributable to access to health facility.

Comparison of Ambulatory Quality Measures Between Shared Practice Panels and Independent Practice Panels

ObjectiveTo assess for differences in patient care outcomes in the primary care setting for patients assigned to an independent practice panel (IPP) or a shared practice panel (SPP). Patients and MethodsWe retrospectively reviewed the electronic health records of patients of 2 Mayo Clinic family medicine primary care clinics from January 1, 2019 to December 31, 2019. Patients were assigned to either an IPP (physician or advanced practice provider [APP]) or an SPP (physician and ≥1 APP). We assessed 6 measures of quality care and compared them between IPP and SPP groups: diabetes optimal care, hypertension control, depression remission at 6 months, breast cancer screening, cervical cancer screening, and colon cancer screening. ResultsThe study included 114,438 patients assigned to 140 family medicine panels during the study period: 87 IPPs and 53 SPPs. The IPP clinicians showed improved quality metrics compared with the SPP clinicians for the percentage of assigned patients achieving depression remission (16.6% vs 11.1%; P<.01). The SPP clinicians showed improved quality metrics compared with that of the IPP clinicians for the percentage of patients with cervical cancer screening (79.1% vs 74.2%; P<.01). The mean percentage of the panels achieving optimal diabetes control, hypertension control, colon cancer screening, and breast cancer screening were not significantly different between IPP and SPP panels. ConclusionThis study shows a considerable improvement in depression remission among IPP panels and in cervical cancer screening rates among SPP panels. This information may help to inform primary care team configuration.

Clinical effect of carotid stenting on cognitive abilities - possible evaluation using candidates for biomarkers.

Micro- and macrovascular consequences of atherosclerosis, arterial hypertension, dyslipidemia, and smoking can affect neurotransmission and markers for neuronal activity. The potential direction and specifics are under study. It is also known that optimal control of hypertension, diabetes, and dyslipidemia in midlife may positively affect cognitive functioning later in life. However, the role of hemodynamically significant carotid stenoses in neuronal activity markers and cognitive functioning is still being debated. With the increased use of interventional treatment for extracranial carotid disease, the question of whether it might affect neuronal activity indicators and whether we can stop or even reverse the path of cognitive deterioration in patients with hemodynamically severe carotid stenoses naturally emerges. The existing state of knowledge provides us with ambiguous answers. We sought the literature for possible markers of neuronal activity that can explain any potential difference in cognitive outcomes and guide us in the assessment of patients throughout carotid stenting. The combination of biochemical markers for neuronal activity with neuropsychological assessment and neuroimaging may be important from practical point of view and may provide the answer to the question for the consequences of carotid stenting for long-term cognitive prognosis.

Presentation of the model and optimal control of non-linear fractional-order chaotic system of glucose–insulin

Recent advances in optimal diabetes control have made it possible for diabetic patients to live longer, healthier, and happier lives. In this research, particle swarm optimization and genetic algorithm are applied in order to control the non-linear fractional order chaotic system of glucose–insulin optimally. A fractional system of differential equations discussed the chaotic behavior of the growth of the blood glucose system. Particle swarm optimization and genetic algorithm were used to solve the presented optimal control problem. The results showed that when the controller is applied from the beginning, the results of the genetic algorithm method are excellent. All the results obtained for the particle swarm optimization method show that this method is also very successful and the results are very close to the genetic algorithm method.

Acute Painful Diabetic Neuropathy in two newly diagnosed adolescents with Type one Diabetes and Eating Disorder

Type 1 Diabetes (T1D) is the most common type of diabetes among children and adolescents. The related chronic macrovascular and microvascular complications are associated with high long-term risk for morbidity and early mortality. We hereby present 2 cases of adolescents with newly diagnosed Type 1 Diabetes (9.8 months and 2 years, respectively) and Eating Disorder (ED) who developed Acute Painful Diabetic Neuropathy (APDN). Both patients had multiple risk factors for Acute Painful Diabetic Neuropathy that have attributed to the early appearance of the disease, such as acute deterioration of glycaemic control, rapid and extreme weight changes and poor compliance with insulin therapy. APDN is a rare Diabetes complication in youth that may appear after extreme weight changes usually in the context of ED. Poor glycemic control is a major risk factor for the development of APDN. Remission of symptoms may occur following restoration of optimal diabetic control and weight normalization. However, neuropathy symptoms may recur following future glycemic deterioration.

New Routes of Insulin for Diabetes Treatment

Diabetes is a chronic condition marked by insufficient insulin production and the subsequent hyperglycemia. Optimal diabetes control has an impact on both microvascular and macrovascular disease, which are both diabetic consequences. Subcutaneous insulin injections or continuous infusions are frequently used by people with diabetes to manage their blood sugar levels. Given that insulin injection therapy is difficult for many patients, novel routes of insulin administration are of interest in the diabetes sector. Inhalational insulin administration will be covered in this review. The effectiveness of inhaled insulin in comparison to subcutaneous insulin in the various populations with diabetes iscovered, as well as its safety. Additionally, the experience and challenges associated with the creation and promotion of insulin for inhalation are reviewed.

