Real-Time Sharing and Following of Continuous Glucose Monitoring Data in Youth

Welsh, John; Derdzinski, Mark; Parker, Andrew S.; Puhr, Sarah; Jimenez, Annika; Walker, Tomas C.

doi:10.1007/s13300-019-0571-0

Cited by 36 publications

(23 citation statements)

References 11 publications

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“…The number of Dexcom Followers was the strongest predictor for reducing TBR suggesting that this functionality is protective. Our data is similar to the assessment of over 25,000 users that showed Dexcom Followers was associated with less TBR 40 . With the option of up to five followers when using the Dexcom G6 mobile app, it is advisable to promote appropriate followers.…”

Section: Discussionsupporting

confidence: 82%

DYNAMIC: Dynamic glucose management strategies delivered through a structured education program improves time in range in a socioeconomically deprived cohort of children and young people with type 1 diabetes with a history of hypoglycemia

et al. 2021

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Objectives Create and evaluate the effectiveness of a structured education program in children and young people (CYP) with type 1 diabetes using continuous glucose monitoring (CGM). Design and methods Step 1: CGM devices were evaluated for predetermined criteria using a composite score. Step 2: The education program was developed following review of international structured education guidance, dynamic glucose management (DynamicGM) literature, award‐winning diabetes educators' websites, and CGM user feedback. Step 3: Program effectiveness was assessed at six months by change in time below range (TBR) (<3.9mmol/L), time in range (TIR) (3.9‐10.0mmol/L), time above range level 2 (TAR2) (>13.9mmol/L), severe hypoglycemia and HbA1c using a paired T‐test. A DynamicGM score was developed to assess proactive glucose management. Factors predicting TBR and TIR were assessed using regression analysis. Results Dexcom G6 was chosen for integrated CGM (iCGM) status and highest composite score (29/30). Progressive DynamicGM strategies were taught through five sessions delivered over two months. Fifty CYP (23 male) with a mean (±SD) age and diabetes duration of 10.2 (±4.8) and 5.2 (±3.7) years respectively, who completed the education program were prospectively evaluated. Evaluation at six months showed a significant reduction in TBR (10.4% to 2.1%, p<.001), TAR2 (14.1% to 7.3%, p<.001), HbA1c [7.4 to 7.1% (57.7 to 53.8 mmol/mol), p<.001] and severe hypoglycemic episodes (10 to 1, p<.05); TIR increased (47.4% to 57.0%, p<.001). Number of Dexcom followers (p<.05) predicted reduction in TBR and DynamicGM score (p<.001) predicted increased TIR. Conclusion Teaching DynamicGM strategies successfully improves TIR and reduces hypoglycemia.

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Section: Discussionsupporting

confidence: 82%

DYNAMIC: Dynamic glucose management strategies delivered through a structured education program improves time in range in a socioeconomically deprived cohort of children and young people with type 1 diabetes with a history of hypoglycemia

et al. 2021

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“…In families, Share is often used by parents to monitor their young children; use of Share was associated with less hypoglycemia in youth in a large real-world study. 16 The Share feature also allows for use of CLARITY software by clinicians to remotely manage patients with new-onset T1D 17 or who are at high risk for diabetic ketosis and hyperglycemia. 18 In the hospital, several studies have described how remote monitoring with Share can be used to reduce inpatient hypoglycemia, 19 improve glucose management, 20 and potentially reduce the need for personal protective equipment in the setting of COVID-19.…”

