Type 1 diabetes: treatment without tears?

Amiel, Stephanie A.

doi:10.1007/s00125-005-1923-z

Cited by 7 publications

(8 citation statements)

References 9 publications

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“… 4–6 These ratios and factors must be optimized for each patient and should be evaluated and adjusted frequently as insulin requirements change. 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

A Minority of Patients with Type 1 Diabetes Routinely Downloads and Retrospectively Reviews Device Data

Wong

Neinstein

Spindler

et al. 2015

Diabetes Technology & Therapeutics

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Background: In type 1 diabetes (T1D), periodic review of blood glucose and insulin dosing should be performed, but it is not known how often patients review these data on their own. We describe the proportion of patients with T1D who routinely downloaded and reviewed their data at home.Materials and Methods: A cross-sectional survey of 155 adults and 185 caregivers of children with T1D at a single academic institution was performed. “Routine Downloaders” (downloaded four or more times in the past year) were also considered “Routine Reviewers” if they reviewed their data most of the time they downloaded from devices. Logistic regression was used to identify factors associated with being a Routine Reviewer.Results: Only 31% of adults and 56% of caregivers reported ever downloading data from one or more devices, whereas 20% and 40%, respectively, were considered Routine Downloaders. Only 12% of adults and 27% of caregivers were Routine Reviewers. Mean hemoglobin A1c was lower in Routine Reviewers compared with non-Routine Reviewers (7.2±1.0% vs. 8.1±1.6% [P=0.03] in adults and 7.8±1.4% vs. 8.6±1.7% [P=0.001] in children). In adjusted analysis of adults, the odds ratio of being a Routine Reviewer of one or more devices for every 10-year increase in age was 1.5 (95% confidence interval, 1.1, 2.1 [P=0.02]). For every 10 years since diabetes diagnosis, the odds ratio of being a Routine Reviewer was 1.7 (95% confidence interval, 1.2, 2.4 [P=0.01]). For caregivers, there were no statistically significant factors associated with being a Routine Reviewer.Conclusions: A minority of T1D patients routinely downloads and reviews data from their devices on their own. Further research is needed to understand obstacles, provide better education and tools for self-review, and determine if patient self-review is associated with improved glycemic control.

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“… 4–6 These ratios and factors must be optimized for each patient and should be evaluated and adjusted frequently as insulin requirements change. 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

A Minority of Patients with Type 1 Diabetes Routinely Downloads and Retrospectively Reviews Device Data

Wong

Neinstein

Spindler

et al. 2015

Diabetes Technology & Therapeutics

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show abstract

“…For a long time now, the inverse relation between intensive insulin therapy and high risk for severe hypoglycemia was accepted to be inevitable and has limited the use of intensive insulin therapy in routine care (2). This paradigm changes because there is increasing evidence that structured self-management programs for intensive insulin therapy can improve glycemic control toward near normoglycemia without increasing the risk of severe hypoglycemia (3)(4)(5).…”

mentioning

confidence: 99%

Flexible Intensive Insulin Therapy in Adults With Type 1 Diabetes and High Risk for Severe Hypoglycemia and Diabetic Ketoacidosis

Sämann

Mühlhauser²,

Bender

et al. 2006

Diabetes Care

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OBJECTIVE -Diabetes treatment and teaching programs (DTTPs) for type 1 diabetes, which teach flexible intensive insulin therapy to enable dietary freedom, have proven to be safe and effective in routine care. This study evaluates DTTP outcomes in patients at high risk for severe hypoglycemia and severe ketoacidosis.RESEARCH DESIGN AND METHODS -There were 96 diabetes centers that participated between 1992 and 2004. A total of 9,583 routine-care patients with type 1 diabetes were examined before and 1 year after a DTTP. History of repeated severe hypoglycemia/severe ketoacidosis was an indication for DTTP participation. Before-after analyses were performed for subgroups of patients with three or more episodes of severe hypoglycemia or two or more episodes of severe ketoacidosis during the year before a DTTP. Main outcome measures were GHb, severe hypoglycemia, severe ketoacidosis, and hospitalization.RESULTS -A total of 341 participants had three or more episodes of severe hypoglycemia the year before a DTTP. Mean baseline GHb was 7.4 vs. 7.2% after the DTTP, incidence of severe hypoglycemia was 6.1 vs. 1.4 events ⅐ patient Ϫ1 ⅐ year Ϫ1 , and hospitalization was 8.6 vs. 3.9 days ⅐ patient Ϫ1 ⅐ year Ϫ1 . In mixed-effects models taking effects of centers and diabetes duration into account, mean difference was Ϫ0.3% (95% CI Ϫ0.5 to Ϫ0.1%; P ϭ 0.0006) for GHb and Ϫ4.7 events ⅐ patient Ϫ1 ⅐ year Ϫ1 (Ϫ5.4 to Ϫ4; P Ͻ 0.0001) for severe hypoglycemia. A total of 95 patients had two or more episodes of severe ketoacidosis. GHb was 9.4% at baseline versus 8.7% after DTTP; incidence of severe ketoacidosis was 3.3 vs. 0.6 events ⅐ patient Ϫ1 ⅐ year Ϫ1 , and hospitalization was 19.4 vs. 10.2 days ⅐ patient Ϫ1 ⅐ year Ϫ1 . In linear models with diabetes duration as the fixed effect, the adjusted mean difference was Ϫ2.7 events ⅐ patient Ϫ1 ⅐ year Ϫ1(95% CI Ϫ3.3 to Ϫ2.1; P Ͻ 0.0001) for severe ketoacidosis and Ϫ8.1 days (Ϫ12.9 to Ϫ3.2; P ϭ 0.0014) for hospitalization.CONCLUSIONS -Patients at high risk for severe hypoglycemia or severe ketoacidosis may benefit from participation in a standard DTTP for intensive insulin therapy and dietary freedom.

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“…The inverse relation between intensive insulin therapy and high risk for SH has limited the use of intensive insulin therapy in routine care, in both children and adults [3]. There is increasing evidence that structured self‐management programmes for intensive insulin therapy can improve glycaemic control in adults without increasing the risk of SH [4–6]. Cooperation between paediatrician and diabetologist can provide a smooth transition of care from childhood to adulthood.…”

Section: Introductionmentioning

confidence: 99%

Flexible, intensive insulin therapy and dietary freedom in adolescents and young adults with Type 1 diabetes: a prospective implementation study

Sämann¹,

Lehmann²,

Kloos³

et al. 2008

Diabetic Medicine

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Type 1 diabetes: treatment without tears?

Cited by 7 publications

References 9 publications

A Minority of Patients with Type 1 Diabetes Routinely Downloads and Retrospectively Reviews Device Data

A Minority of Patients with Type 1 Diabetes Routinely Downloads and Retrospectively Reviews Device Data

Flexible Intensive Insulin Therapy in Adults With Type 1 Diabetes and High Risk for Severe Hypoglycemia and Diabetic Ketoacidosis

Flexible, intensive insulin therapy and dietary freedom in adolescents and young adults with Type 1 diabetes: a prospective implementation study

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