Abstract P572: Racial and Ethnic Disparities in Healthcare Access and Utilization Among People With Diabetes in the US

Introduction: Despite advances in diabetes care, racial disparities in diabetes care and outcomes remain. Moreover, better access to and utilization of healthcare is associated with optimal diabetes control. Yet, little is known about race and ethnicity disparities in diabetes care utilization in the US. Objective: To estimate racial/ethnic differences in access and utilization of health services among adults diagnosed with diabetes in the US population. Methods: In this cross-sectional analyses, we identified and analysed data of 3,563 adults diagnosed with diabetes from the National Health and Nutrition Examination Survey, 2011-2018. The sample (Whites N=1,100, Black N=1,002, Asian N=438, Hispanic N=1,023) included adults ≥18 years who had self-reported diagnosed diabetes. The exposure variable was race/ethnicity groups. Healthcare care access was defined as having a routine place of healthcare, health insurance, and provider for diabetes care; and utilization measures were defined as having checked HbA1c and received diabetes care ≥4 times in the past year. We fitted generalized linear models with Poisson distribution to examine disparities in healthcare access and utilization by race/ethnicity among adults with diabetes. Results: Participants had a mean age of 59 (SE .32) years old, 49% female. In the fully adjusted models, compared to White adults, Hispanic adults were less likely to have health insurance (adjusted Odds Ratio [aOR]: 0.96; 95% CI 0.91-0.99) and less likely to have their HbA1c checked in the past year (aOR: 0.92; 95% CI: 0.86-0.98) ( Table ). There were no significant differences in having a routine place for healthcare, provider for diabetes care, and diabetes care received (≥4 times) in the past year in the fully adjusted analyses. Conclusion: Racial differences exist with lower access and utilization of diabetes care particularly among Hispanic adults. Targeted health interventions to address access to diabetes care are needed.

Potential health and economic impact associated with achieving risk factor control in Chinese adults with diabetes: a microsimulation modelling study

The prevalence of diabetes has risen sharply in China. Improving modifiable risk factors such as glycaemia and blood pressure could substantially reduce disease burden and treatment costs to achieve a healthier China by2030. We used a nationally representative population-based survey of adults with diabetes in 31 provinces in mainland China to assess the prevalence of risk factor control. We adopted a microsimulation approach to estimate the impact of improved control of blood pressure and glycaemia on mortality, quality-adjusted life-years (QALYs), and healthcare cost. We applied the validated CHIME diabetes outcomes model over a 10-year time horizon. Baseline scenario of status quo was evaluated against alternative strategies based on World Health Organization and Chinese Diabetes Society guidelines. Among 24,319 survey participants with diabetes (age 30-70), 69.1% (95% CI: 67.7-70.5) achieved optimal diabetes control (HbA1c <7% [53mmol/mol]), 27.7% [26.1-29.3] achieved blood pressure control (<130/80mmHg) and 20.1% (18.6-21.6) achieved both targets. Achieving 70% control rate for people with diabetes could reduce deaths before age 70 by 7.1% (5.7-8.7), reduce medical costs by 14.9% (12.3-18.0), and gain 50.4 QALYs (44.8-56.0) per 1000 people over 10 years compared to the baseline status quo. The largest health gains were for strategies including strict blood pressure control of 130/80mmHg, particularly in rural areas. Based on a nationally representative survey, few adults with diabetes in China achieved optimal control of glycaemia and blood pressure. Substantial health gains and economic savings are potentially achievable with better risk factor control especially in rural settings. Chinese Central Government, Research Grants Council of the Hong Kong Special Administrative Region, China [27112518].

THE ASSESSMENT OF COMPENSATION OF CARBOHYDRATE METABOLISM IN PATIENTS WITH TYPE 2 DIABETES MELLITUS WITH METABOLIC SYNDROME BEYOND THE LIMITS OF GLYCATED HEMOGLOBIN.

The aim: To investigate glycemic variability in type 2 diabetes patients with metabolic syndrome (MS) and to assess its effect on diabetes compensation. Materials and methods: We used traditional indicators of glycemia variability according to the recommendations of the American Diabetes Association Professional Practice Committee. We proved that patients with type 2 diabetes mellitus with MS reliably have worse CGM indicators: Time in range TIR: (3.9-10.0 mmol/l) - 53.30±5.90%; Time above range (TAR): (time above range) (>10.1 mmol/l) - 43.33±5.96%; Time above TAR range (>13.9 mmol/l) - 22.1±3.91%; Glucose Variability СV - 44.10±4.89% compared to patients with type 2 diabetes without MS, which proves the negative effect of insulin resistance on compensation of diabetes. Results: Determination of the level of EI in the blood, calculation of the Caro index, HOMA-IR are informative for verifying the presence of IR in patients with type 2 diabetes with MS. For optimal diabetes control, in addition to HbA1c, we must consider CGM data and % Time in range (TIR). Conclusions: TIR should be used as a target point and an indicator of glycemic control in routine clinical practice. TIR provides accurate data on a patient's glycemic status and helps better control diabetes.

