7. Diabetes Technology: <i>Standards of Medical Care in Diabetes—2022</i>

Draznin, Boris; Aroda, Vanita R.; Bakris, George L.; Benson, Gretchen; Brown, F. C.; Freeman, RaShaye; Green, Jennifer; Huang, Elbert S.; Isaacs, Diana; Kahan, Scott; León, José; Lyons, Sarah K.; Peters, Anne L.; Prahalad, Priya; Reusch, Jane E.B.; Young-Hyman, Deborah Lee; Das, Sandeep R; Kosiborod, Mikhail

doi:10.2337/dc22-s007

Cited by 193 publications

(130 citation statements)

References 213 publications

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“…Individualized management of overweight and obese adults was also emphasized to prevent diabetes and comorbidities [ 26 ]. With developments of technology, it was recommended to consider technological assistance according to the individual’s preference [ 27 ].…”

Section: Standards Of Medical Care In Diabetes Of the American Diabet...mentioning

confidence: 99%

“…This change reflects the findings that opportunistic universal screening among individuals aged ≥35 years could greatly reduce the national prevalence of undiagnosed prediabetes or diabetes at a relatively low cost. In the glycemic assessment section, TIR along with A1C has been more fully incorporated into the guideline [ 27 ]. A 14-day CGM assessment of TIR and use of a glucose management indicator can serve as a surrogate for A1C in clinical management.…”

Section: Standards Of Medical Care In Diabetes Of the American Diabet...mentioning

confidence: 99%

“…The updates state that the individualization of technology type and selection is necessary both to prevent diabetes and to manage diabetes patients. Related education and evaluation of usage should also be conducted periodically [ 27 ]. The important point in the updates is that the active use of CGM devices has been added.…”

Section: Standards Of Medical Care In Diabetes Of the American Diabet...mentioning

confidence: 99%

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Recent Updates to Clinical Practice Guidelines for Diabetes Mellitus

Lee

Kim

2022

Endocrinol Metab

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Guidelines for the management of patients with diabetes have become an important part of clinical practice that improve the quality of care and help establish evidence-based medicine in this field. With rapidly accumulating evidence on various aspects of diabetes care, including landmark clinical trials of treatment agents and newer technologies, timely updates of the guidelines capture the most current state of the field and present a consensus. As a leading academic society, the Korean Diabetes Association publishes practice guidelines biennially and the American Diabetes Association does so annually. In this review, we summarize the key changes suggested in the most recent guidelines. Some of the important updates include treatment algorithms emphasizing comorbid conditions such as atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease in the selection of anti-diabetic agents; wider application of continuous glucose monitoring (CGM), insulin pump technologies and indices derived from CGM such as time in range; more active screening of subjects at high-risk of diabetes; and more detailed individualization in diabetes care. Although there are both similarities and differences among guidelines and some uncertainty remains, these updates provide a good approach for many clinical practitioners who are battling with diabetes.

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Section: Standards Of Medical Care In Diabetes Of the American Diabet...mentioning

confidence: 99%

Section: Standards Of Medical Care In Diabetes Of the American Diabet...mentioning

confidence: 99%

Section: Standards Of Medical Care In Diabetes Of the American Diabet...mentioning

confidence: 99%

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Recent Updates to Clinical Practice Guidelines for Diabetes Mellitus

Lee

Kim

2022

Endocrinol Metab

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“…For patients with type 1 diabetes (T1D) receiving insulin therapy, the American Diabetes Association (ADA) recommends the use of continuous glucose monitors (CGMs) as the standard of care along with quarterly clinic visits with hemoglobin A 1c (HbA 1c ) laboratory testing [ 1 ]. However, most people with T1D remain on self-monitored blood glucose because of patient, clinician, or insurance preference and do not meet the current HbA 1c targets [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, CGMs record glucose levels once every 5-15 minutes (96-288 times per day). The initiation and continued use of CGMs have increased and are associated with improved clinical outcomes and patient-reported quality of life measures [ 1 - 9 ]. In a US pediatric T1D registry, the use of CGMs increased from 4% in 2013 to 33% in 2017 [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Algorithm-Enabled, Personalized Glucose Management for Type 1 Diabetes at the Population Scale: Prospective Evaluation in Clinical Practice

Scheinker¹,

Gu²,

Grossman³

et al. 2022

JMIR Diabetes

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Background The use of continuous glucose monitors (CGMs) is recommended as the standard of care by the American Diabetes Association for individuals with type 1 diabetes (T1D). Few hardware-agnostic, open-source, whole-population tools are available to facilitate the use of CGM data by clinicians such as physicians and certified diabetes educators. Objective This study aimed to develop a tool that identifies patients appropriate for contact using an asynchronous message through electronic medical records while minimizing the number of patients reviewed by a certified diabetes educator or physician using the tool. Methods We used consensus guidelines to develop timely interventions for diabetes excellence (TIDE), an open-source hardware-agnostic tool to analyze CGM data to identify patients with deteriorating glucose control by generating generic flags (eg, mean glucose [MG] >170 mg/dL) and personalized flags (eg, MG increased by >10 mg/dL). In a prospective 7-week study in a pediatric T1D clinic, we measured the sensitivity of TIDE in identifying patients appropriate for contact and the number of patients reviewed. We simulated measures of the workload generated by TIDE, including the average number of time in range (TIR) flags per patient per review period, on a convenience sample of eight external data sets, 6 from clinical trials and 2 donated by research foundations. Results Over the 7 weeks of evaluation, the clinical population increased from 56 to 64 patients. The mean sensitivity was 99% (242/245; SD 2.5%), and the mean reduction in the number of patients reviewed was 42.6% (182/427; SD 10.9%). The 8 external data sets contained 1365 patients with 30,017 weeks of data collected by 7 types of CGMs. The rates of generic and personalized TIR flags per patient per review period were, respectively, 0.15 and 0.12 in the data set with the lowest average MG (141 mg/dL) and 0.95 and 0.22 in the data set with the highest average MG (207 mg/dL). Conclusions TIDE is an open-source hardware-agnostic tool for personalized analysis of CGM data at the clinical population scale. In a pediatric T1D clinic, TIDE identified 99% of patients appropriate for contact using an asynchronous message through electronic medical records while reducing the number of patients reviewed by certified diabetes care and education specialists by 43%. For each of the 8 external data sets, simulation of the use of TIDE produced fewer than 0.25 personalized TIR flags per patient per review period. The use of TIDE to support telemedicine-based T1D care may facilitate sensitive and efficient guideline-based population health management.

