Poor adherence to integral daily tasks limits the efficacy of CSII in youth

Glucose monitoring either by self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM) plays an important role in diabetes management and in reducing risk for diabetes-related complications. However, despite evidence supporting the role of glucose monitoring in better patient health outcomes, studies also reveal relatively poor adherence rates to SMBG and CGM use and numerous patient-reported barriers. Fortunately, some promising intervention strategies have been identified that promote at least short-term improvements in patients' adherence to SMBG. These include education, problem solving, contingency management, goal setting, cognitive behavioral therapy, and motivational interviewing. Specific to CGM, interventions to promote greater use among patients are currently under way, yet one pilot study provides data suggesting better maintenance of CGM use in patients showing greater readiness for behavior change. The purpose of this review is to summarize the literature specific to glucose monitoring in patients with diabetes focusing specifically on current adherence rates, barriers to monitoring, and promising intervention strategies that may be ready to deploy now in the clinic setting to promote greater patient adherence to glucose monitoring. Yet, to continue to help patients with diabetes adhere to glucose monitoring, future research is needed to identify the treatment strategies and the intervention schedules that most likely lead to long-term maintenance of optimal glycemic monitoring levels.

Section: Smbgmentioning

confidence: 99%

mentioning

confidence: 99%

Adherence to Glycemic Monitoring in Diabetes

Patton

2015

“…[4][5][6][7] While CSII can provide increased meal and exercise flexibility relative to injectable insulin regimens, achievement of adequate glycemic control remains highly dependent on user behavior. [8][9][10] Achievement of target HbA1c has repeatedly been shown to positively correlate with the number of BGLs performed per day, both in youth on injectable insulin regimens and in those utilizing CSII. 8,[11][12][13][14][15][16][17] Studies of this correlation have mainly relied on BGL data obtained from self-report or logbook, with few studies using objective BGL data extracted directly from glucometers.…”

Section: Original Articlementioning

confidence: 99%

“…[8][9][10] Achievement of target HbA1c has repeatedly been shown to positively correlate with the number of BGLs performed per day, both in youth on injectable insulin regimens and in those utilizing CSII. 8,[11][12][13][14][15][16][17] Studies of this correlation have mainly relied on BGL data obtained from self-report or logbook, with few studies using objective BGL data extracted directly from glucometers. [15][16][17] For BGLs to positively impact on glycemia with use of CSII, they need to be performed and also entered into the user's pump, to enable correction insulin delivery when required.…”

Section: Original Articlementioning

confidence: 99%

Can Integrated Technology Improve Self-Care Behavior in Youth With Type 1 Diabetes? A Randomized Crossover Trial of Automated Pump Function

Neylon

O’Connell

Donath

et al. 2014

Background: Automated blood glucose (BG) and insulin pump systems allow wireless transmission of all BG readings to a user's pump. This study aimed to assess whether use of such a system, as compared with a manual BG entry insulin pump, resulted in higher mean daily frequency of BGs recorded after 6 months. Methods:A 12-month randomized crossover trial, comprising 2 phases, was conducted. All participants used insulin pump devices with automated vs manual BG entry for 6 months each; order of system use was randomly assigned. Device interactions were assessed from pump and glucometer downloads.Results: Thirty-five participants were enrolled; 9 withdrew during the study. Use of the automated insulin pump system resulted in higher mean daily BG recorded over 6 months of use when compared to a manual BG entry system (5.8 ± 1.7 vs 5.0 ± 1.9; P = .02 [95% confidence interval, 0.14 to 1.58]). Bolus frequency was similar between groups. No HbA1c difference was observed between groups at 6 months (8.0% [64 mmol/l] ± 1.3 automated vs 7.7% [61 mmol/l] ± 0.9 manual; P = .38). Post hoc analysis demonstrated improved ∆HbA1c with automated system use in an adolescent subgroup with suboptimal baseline BG frequency (-0.9% vs + 0.5%; P = .003). Conclusions:Use of an automated glucometer/insulin pump resulted in higher number of BGs recorded over 6 months when compared to an insulin pump with manual BG entry. This may be especially beneficial for adolescent manual system users who enter <5 BGs per day into their pump.

“…2 Pump data downloaded from 100 adolescents in Australia found a similar daily bolus frequency of 6.1 per day. 13 Time intervals between boluses from this study would average between 2.95 to 3.93 hours if boluses were given during an 18-hour daytime period or during the entire 24-hour day, respectively. These data suggest that insulin stacking is common and that at least two-thirds of all boluses involve some degree of stacking.…”

mentioning

confidence: 99%

Confusion Regarding Duration of Insulin Action

Walsh

Roberts²,

Heinemann

2014

Modern insulin pumps assist wearers in achieving their metabolic goal of an optimal A1c with low glycemic variability. When basal/bolus therapy is used in insulin-requiring patients, administration of basal insulin by insulin pumps or with syringes averages 48% to 54% of the total daily insulin dose (TDD) with interindividual variation. 1-3 Basal insulin's role is to maintain a steady glycemia in the fasting state. A pump's bolus calculator (BC) assists with the more complex bolus dose calculations that a user encounters in daily life when it comes to determination of bolus insulin doses. 4 A BC's role is to support the user by recommending adequate bolus doses needed to balance carbohydrate (carb), fat, and protein intake (often simplified as carb counting), and to correct episodes of hyperglycemia. Bolus doses are frequently taken within a few hours of each other while prior insulin boluses retain a substantial degree of glucose-lowering activity. This activity, measured as bolus insulin on board (BOB or IOB) typically lasts more than 5 hours with today's rapid-acting insulin analogs. 5-10 For example, in Mudaliar and colleagues' clamp study of insulin aspart (0.2 U/kg), on which the curvilinear decline in rapid-acting insulin activity was largely based, about 40% of aspart's activity remained at 3 hours following an abdominal injection. 11 BOB, measured in units of insulin, is monitored through the day by the BC to account for the residual glucose-lowering activity from prior boluses to avoid insulin stacking that would otherwise begin after the first bolus of the day. The accuracy of a pump's duration of insulin action (DIA) setting is critical for assessing the number of units of BOB and appropriately reducing the size of the next bolus dose. Regardless of the duration over which a bolus or injection will lower the glucose, the BC uses the DIA value entered to calculate residual insulin or BOB.