Health-Related Quality of Life and Treatment Satisfaction in the Sensor-Augmented Pump Therapy for A1C Reduction 3 (STAR 3) Trial

Rubin, Richard R.; Peyrot, Mark

doi:10.1089/dia.2011.0162

Cited by 74 publications

(63 citation statements)

References 23 publications

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“…Treatment satisfaction in those randomized to RT was no greater than in those continuing on conventional SMBG, in keeping with other studies reporting both benefits and hassles with RT (32). Our study demonstrated similar reduction in fear of hypoglycemia in all groups, whereas previous studies have tended to favor technology over MDI/SMBG regimens (33).…”

Section: Baselinesupporting

confidence: 67%

Recovery of Hypoglycemia Awareness in Long-standing Type 1 Diabetes: A Multicenter 2 × 2 Factorial Randomized Controlled Trial Comparing Insulin Pump With Multiple Daily Injections and Continuous With Conventional Glucose Self-monitoring (HypoCOMPaSS)

et al. 2014

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OBJECTIVETo determine whether impaired awareness of hypoglycemia (IAH) can be improved and severe hypoglycemia (SH) prevented in type 1 diabetes, we compared an insulin pump (continuous subcutaneous insulin infusion [CSII]) with multiple daily injections (MDIs) and adjuvant real-time continuous glucose monitoring (RT) with conventional self-monitoring of blood glucose (SMBG). RESEARCH DESIGN AND METHODSA 24-week 2 3 2 factorial randomized controlled trial in adults with type 1 diabetes and IAH was conducted. All received comparable education, support, and congruent therapeutic targets aimed at rigorous avoidance of biochemical hypoglycemia without relaxing overall control. Primary end point was between-intervention difference in 24-week hypoglycemia awareness (Gold score). RESULTSA total of 96 participants (mean diabetes duration 29 years) were randomized. Overall, biochemical hypoglycemia (£3.0 mmol/L) decreased (53 6 63 to 24 6 56 min/24 h; P = 0.004 [t test]) without deterioration in HbA 1c . Hypoglycemia awareness improved (5.1 6 1.1 to 4.1 6 1.6; P = 0.0001 [t test]) with decreased SH (8.9 6 13.4 to 0.8 6 1.8 episodes/patient-year; P = 0.0001 [t test]). At 24 weeks, there was no significant difference in awareness comparing CSII with MDI (4.1 6 1.6 vs. 4.2 6 1.7; difference 0.1; 95% CI 20.6 to 0.8) and RT with SMBG (4.3 6 1.6 vs. 4.0 6 1.7; difference 20.3; 95% CI 21.0 to 0.4). Between-group analyses demonstrated comparable reductions in SH, fear of hypoglycemia, and insulin doses with equivalent HbA 1c . Treatment satisfaction was higher with CSII than MDI (32 6 3 vs. 29 6 6; P = 0.0003 [t test]), but comparable with SMBG and RT (30 6 5 vs. 30 6 5; P = 0.79 [t test]). CONCLUSIONSHypoglycemia awareness can be improved and recurrent SH prevented in longstanding type 1 diabetes without relaxing HbA 1c . Similar biomedical outcomes can be attained with conventional MDI and SMBG regimens compared with CSII/RT, although satisfaction was higher with CSII.

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Section: Baselinesupporting

confidence: 67%

Recovery of Hypoglycemia Awareness in Long-standing Type 1 Diabetes: A Multicenter 2 × 2 Factorial Randomized Controlled Trial Comparing Insulin Pump With Multiple Daily Injections and Continuous With Conventional Glucose Self-monitoring (HypoCOMPaSS)

et al. 2014

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“…It could also impact quality of life and explain inconsistent related outcomes reported in previous studies. [15][16][17] The wider adoption of CGM technology still faces challenges related to cost, reliability, comfort, ease of use, and integration with other technologies. 18 A limitation specific to the Combo-Set itself is that there is a difference between the current recommendations for optimal duration for use of the insulin delivery catheter (3 days) and the glucose sensor (6 days).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Adjacent Insulin Infusion and Continuous Glucose Monitoring via the Medtronic Combo-Set