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Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

et al. 2023

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ImportanceContinuous glucose monitoring (CGM) is associated with improvements in hemoglobin A1c (HbA1c) in youths with type 1 diabetes (T1D); however, youths from minoritized racial and ethnic groups and those with public insurance face greater barriers to CGM access. Early initiation of and access to CGM may reduce disparities in CGM uptake and improve diabetes outcomes.ObjectiveTo determine whether HbA1c decreases differed by ethnicity and insurance status among a cohort of youths newly diagnosed with T1D and provided CGM.Design, Setting, and ParticipantsThis cohort study used data from the Teamwork, Targets, Technology, and Tight Control (4T) study, a clinical research program that aims to initiate CGM within 1 month of T1D diagnosis. All youths with new-onset T1D diagnosed between July 25, 2018, and June 15, 2020, at Stanford Children’s Hospital, a single-site, freestanding children’s hospital in California, were approached to enroll in the Pilot-4T study and were followed for 12 months. Data analysis was performed and completed on June 3, 2022.ExposuresAll eligible participants were offered CGM within 1 month of diabetes diagnosis.Main Outcomes and MeasuresTo assess HbA1c change over the study period, analyses were stratified by ethnicity (Hispanic vs non-Hispanic) or insurance status (public vs private) to compare the Pilot-4T cohort with a historical cohort of 272 youths diagnosed with T1D between June 1, 2014, and December 28, 2016.ResultsThe Pilot-4T cohort comprised 135 youths, with a median age of 9.7 years (IQR, 6.8-12.7 years) at diagnosis. There were 71 boys (52.6%) and 64 girls (47.4%). Based on self-report, participants’ race was categorized as Asian or Pacific Islander (19 [14.1%]), White (62 [45.9%]), or other race (39 [28.9%]); race was missing or not reported for 15 participants (11.1%). Participants also self-reported their ethnicity as Hispanic (29 [21.5%]) or non-Hispanic (92 [68.1%]). A total of 104 participants (77.0%) had private insurance and 31 (23.0%) had public insurance. Compared with the historical cohort, similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were observed for Hispanic individuals (estimated difference, −0.26% [95% CI, −1.05% to 0.43%], −0.60% [−1.46% to 0.21%], and −0.15% [−1.48% to 0.80%]) and non-Hispanic individuals (estimated difference, −0.27% [95% CI, −0.62% to 0.10%], −0.50% [−0.81% to −0.11%], and −0.47% [−0.91% to 0.06%]) in the Pilot-4T cohort. Similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were also observed for publicly insured individuals (estimated difference, −0.52% [95% CI, −1.22% to 0.15%], −0.38% [−1.26% to 0.33%], and −0.57% [−2.08% to 0.74%]) and privately insured individuals (estimated difference, −0.34% [95% CI, −0.67% to 0.03%], −0.57% [−0.85% to −0.26%], and −0.43% [−0.85% to 0.01%]) in the Pilot-4T cohort. Hispanic youths in the Pilot-4T cohort had higher HbA1c at 6, 9, and 12 months postdiagnosis than non-Hispanic youths (estimated difference, 0.28% [95% CI, −0.46% to 0.86%], 0.63% [0.02% to 1.20%], and 1.39% [0.37% to 1.96%]), as did publicly insured youths compared with privately insured youths (estimated difference, 0.39% [95% CI, −0.23% to 0.99%], 0.95% [0.28% to 1.45%], and 1.16% [−0.09% to 2.13%]).Conclusions and RelevanceThe findings of this cohort study suggest that CGM initiation soon after diagnosis is associated with similar improvements in HbA1c for Hispanic and non-Hispanic youths as well as for publicly and privately insured youths. These results further suggest that equitable access to CGM soon after T1D diagnosis may be a first step to improve HbA1c for all youths but is unlikely to eliminate disparities entirely.Trial RegistrationClinicalTrials.gov Identifier: NCT04336969

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7. Diabetes Technology: Standards of Medical Care in Diabetes—2022

Cited by 193 publications

References 213 publications

Recent Updates to Clinical Practice Guidelines for Diabetes Mellitus

Recent Updates to Clinical Practice Guidelines for Diabetes Mellitus

Algorithm-Enabled, Personalized Glucose Management for Type 1 Diabetes at the Population Scale: Prospective Evaluation in Clinical Practice

Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

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7. Diabetes Technology: Standards of Medical Care in Diabetes—2022

Cited by 193 publications

References 213 publications

Recent Updates to Clinical Practice Guidelines for Diabetes Mellitus

Recent Updates to Clinical Practice Guidelines for Diabetes Mellitus

Algorithm-Enabled, Personalized Glucose Management for Type 1 Diabetes at the Population Scale: Prospective Evaluation in Clinical Practice

Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring

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Product

Resources

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Disparities in Hemoglobin A_1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring