Diabetes Technology & Therapeutics

OBJECTIVE: The article provides practical guidance for 1) interpreting and confirming islet autoantibody screening results for type 1 diabetes and 2) follow up of individuals with early stages of type 1 diabetes with the goal of ensuring medical safety and providing patients and their families with an assessment of risk for progression to a clinical diagnosis of type 1 diabetes. RESEARCH DESIGN AND METHODS: We used an explicit a priori methodology to identify areas of agreement and disagreement in how to manage patients with early type 1 diabetes...

OBJECTIVE: To describe management strategies that contributed to optimal outcomes in pediatric recipients of a total pancreatectomy with islet autotransplantation (TPIAT). RESEARCH DESIGN AND METHODS: We provide a comprehensive report of the approach to endocrine management of the pediatric TPIAT recipient from initial evaluation through the first 4 years post-surgery. We performed a retrospective review of the endocrine outcomes of TPIAT recipients to describe the impact of this approach on post-TPIAT glycemic management...

Continuous glucose monitoring (CGM) has transformed the way people with type 1 diabetes can self-monitor glucose levels. Past studies have evaluated the accuracy of CGM devices in clinic-based studies, but few have analyzed their accuracy in real-world settings. The Insulin-Only Bionic Pancreas Trial provided the opportunity to assess real-world accuracy of the blinded Dexcom G6 Pro sensor over the first 48-60 hours of wear using a blood glucose meter (BGM) as a comparator for 1,073 CGM-BGM pairs across 53 participants...

Background The glycemic risk index (GRI) is a novel composite continuous glucose monitor (CGM) metric that gives greater weight to hypoglycemia than to hyperglycemia and to extreme hypo/hyperglycemia over less extreme hypo/hyperglycemia. This study aimed to validate the effectiveness of GRI and to compare it with time in range (TIR) in assessing glycemic quality in clinical practice. Methods A total of 524 90-day CGM tracings of 194 insulin-treated adults with diabetes were included in the analysis. GRI was assessed according to standard metrics in ambulatory glucose profiles...

Background Since the introduction of insulin pumps into the therapy of paediatric subjects, different approaches have been taken to find optimal basal rates. Previously, the DPV registry provided circadian basal rate patterns for different age groups. As the number of pump users has increased recently and short-acting insulin analogues are now predominant, we performed a new analysis with a larger data pool. Methods We included all recent basal profiles from T1D patients between 1 and 25 years from the DPV 2021 data pool...

BACKGROUND: Pivotal trials of diabetes technologies have demonstrated glycemic improvements, however these trials include patients of limited diversity and ranges of glycemic control. We assessed changes in glycemic control during the first 90 days of Omnipod 5 use in a real-world cohort of youth with type 1 diabetes (T1D). METHODS: Youth 2-21 years with T1D initiating Omnipod 5 at two pediatric academic centers were included. 14 days of baseline CGM data were compared against data from the first 90 days of Omnipod 5 use...

BACKGROUND: While evidence supports glycemic control benefits for individuals with type 1 diabetes mellitus (T1DM) using hybrid closed-loop (HCL) systems, HCL automated insulin delivery therapy in China has not been assessed. This study evaluated safety events and effectiveness during HCL system use by Chinese adolescents and adults with T1DM. METHODS: Sixty-two participants (n=12 adolescents [mean±SD of 15.5±1.1 years] and n=50 adults [mean±SD of 37...

Introduction Multiple daily injection (MDI) insulin therapy frequently fails to meet hospital glycemic goals and is prone to hypoglycemia. Automated insulin delivery (AID) with remote glucose monitoring offers a solution to these shortcomings. Research Design and Methods In a single-arm multicenter pilot trial, we tested the feasibility, safety, and effectiveness of the Omnipod 5 AID System with real-time continuous glucose monitoring (CGM) for up to 10 days in hospitalized patients with insulin-requiring requiring diabetes on non-ICU medical-surgical units...

Numerous studies have demonstrated the clinical benefits of continuous glucose monitoring (CGM) in individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D) who are treated with intensive insulin regimens. Based on this evidence, CGM is now a standard of care for individuals within these diabetes populations and widely covered by commercial and public insurers. Moreover, recent clinical guidelines from the American Diabetes Association and American Association of Clinical Endocrinology now endorse CGM use in individuals treated with nonintensive insulin regimens...