Association between diabetes-related distress and glycemic control in primary care patients with Type 2 diabetes during the coronavirus disease 2019 (COVID-19) pandemic in Egypt.

Diabetes-related distress and glycemic control are of a particular concern to primary care physicians because of the impact of the coronavirus disease 2019 pandemic on diabetic patients' lifestyle, psychological well-being and healthcare access. Our aim was to evaluate the relationship between diabetes-related distress and glycemic control in diabetic patients with Type 2 diabetes mellitus (T2DM) in primary care settings during the pandemic. This cross-sectional study was conducted at primary healthcare clinics in a rural area in Egypt among 430 patients with T2DM during the period from September 2020 to June 2021. All patients were interviewed for their sociodemographic, lifestyle, and clinical characteristics. Diabetes-related distress was measured by the problem areas in the diabetes scale (PAID), where a total score of ≥40 indicated a severe diabetes-related distress. The most recent glycosylated hemoglobin (HbA1c) measurements were used to indicate the glycemic control. Quantile regression model (0.50 quantile) was used to perform the multivariate analysis to identify significant factors associated with HbA1c level. Most of the participants had a suboptimal glycemic control (92.3%), while 13.3% had severe diabetes-related distress. HbA1c level was significantly and positively correlated with the total PAID score and all its sub-domains. Multivariate quantile regression revealed that obesity, multi-morbidity, and severe diabetes-related distress were the only significant determinants of the HbA1c median level. Obese patients had significantly higher median HbA1c compared to patients who were not obese (coefficient = 0.25, P < 0.001). Patients with two or more comorbidities (i.e., multimorbidity) had a significantly higher median HbA1c than patients with single or no chronic comorbidities (coefficient = 0.41, P < 0.001). Severe diabetes-related distress was significantly associated with higher median HbA1c compared to nonsevere diabetes-related distress (coefficient = 0.20, P = 0.018). Diabetes-related distress had a significant association with HbA1c level. Family physicians should implement multifaceted programs to optimize diabetes control and reduce any associated distress.

Trends in all-cause mortality and major causes of death between 2007 and 2018 among patients with diabetes in Taiwan.

Optimal control of diabetes and relevant risk factors substantially reduce the risks of chronic complications and mortality. We investigated all-cause mortality rate and major causes of death between 2007 and 2018 in patients with diabetes in Taiwan. This study was conducted using data from Taiwan National Health Insurance Research Database. We selected patients with diabetes diagnosed between 2007 and 2017 (grouped according to the year of diabetes diagnosis 2007-2010 vs. 2011-2017). Information on mortality and causes of death by the end of 2018 was confirmed through linking to the National Death Registry. Standardized mortality rate (SMR) were calculated by weighting the World Health Organization (WHO) standard population (WHO 2000-2025). More than 2.7 million of patients with diabetes were analyzed and a total of 566121 deaths were identified. Overall, the SMR was 11.72 per 1000 person-years. Patients with diabetes diagnosed in 2011-2017 had a lower SMR (8.42 vs. 12.92 per 1000 person-years) than those diagnosed in 2007-2010. Similar finding were noted regarding the major causes of death (cancer, diabetes, heart disease, hypertensive disease, and cerebrovascular disease). Compared with patients who were diagnosed in 2008-2010, those who were diagnosed in 2011-2014 and 2015-2018 had a higher 3-year survival rate (0.9356 vs. 0.9438 vs. 0.946, log-rank test p<0.001) after the diagnosis of diabetes. Patients who were diagnosed with diabetes after 2011 had a lower rate of all-cause mortality and major causes of death, compared with those who were diagnosed before 2010 in Taiwan.

Diabetes Specialists Value Continuous Glucose Monitoring Despite Challenges in Prescribing and Data Review Process.

Diabetes clinicians are key facilitators of continuous glucose monitoring (CGM) provision, but data on provider behavior related to CGM use and CGM generated data are limited. We conducted a national survey of providers caring for people with diabetes on CGM-related opinions, facilitators and barriers to prescription, and data review practices. Of 182 survey respondents, 73.2% worked at academic centers, 70.6% were endocrinologists, and 70.7% practiced in urban settings. Nearly 70% of providers reported CGM use in the majority of their patients with type 1 diabetes. Half of the providers reported CGM use in 10% to 50% of their patients with type 2 diabetes. All respondents believed CGM improved quality of life and could optimize diabetes control. We found no differences in reported rates of CGM use based on providers' years of experience, patient volume, practice setting, or clinic type. Most providers reviewed CGM data each visit (97.7%) and actively involved patients in the data interpretation (98.8%). Only 14.1% of clinicians reported reviewing CGM data without any prompting from patients or their family members outside of visits. Most providers (80.7%) reported their CGM data review was valued by patients although only half reported having adequate time (45.1%) or an efficient process (56.1%) to do so. Despite uniform support for CGM by providers, ongoing challenges related to cost, insurance coverage, and difficulties with prescription were major barriers to CGM use. Increased use of CGM in appropriate populations will necessitate improvements in data access and integration, clearly defined workflows, and decreased administrative burden to obtain CGM.