Diabetes Technology & Therapeutics

Objective To date, there are no widely implemented machine learning (ML) models that predict progression from prediabetes to diabetes. Addressing this knowledge gap would aid in identifying at-risk patients within this heterogeneous population who may benefit from targeted treatment and management in order to preserve glucose metabolism and prevent adverse outcomes. The objective of this study was to utilize readily available laboratory data to train and test the performance of ML-based predictive risk models for progression from prediabetes to diabetes...

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Aims We evaluated attainment of the HbA1c target of ≤7.0%, its temporal trends, and associated factors among adults with type 1 diabetes in Ontario, Canada using administrative data. Methods We conducted a retrospective cohort study including Ontarians with type 1 diabetes ≥18 years old with ≥1 HbA1c test between April 1, 2012 (fiscal year 2013) and March 31, 2023. Generalized estimating equations were used to determine probabilities of meeting the HbA1c target, as well as associations between fiscal year and individual-, physician-, and system-level factors on odds of meeting the target...

BACKGROUND: Despite the known glycemic benefits of continuous glucose monitoring (CGM) for adults with type 2 diabetes (T2D), the attitudinal and behavioral changes underlying these glycemic improvements remain understudied. This study aimed to qualitatively explore these changes among a sample of adults with T2D. METHODS: In-depth, semi-structured interviews were conducted with adults with T2D who had been using CGM for 3 - 6 months as part of a larger community project in Ohio...

INTRODUCTION & OBJECTIVE: Most patients with type 1 diabetes (T1D) in the USA are overweight (OW) or obese (OB), contributing to insulin resistance and suboptimal glucose control. The primary FDA approved treatment for T1D is insulin, which may adversely affect weight. Tirzepatide is approved for managing type 2 diabetes, improves glucose control, facilitates weight loss, and improves CVD outcomes. We assessed the use of tirzepatide in OW/OB subjects with T1D. METHODS: This was a retrospective single-center, real-world study in 62 OW/OB adult patients with T1D who were prescribed tirzepatide (treated group) and followed for one year...

Context : Limited evidence is available on the real-world effect of insulin degludec (IDeg) in type 1 diabetes (T1D), using continuous glucose monitoring (CGM)-derived metrics. Objective : To assess the real-world effect of switching to IDeg from other long-acting insulins on time in ranges measured by CGM, metabolic control, and insulin dose for people with T1D. Design : This retrospective multicenter study encompassed five time points during a 12-month pre-switch of IDeg and a 12-month follow-up period. For each visit, clinical and CGM data were collected to evaluate temporal trends in glycemic outcomes...

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Introduction This study examined associations between hypoglycemia awareness status and hypoglycemia symptoms reported in real-time using the novel Hypo-METRICS smartphone application (app) among adults with insulin-treated type 1 (T1D) or type 2 diabetes (T2D). Methods Adults who experienced at least one hypoglycemic episode in the previous three months were recruited to the Hypo-METRICS study. They prospectively reported hypoglycemia episodes using the app for 10 weeks. Any of eight hypoglycemia symptoms were considered present if intensity was rated between 'A little bit' to 'Very much' and absent if rated 'Not at all'...

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INTRODUCTION: This study aimed to compare efficacy and safety of ultra-rapid-acting insulin analogs (URAI; Faster Aspart - FAsp, Ultra-rapid Lispro - URLi, and Insulin Technosphere - TI) with rapid-acting insulin analogs (RAI) in individuals with type 1 (T1D) or type 2 diabetes (T2D). METHODS: Searching for RCT comparing the effects of URAI versus RAI that lasted at least 12 weeks, we initially selected 15 studies for analysis. Three studies involving TI were excluded due to a high degree of heterogeneity...

Aims: Diabetic ketoacidosis (DKA) is a serious life-threatening condition caused by a lack of insulin, which leads to elevated plasma glucose and metabolic acidosis. Early identification of developing DKA is important to start treatment and minimize complications and risk of death. The aim of the present study is to develop and test prediction model(s) that gives an alarm about their risk of developing elevated ketone bodies during hyperglycemia. Methods: We analyzed data from 138 type 1 diabetes patients with measurements of ketone bodies and continuous glucose monitoring (CGM) data from over 30,000 days of wear time...