Section: Conclusion/discussionmentioning

confidence: 99%

Real-World Evidence and Glycemic Improvement Using Dexcom G6 Features

Aktürk¹,

Dowd

Shankar

et al. 2021

Diabetes Technology & Therapeutics

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Background: Optional features of continuous glucose monitoring (CGM) systems empower patients and caregivers to understand and manage diabetes in new ways. We examined associations between use of optional features, demographics, and glycemic outcomes. Methods: Retrospective cohort studies were performed with data from US-based users of the G6 CGM System (Dexcom, Inc.). For all cohorts, data included sensor glucose values (SGVs). In separate cohorts, use of alert features (for hyperglycemia, existing hypoglycemia, and impending hypoglycemia), remote data sharing feature (Share), software for retrospective pattern analysis (CLARITY), ''virtual assistant'' feature that announces the current SGV and trend in response to a spoken request were assessed. Descriptive statistics were used to summarize feature set utilization patterns and relate them to glycemic outcomes. Results: Most individual features were consistently adopted by high proportions of G6 users. Threshold SGVs chosen for activating hyperglycemia and hypoglycemia alerts varied with age and were higher among the youngest and oldest patients. Use of the Share feature was more common among young patients and those with type 1 diabetes. Individuals who used more of the alert and notification features had more favorable glycemic outcomes, including time in range (TIR), than those who used fewer. More extensive engagement with CLARITY notifications was associated with higher TIR. Frequent use of the virtual assistant feature was associated with higher TIR and lower mean SGV. Conclusions: Optional features of the G6 CGM system are acceptable to and appear to benefit patients who use them. Different levels of engagement suggest that demographics and personal circumstances play a role in how patients and caregivers use CGM features to help manage diabetes.

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“…Data collected with CGM have also provided an important tool for testing the feasibility and effectiveness of insulin delivery systems, insulin treatments, adjunctive diabetes medications, T1D screening, new glucose monitoring systems, algorithms for the promotion of improved glycemic control, sensor-augmented therapy algorithms, and closed-loop systems ; diabetes alert dogs [92]; education programs aimed at improving impaired hypoglycemia unawareness, daily therapy decisions, and cardiovascular health [93][94][95]; and use of glucose sharing data with others [96]. This technology has also been used to assess the relationship between continuous glucose measures and other diabetes-related outcomes, including long-term glycemic control, dysglycemia [97,98], future T1D diagnosis or dysglycemia in preclinical youth [99][100][101], HbA 1c [102][103][104][105], C-peptide [102], insulin sensitivity [106], severe hypoglycemia [107], time in target range [108][109][110], glucose variability [109][110][111][112][113], detection of hypo-or hyperglycemia [108][109][110][114][115][116], glycated albumin [104], fructosamine [104], and 1,5-anhydroglucitrol [104].…”

Section: Using Cgm To Measure Outcomesmentioning

confidence: 99%

Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies

Ray¹,

McMichael²,

Rivera-Santana³

et al. 2021

JMIR Diabetes

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Type 1 diabetes (T1D) is one of the most common chronic childhood diseases, and its prevalence is rapidly increasing. The management of glucose in T1D is challenging, as youth must consider a myriad of factors when making diabetes care decisions. This task often leads to significant hyperglycemia, hypoglycemia, and glucose variability throughout the day, which have been associated with short- and long-term medical complications. At present, most of what is known about each of these complications and the health behaviors that may lead to them have been uncovered in the clinical setting or in laboratory-based research. However, the tools often used in these settings are limited in their ability to capture the dynamic behaviors, feelings, and physiological changes associated with T1D that fluctuate from moment to moment throughout the day. A better understanding of T1D in daily life could potentially aid in the development of interventions to improve diabetes care and mitigate the negative medical consequences associated with it. Therefore, there is a need to measure repeated, real-time, and real-world features of this disease in youth. This approach is known as ecological momentary assessment (EMA), and it has considerable advantages to in-lab research. Thus, this viewpoint aims to describe EMA tools that have been used to collect data in the daily lives of youth with T1D and discuss studies that explored the nuances of T1D in daily life using these methods. This viewpoint focuses on the following EMA methods: continuous glucose monitoring, actigraphy, ambulatory blood pressure monitoring, personal digital assistants, smartphones, and phone-based systems. The viewpoint also discusses the benefits of using EMA methods to collect important data that might not otherwise be collected in the laboratory and the limitations of each tool, future directions of the field, and possible clinical implications for their use.

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Real-Time Sharing and Following of Continuous Glucose Monitoring Data in Youth

Cited by 36 publications

References 11 publications

DYNAMIC: Dynamic glucose management strategies delivered through a structured education program improves time in range in a socioeconomically deprived cohort of children and young people with type 1 diabetes with a history of hypoglycemia

DYNAMIC: Dynamic glucose management strategies delivered through a structured education program improves time in range in a socioeconomically deprived cohort of children and young people with type 1 diabetes with a history of hypoglycemia

Real-World Evidence and Glycemic Improvement Using Dexcom G6 Features

Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies

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