How does a predictive low glucose suspend (PLGS) system tackle pediatric lifespan challenges in diabetes treatment? Real world data analysis.
Adolescent
Age Factors
Blood Glucose
/ analysis
Child
Child, Preschool
Diabetes Mellitus, Type 1
/ drug therapy
Female
Glycemic Control
Humans
Hypoglycemia
/ chemically induced
Hypoglycemic Agents
/ administration & dosage
Insulin
/ administration & dosage
Insulin Infusion Systems
/ statistics & numerical data
Male
Retrospective Studies
Young Adult
diabetes
insulin pumps
technology
Journal
Pediatric diabetes
ISSN: 1399-5448
Titre abrégé: Pediatr Diabetes
Pays: Denmark
ID NLM: 100939345
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
05
05
2019
revised:
17
09
2019
accepted:
28
10
2019
pubmed:
13
11
2019
medline:
17
2
2021
entrez:
13
11
2019
Statut:
ppublish
Résumé
The aim of the study was to assess the benefits of a predictive low glucose suspend (PLGS) system in real-life in children and adolescents with type 1 diabetes of different age and age-related clinical challenges. Real life retrospective and descriptive analysis included 44 children (26 girls) with type 1 diabetes who were introduced to PLGS system. We divided them in three age groups: I (3-6 years old, n = 12), II (7-10 y/o, n = 16), III (11-19 y/o, n = 16). All children and their caregivers received unified training in self-management during PLGS therapy. Patients' data included: age, HbA1C levels, sex. While from the CGM metric, we obtained: time of sensor use (SENSuse), time in range (TiR): in, below and over target range and average blood glycemia (AVG), insulin suspension time (INSsusp). SENSuse was 93% in total, with 92%, 94%, and 87% in age groups I, II, III, respectively. In total the reduction of mean HbA1C from 7.61% to 6.88% (P < .05), while for the I, II, and III it was 7.46% to 6.72%, 6.91% to 6.41%, and 8.46 to 7.44%, respectively (P < .05). Although we observed a significant reduction of HbA1C, the time below target range was minimal. Specific findings included: group I-longest INSsusp (17%), group II-lowest glycemic variability (CV) (36%), and group III-highest AVG (169 mg/dL). There was a reverse correlation between suspend before low and age (-0.32, P < .05). In group I CV reduced TiR in target range (TiRin) (-0.82, P < .05), in group II use of complex boluses increased TiRin (0.52, P < .05). In group III higher CV increased HbA1C (0.64, P < .05) while reducing TiRin (-0.72, P < .05). PLGS is a suitable and safe therapeutic option for children with diabetes of all age and it is effective in addressing age-specific challenges. PLGS improves glycemic control in children of all age, positively affecting its different parameters.
Substances chimiques
Blood Glucose
0
Hypoglycemic Agents
0
Insulin
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
280-287Informations de copyright
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Gaweł W, Tabor A, Kaminska H, Deja G, Jarosz-Chobot P. How modern technologies improve daily diabetic control. Pediatr Endocrinol Diabetes Metab. 2018;24(3):140-144. https://doi.org/10.5114/pedm.2018.80996.
Silink M. A United Nations resolution on diabetes-the result of a joint effort. US Endocrinol. 2007;00(01):12. https://doi.org/10.17925/use.2007.00.1.12.
Chobot A, Polanska J, Brandt A, et al. Updated 24-year trend of type 1 diabetes incidence in children in Poland reveals a sinusoidal pattern and sustained increase. Diabet Med. 2017;34(9):1252-1258. https://doi.org/10.1111/dme.13345.
Patterson C, Harjutsalo V, Rosenbauer J, et al. Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989-2013: a multicentre prospective registration study. Diabetologia. 2018;62(3):408-417. https://doi.org/10.1007/s00125-018-4763-3.
Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986. https://doi.org/10.1056/nejm199309303291401.
Influence of intensive diabetes treatment on quality-of-life outcomes in the diabetes control and complications trial. Diabetes Care. 1996;19(3):195-203. https://doi.org/10.2337/diacare.19.3.195.
Schnell O, Cappuccio F, Genovese S, Standl E, Valensi P, Ceriello A. Type 1 diabetes and cardiovascular disease. Cardiovasc Diabetol. 2013;12(1):156. https://doi.org/10.1186/1475-2840-12-156.