BACKGROUND: Despite new pharmacotherapy, most patients with long-term Type 2 Diabetes are still hyperglycemic. This could have been solved by insulin with its unlimited potential efficacy, but its dynamic physiology demands frequent titrations which are overdemanding. This report provides a real-life account for a scalable transformation of diabetes care in a community-based endocrinology center by harnessing AI-based autonomous insulin titration. METHODS: The center embedded the d-Nav® technology and its dedicated clinical support...

INTRODUCTION: Sodium glucose cotransporter (SGLT) inhibitors may increase beta-hydroxybutyrate (BHB) in insulin-requiring patients. We determined factors associated with BHB changes from baseline (ΔBHB) and diabetic ketoacidosis (DKA) in patients with type 1 diabetes (T1D) receiving sotagliflozin as an insulin adjunct. RESEARCH DESIGN AND METHODS: This post-hoc analysis compared ΔBHB levels in adults with T1D receiving sotagliflozin 400 mg or placebo for 6 months...

This study aimed to evaluate the impact of advanced hybrid closed-loop (AHCL) on glycemic control throughout the menstrual cycle (MC) in women with type 1 diabetes (T1D). We included 39 pairs of spontaneous MC from 13 participants, before and after switching from sensor-augmented pump to AHCL. Baseline time below range <70 mg/dL (TBR<70) was significantly higher during the mid-follicular phase than during late luteal phase (5.7±5.0% vs. 4.1±3.0%), but similar time in range 70-180 mg/dL (TIR) was observed throughout the MC...

Objective Continuous glucose monitoring (CGM) devices are integral in the outpatient care of people with type 1 diabetes (T1D), though they lack inpatient labeling. FDA began allowing inpatient use during the COVID-19 pandemic, with some accuracy data now available, primarily from adult hospitals. Pediatric inpatient data remains limited, particularly during DKA admissions and for patients receiving IV insulin. Design and Methods This retrospective chart review compared point of care (POC) glucose values to personal Dexcom G6 sensor data during pediatric hospitalizations...

Introduction: The Closing the Loop in Adults With Type 1 Diabetes (CLEAR) randomized crossover study compared a novel fully closed-loop insulin delivery system with no carbohydrate entry or mealtime bolusing (CamAPS HX), with standard insulin pump therapy and glucose sensor in adults with type 1 diabetes and suboptimal glycemic outcomes. This qualitative substudy aimed to understand the psychosocial impact of using the fully automated system. Materials and Methods: Adults participating in the CLEAR study were invited to take part in a virtual semistructured interview after they had completed 8 weeks using the fully closed-loop system...

BACKGROUND: Carbohydrate counting (CC) and meal announcements, prior to eating, introduce a significant burden for individuals managing type 1 diabetes (T1D). An automated insulin delivery (AID) system with automatic bolusing that eliminates the need for CC and pre-meal bolusing (i.e., a hands-free closed-loop system) was assessed in a feasibility trial of adults with T1D. METHODS: The system included the MiniMed™ 780G pump and a smartphone-paired smartwatch with the Klue application (Klue, Inc...

BACKGROUND: Managing exercise in type 1 diabetes (T1D) is challenging, in part because different types of exercise can have diverging effects on glycemia. The aim of this work was to develop a classification model that can classify an exercise event (structured or unstructured) as aerobic, interval or resistance for the purpose of incorporation into an automated insulin delivery (AID) system. METHODS: A long short-term memory (LSTM) network model was developed with real world data from 30-minute structured sessions of at-home exercise (aerobic, resistance, or mixed) using tri-axial accelerometer, heart rate and activity duration information...

OBJECTIVE: Since the introduction of continuous glucose monitoring technology, developers have rigorously researched the feasibility of creating a noninvasive glucose monitoring device. In a recent pilot study, investigators reported a strong correlation between glucose values obtained from novel, noninvasive monitoring device (GWave) values to venous and capillary glucose measurements. RESEARCH DESIGN AND METHODS: We investigated if the level of accuracy observed in the pilot study could be reproduced in a larger cohort, using a smaller third-generation, manufacturable device (Gen III GWave) containing a standardized sensor chip that can be mass produced for commercial use...