An effective and cost‐saving structured education program teaching
            <scp>dynamic</scp>
            glucose management strategies to a socio‐economically deprived cohort with type 1 diabetes in a
            <scp>VIRTUAL</scp>
            setting

Pemberton, J.; Barrett, Timothy; Dias, Renuka; Kershaw, Melanie; Krone, Ruth; Uday, Suma

doi:10.1111/pedi.13381

Cited by 6 publications

(11 citation statements)

References 35 publications

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“…This suggests using moderate activity to quickly treat hyperglycemia between meals may be a novel strategy worth exploring in clinical trials. In addition, for 100 youths, the implementation of the mnemonic “GAME,” Glucose time in range desired, Alert on high set accordingly, Mode of moderate‐intensity activity, Exercise on high alert between meals if possible for 10–40 min depending on glucose value and trend arrow, was the strongest predictor of time in range (3.9–10.0 mmol/L or 70–180 mg/dl) 6 months after attending structured education focused on pro‐active CGM management 131 . A strategy like this may offer parents and children another option to improve time in range by quickly lowering between‐meal hyperglycemia, provided the blood ketone level is not elevated.…”

Section: Integrating Insulin and Nutrition Strategies For Acute Exerc...mentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

et al. 2022

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Section: Integrating Insulin and Nutrition Strategies For Acute Exerc...mentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

et al. 2022

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“…Study Population. CYPD attending the "CGM Academy" from April 2019 to January 2022 at our centre [14]. All CYPD at Birmingham Children's Hospital who were initiated on CGM as per the National Institute for Health and Care Excellence (NICE) [15] criteria attended the CGM academy.…”

Section: Methodsmentioning

confidence: 99%

“…At our tertiary centre, as part of our continuous glucose monitoring (CGM) structured education programme, the "CGM Academy" initiated in 2019, we have taught the use of 10-15 min moderate activity between meals to lower blood glucose by ∼2.0 mmol/L [13,14]. We have previously reported the effectiveness of our structured education programme (n = 100) and demonstrated that using short bursts of activity to lower hyperglycaemia between meals is one of the strongest predictors of improved TIR [14]. In the current report, we aimed to further evaluate the specific relationship between the level of activity used and its effect on lowering hyperglycaemia and the risk of hypoglycaemia in the CGM academy cohort.…”

Section: Introductionmentioning

confidence: 99%

Integrating Physical Activity Strategies to Lower Hyperglycaemia in Structured Education Programmes for Children and Young People with Type 1 Diabetes Improves Glycaemic Control without Augmenting the Risk of Hypoglycaemia

et al. 2023

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Objectives. Investigate the effect of using short bursts of moderate-intensity activity between meals to lower hyperglycaemia on glucose metrics. Design and Methods. Children and young people with type 1 diabetes (CYPD) attending continuous glucose monitoring education were taught to use moderate-intensity activity to lower high glucose levels (to <10.0 mmol/L using 10–15 minlowers ∼2.0 mmol/L) between meals. Retrospective cross-sectional data analysis of CYPD at a single tertiary centre between 2019 and 2022. Data were collected on demographics and glucose metrics (HbA1c, time in range (TIR, 3.9–10.0 mmol/L), time above range (TAR, >10.0 mmol/L), time below range (TBR, <3.9 mmol/L)). Minutes of activity usually performed to lower a glucose level of 14.0 mmol/L trending steady at 6 months grouped the CYPD into low (<5 min), mild (5–10 min), or moderate (11–20 min) activity groups. Results. 125 (n = 53, 40% male) CYPD with a mean (standard deviations) age of 12.3 (±3.7) years and diabetes duration of 7.0 ± 3.7 years were included. HbA1c improved from 58.5 (±8.6) mmol/mol at baseline to 54.9 (±7.2) mmol/mol at 6 months ( p < 0.001 ). Low, mild, and moderate activity was reported by 30% (n = 37), 34% (n = 43), and 36% (n = 45), respectively. At 6 months, HbA1c (52.0 vs. 54.3 vs. 59.4 mmol/mol, p < 0.001 ), TIR (68.0% vs. 59.71 vs. 51.1%, p < 0.001 ) and TAR (29.9% vs. 38.3% vs. 45.3%, p < 0.001 ) were significantly different across the moderate, mild, and low activity groups, respectively. No association was found for TBR (2.16% vs. 2.32% vs. 2.58%, p = 0.408 ) across groups. Conclusion. Increasing the use of moderate-intensity activity to lower hyperglycaemia between meals is associated with improved glucose control without increasing hypoglycaemia for CYPD.

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“… 23 24 We have successfully implemented this model in our CGM academy. 6 Inspired by this, we developed a similar virtual flipped learning programme catering for each AID system and evaluated its efficacy.…”

Section: Introductionmentioning

confidence: 99%

Enhancing equity in access to automated insulin delivery systems in an ethnically and socioeconomically diverse group of children with type 1 diabetes

Pemberton,

Collins,

Drummond

et al. 2024

BMJ Open Diab Res Care

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IntroductionManufacturer-supported didactic teaching programmes offer effective automated insulin delivery (AID) systems onboarding in children and young people (CYP) with type 1 diabetes (T1D). However, this approach has limited flexibility to accommodate the needs of families requiring additional support.Research design and methodsEvaluate the efficacy of an inperson manufacturer-supported didactic teaching programme (Group A), in comparison to a flexible flipped learning approach delivered virtually or inperson (Group B). Retrospective analysis of CYP with T1D using continuous glucose monitoring (CGM), who were initiated on AID systems between 2021 and 2023. Compare CGM metrics from baseline to 90 days for both groups A and B. Additionally, compare the two groups for change in CGM metrics over the 90-day period (∆), patient demographics and onboarding time.ResultsGroup A consisted of 74 CYP (53% male) with median age of 13.9 years and Group B 91 CYP (54% male) with median age of 12.7 years. From baseline to 90 days, Group A lowered mean (±SD) time above range (TAR, >10.0 mmol/L) from 47.6% (±15.0) to 33.2% (±15.0) (p<0.001), increased time in range (TIR, 3.9–10.0 mmol/L) from 50.4% (±14.0) to 64.7% (±10.2) (p<0.001). From baseline to 90 days, Group B lowered TAR from 51.3% (±15.1) to 34.5% (±11.3) (p<0.001) and increased TIR from 46.5% (±14.5) to 63.7% (±11.0) (p<0.001). There was no difference from baseline to 90 days for time below range (TBR, <3.9 mmol/L) for Group A and Group B. ∆ TAR, TIR and TBR for both groups were comparable. Group B consisted of CYP with higher socioeconomic deprivation, greater ethnic diversity and lower carer education achievement (p<0.05). The majority of Group B (n=79, 87%) chose virtual flipped learning, halving diabetes educator time and increasing onboarding cadence by fivefold.ConclusionsA flexible virtual flipped learning programme increases onboarding cadence and capacity to offer equitable AID system onboarding.

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An effective and cost‐saving structured education program teaching dynamic glucose management strategies to a socio‐economically deprived cohort with type 1 diabetes in a VIRTUAL setting

Cited by 6 publications

References 35 publications

ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

Integrating Physical Activity Strategies to Lower Hyperglycaemia in Structured Education Programmes for Children and Young People with Type 1 Diabetes Improves Glycaemic Control without Augmenting the Risk of Hypoglycaemia

Enhancing equity in access to automated insulin delivery systems in an ethnically and socioeconomically diverse group of children with type 1 diabetes

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