Lehecka KE, Renukuntla VS, Heptulla RA. Insight into hypoglycemia in pediatric type 1 diabetes mellitus. Int J Pediatr Endocrinol. 2012;2012(1):19. https://doi.org/10.1186/1687-9856-2012-19.
Smith CB, Choudhary P, Pernet A, Hopkins D, Amiel SA. Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit. Diabetes Care. 2009;32(7):1196-1198. https://doi.org/10.2337/dc08-2259.
Cengiz E, Xing D, Wong J, et al. Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D exchange clinic registry. Pediatr Diabetes. 2013;14(6):447-454. https://doi.org/10.1111/pedi.12030.
Kelsey MM, Zeitler PS. Insulin resistance of puberty. Curr Diab Rep. 2016;16(7):64. https://doi.org/10.1007/s11892-016-0751-5.
Deja G, Jarosz-Chobot P, Polanska J. The rate of improvement in metabolic control in children with diabetes mellitus type 1 on insulin glargine depends on age. Exp Clin Endocrinol Diabetes. 2007;115(10):662-668. https://doi.org/10.1055/s-2007-984444.
Gómez AM, Carrillo LF, Velandia OM, et al. Long-term efficacy and safety of sensor augmented insulin pump therapy with low-glucose suspend feature in patients with type 1 diabetes. Diabetes Technol Ther. 2017;19(2):109-114. https://doi.org/10.1089/dia.2016.0332.
De Valk H, Lablanche S, Bosi E, et al. Study of MiniMed 640G insulin pump with SmartGuard in prevention of low glucose events in adults with type 1 diabetes (SMILE): design of a hypoglycemia prevention trial with continuous glucose monitoring data as outcomes. Diabetes Technol Ther. 2018;20(11):758-766. https://doi.org/10.1089/dia.2018.0222.
Ly T, Brnabic A, Eggleston A, et al. A cost-effectiveness analysis of sensor-augmented insulin pump therapy and automated insulin suspension versus standard pump therapy for hypoglycemic unaware patients with type 1 diabetes. Value Health. 2014;17(5):561-569. https://doi.org/10.1016/j.jval.2014.05.008.
Araszkiewicz A, Bandurska-Stankiewicz E, Budzyński A, et al. 2016 Guidelines on the management of diabetic patients. A position of diabetes Poland. Diabetol Klin. 2016;5:A1-A73.
Quispe BV, Frías MM, Martín MB, Valverde RY, Gómez MÁ, Castellanos RB. Effectiveness of MiniMed 640G with SmartGuard ® system for prevention of hypoglycemia in pediatric patients with type 1 diabetes mellitus. Endocrinol Diabetes Nutr. 2017;64(4):198-203. https://doi.org/10.1016/j.endien.2017.02.009.
Forlenza G, Li Z, Buckingham B, et al. Predictive low-glucose suspend reduces hypoglycemia in adults, adolescents, and children with type 1 diabetes in an at-home randomized crossover study: results of the PROLOG trial. Diabetes Care. 2018;41(10):2155-2161. https://doi.org/10.2337/dc18-0771.
Mori H, Okada Y, Kurozumi A, Narisawa M, Tanaka Y. Factors influencing inter-day glycemic variability in diabetic outpatients receiving insulin therapy. J Diabetes Investig. 2016;8(1):69-74. https://doi.org/10.1111/jdi.12551.
Perantie DC, Koller JM, Weaver PM, et al. Prospectively determined impact of type 1 diabetes on brain volume during development. Diabetes. 2011;60(11):3006-3014. https://doi.org/10.2337/db11-0589.
Biester T, Kordonouri O, Holder M, et al. “Let the algorithm do the work”: reduction of hypoglycemia using sensor-augmented pump therapy with predictive insulin suspension (SmartGuard) in pediatric type 1 diabetes patients. Diabetes Technol Ther. 2017;19(3):173-182. https://doi.org/10.1089/dia.2016.0349.
Tabor A, Gaweł WB, Goik O, Deja G, Jarosz-Chobot P. Evaluation of the quality of life and satisfaction with the therapy in patients with type 1 diabetes-is Medtronic MiniMed 640G system able to improve it? Preliminary insights. Clin Diabetol. 2017;6(1):1-7. https://doi.org/10.5603/dk.2017.0002.