Background: Studies have reported significantly higher hemoglobin A1c (A1C) in African American patients than in White patients with the same mean glucose, but less is known about other racial/ethnic groups. We evaluated racial/ethnic differences in the association between mean glucose, based on continuous glucose monitor (CGM) data, and A1C. Methods: Retrospective study among 1788 patients with diabetes from Kaiser Permanente Northern California (KPNC) who used CGM devices during 2016 to 2021. In this study population, there were 5264 A1C results; mean glucose was calculated from 124,388,901 CGM readings captured during the 90 days before each A1C result...

OBJECTIVE: To evaluate the psychosocial impact and user experience for the insulin-only configuration of the iLet bionic pancreas (BP) in persons ages 6-83 years old with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: In this multi-center, randomized controlled, 13-week trial, 275 adults (221 randomly assigned to the BP group and 54 to the standard of care [SC] group) and 165 youth and their caregivers (112 randomly assigned to the BP group and 53 to the SC group) completed psychosocial questionnaires at baseline, mid-study and at the end of the trial...

Continuous glucose monitoring (CGM) based metrics such as time in range and time below range and their clinical targets are recommended along with A1C to optimize diabetes care. CGM metrics are easy to understand by people with diabetes and have been widely accepted among health care providers. Time below range (TBR); i.e. time spent below a certain glucose level (e.g. <70 mg/dL and <54 mg/dL), is expressed as a percentage. This brief report draws attention to some limitations of TBR when expressed as an integer percentage and highlights problems introduced by rounding-off of numerical values for TBR on Ambulatory Glucose Profile and other reports from CGM and automated insulin delivery (AID) systems that may be misleading or incorrectly interpreted...

No abstract text is available yet for this article.

INTRODUCTION: The glycemia risk index (GRI) and Continuous Glucose Monitoring Index (COGI) are newly defined composite metric parameters derived from continuous glucose monitoring (CGM) data. GRI is divided into five separate risk zones (from lowest to highest: A-E). In this study, the effect of the advanced hybrid closed loop (AHCL) system on GRI and COGI in children with type 1 diabetes (T1D) was evaluated. MATERIAL AND METHODS: Forty-five children who had started using the AHCL and whose baseline and 6th-month CGM data were available were analyzed in terms of achievement of CGM consensus goals and changes in GRI scores and zones...

Type 1 diabetes and type 2 diabetes have high rates of associated exocrine pancreatic insufficiency (EPI). This review evaluated the current evidence on prevalence and treatment of EPI in type 1 and type 2 diabetes and compared general population prevalence rates of EPI and prevalence of other common gastrointestinal conditions such as celiac disease and gastroparesis based on within-diabetes rates of common gastrointestinal (GI) conditions. Prevalence of EPI in type 1 diabetes ranges from 14% to 77.5% (median 33%), while EPI in type 2 diabetes ranges from 16...

No abstract text is available yet for this article.

OBJECTIVE: To evaluate the use of faster-acting and standard insulin aspart with hybrid automated insulin delivery (AID) in active youth with type 1 diabetes. RESEARCH DESIGN AND METHODS: In this double-blind, multinational, randomized, crossover trial, 30 children and adolescents with type 1 diabetes (16 females; aged 15.0±1.7 years; baseline HbA1c 7.5±0.9%[58±9.8mmol/mol]) underwent two unrestricted four-week periods using hybrid AID with either faster-acting insulin aspart or standard insulin aspart in random order...

Not applicable.

BACKGROUND AND AIMS: A preliminary study compared the use of continuous glucose monitoring (CGM) to self-monitoring blood glucose (SMBG) by pilots with insulin-treated diabetes in the UK, Ireland, and Austria, certified to fly commercial aircraft within the European Aviation Safety Agency ARA.MED.330 protocol. METHODS: SMBG and simultaneous interstitial glucose measurements using CGM (Dexcom G6®) were recorded during pre- and in-flight periods. RESULTS: Eight male pilots (seven with type 1 diabetes; one with type 3c diabetes), median age of 48...

Irritant contact dermatitis (ICD) occurs frequently with the use of diabetes devices, but no guidelines for treatment exist. Since subsequent devices need intact skin for intended use, quick healing is crucial. Normal wound healing is expected to be 7-10 days. This was a single-center cross-over study that investigated the effectiveness of an occlusive hydrocolloid-based patch versus nonocclusive treatment of ICD. Participants were aged 6-20 years with active ICD caused by using diabetes device. First study period was patch treatment for 3 days...