O’Neal

Adhya

Jenkins

et al. 2013

J Diabetes Sci Technol

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“…62 Responders were also more likely than nonresponders to report their partner was interested in their CGM. 62 Several studies reported no QOL differences with SAPT, 57,61,63 but others found that SAPT improved diabetesspecific HRQOL (Hypoglycaemia Fear Survey Worry and Behaviour subscales) 58,59 and health and social functioning. 60 This is reassuring as there have been concerns that CGM data overload could have negative effects on QOL.…”

Section: 52mentioning

confidence: 99%

Influences on Technology Use and Efficacy in Type 1 Diabetes

Franklin

2016

J Diabetes Sci Technol

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Since 1921 technology has existed to replace insulin and treat diabetes. Although a definitive link was established between HbA1c and complication risk over 20 years ago, 1 only a minority achieve HbA1c targets despite intensified insulin regimens and new technologies. 2 This narrative review focuses on how psychosocial functioning affects uptake and use of technologies and the impact of technology on psychosocial outcomes in adults and children with type 1 diabetes and their caregivers. It examines evidence from large meta-analyses to small qualitative studies which provide detailed insight into technology use. Self Monitoring of Blood GlucoseFrequent blood glucose testing should be a routine part of diabetes self-care 3,4 as it is integral to intensive insulin therapy 1 and improves glycemic control. 5 However, studies of adult patients reveal low testing frequency, 6,7 which is influenced by psychosocial factors, with increased testing in patients of older age, female gender, longer diabetes duration, on basal bolus therapy compared with less intensive regimens, with decreased hypoglycemic awareness, higher "fear of hypoglycemia" and positive self-care personality traits 6 and less testing in ethnic minorities, smokers, those with low education, 8 low income and language barriers. 7 In adolescents, testing is more frequent in younger age groups, higher social status, and higher self-efficacy and less frequent in those with lower self-esteem, high-stress life events, lower parental support, 9,10 from single parent, lower-income, and ethnic minorities, and when given self-care autonomy before reaching cognitive and social maturity.11 In children, family functioning 12 and parental education 13 predict adherence to diabetes self-management and glycemic control.Qualitative studies in adults show that some perceive selfmonitoring of blood glucose (SMBG) as a tool to achieve good control and a normal life, but others see SMBG as a 639315D STXXX10.1177/1932296816639315Journal of Diabetes Science and TechnologyFranklin AbstractThe majority of people with type 1 diabetes have suboptimal glycemic control, increasing their complication risk. Technology to support diabetes self-care has advanced significantly and includes self-monitoring of blood glucose (SMBG), insulin pump therapy (IPT), continuous glucose monitoring (CGM), and sensor-augmented pump therapy (SAPT), which are stepping stones toward the "artificial pancreas" using closed-loop technology. Use of these technologies improves clinical outcomes for patients with the appropriate skills and motivation. This review addresses the psychosocial factors that influence both technology provision and clinical outcome and also how technology impacts on psychological outcomes. Optimal use of the various diabetes self-management technologies is influenced by previous self-care behaviors, demographic and psychological factors. Provision of IPT is also influenced by the same factors. Despite technology increasing the complexity of treatment, the lack of evidence for adverse...

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Health-Related Quality of Life and Treatment Satisfaction in the Sensor-Augmented Pump Therapy for A1C Reduction 3 (STAR 3) Trial

Cited by 74 publications

References 23 publications

Recovery of Hypoglycemia Awareness in Long-standing Type 1 Diabetes: A Multicenter 2 × 2 Factorial Randomized Controlled Trial Comparing Insulin Pump With Multiple Daily Injections and Continuous With Conventional Glucose Self-monitoring (HypoCOMPaSS)

Recovery of Hypoglycemia Awareness in Long-standing Type 1 Diabetes: A Multicenter 2 × 2 Factorial Randomized Controlled Trial Comparing Insulin Pump With Multiple Daily Injections and Continuous With Conventional Glucose Self-monitoring (HypoCOMPaSS)

Feasibility of Adjacent Insulin Infusion and Continuous Glucose Monitoring via the Medtronic Combo-Set

Influences on Technology Use and Efficacy in Type 1 Diabetes

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