Johnson SR, Cooper MN, Davis EA, Jones TW. Hypoglycaemia, fear of hypoglycaemia and quality of life in children with type 1 diabetes and their parents. Diabet Med. 2013;30(9):1126-1131. https://doi.org/10.1111/dme.12247.
Herbert LJ, Monaghan M, Cogen F, Streisand R. The impact of parents sleep quality and hypoglycemia worry on diabetes self-efficacy. Behav Sleep Med. 2014;13(4):308-323. https://doi.org/10.1080/15402002.2014.898303.
Sparapani VD, Liberatore RD, Damião EB, Dantas IR, Camargo RA, Nascimento LC. Children with type 1 diabetes mellitus: self-management experiences in school. J Sch Health. 2017;87(8):623-629. https://doi.org/10.1111/josh.12529.
Marks A, Wilson V, Crisp J. The management of type 1 diabetes in primary school: review of the literature. Issues Compr Pediatr Nurs. 2013;36(1-2):98-119. https://doi.org/10.3109/01460862.2013.782079.
Kise SS, Hopkins A, Burke S. Improving school experiences for adolescents with type 1 diabetes. J Sch Health. 2017;87(5):363-375. https://doi.org/10.1111/josh.12507.
Guo J, Whittemore R, Jeon S, et al. Diabetes self-management, depressive symptoms, metabolic control and satisfaction with quality of life over time in Chinese youth with type 1 diabetes. J Clin Nurs. 2014;24(9-10):1258-1268. https://doi.org/10.1111/jocn.12698.
Abraham MB, Nicholas JA, Smith GJ, et al. Reduction in hypoglycemia with the predictive low-glucose management system: A long-term randomized controlled trial in adolescents with type 1 diabetes. Diabetes Care. 2018;41(2):303-310. https://doi.org/10.2337/dc17-1604.
Abraham M, Heels K, Nicholas J, et al. Unexpected management behaviors in adolescents with type 1 diabetes using sensor-augmented pump therapy. J Diabetes Sci Technol. 2018;12(3):592-598. https://doi.org/10.1177/1932296817752188.
Škrha J, Šoupal J, Škrha J, Prázný M. Glucose variability, HbA1c and microvascular complications. Rev Endocr Metab Disord. 2016;17(1):103-110. https://doi.org/10.1007/s11154-016-9347-2.
Pfeiffer KM, Basse A, Lee XY, Waldman LT. Diabetes management and healthcare resource use when intensifying from basal insulin to basal-bolus: a survey of type 2 diabetes patients. Diabetes Ther. 2018;9(5):1931-1944. https://doi.org/10.1007/s13300-018-0487-0.
Wood M, Shulman D, Forlenza G, et al. In-clinic evaluation of the MiniMed 670G system “suspend before low” feature in children with type 1 diabetes. Diabetes Technol Ther. 2018;20(11):731-737. https://doi.org/10.1089/dia.2018.0209.
Battelino T, Nimri R, Dovc K, Phillip M, Bratina N. Prevention of hypoglycemia with predictive low glucose insulin suspension in children with type 1 diabetes: a randomized controlled trial. Diabetes Care. 2017;40(6):764-770. https://doi.org/10.2337/dc16-2584.
Shin G, Feng Y, Jarrahi MH, Gafinowitz N. Beyond novelty effect: a mixed-methods exploration into the motivation for long-term activity tracker use. JAMIA Open. 2018;2:62-72. https://doi.org/10.1093/jamiaopen/ooy048.
Buckingham B, Raghinaru D, Cameron F, et al. Predictive low-glucose insulin suspension reduces duration of nocturnal hypoglycemia in children without increasing ketosis. Diabetes Care. 2015;38(7):1197-1204. https://doi.org/10.2337/dc14-3053.
Maahs DM, Calhoun P, Buckingham BA, et al. A randomized trial of a home system to reduce nocturnal hypoglycemia in type 1 diabetes. Diabetes Care. 2014;37(7):1885-1891. https://doi.org/10.2337/dc13-2159.
Beck RW, Raghinaru D, Wadwa RP, Chase HP, Maahs DM, Buckingham BA. Frequency of morning ketosis after overnight insulin suspension using an automated nocturnal predictive low glucose suspend system. Diabetes Care. 2014;37(5):1224-1229. https://doi.org/10.2337/dc13-2775.