Real-World Experience With Automated Insulin Pump Technology in Veterans With Type 1 Diabetes.
Journal
Federal practitioner : for the health care professionals of the VA, DoD, and PHS
ISSN: 1078-4497
Titre abrégé: Fed Pract
Pays: United States
ID NLM: 9500574
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
entrez:
9
2
2022
pubmed:
10
2
2022
medline:
10
2
2022
Statut:
ppublish
Résumé
Advancements in diabetes technology now allow insulin pump and continuous glucose monitor (CGM) technology to be a part of usual US Department Veterans Affairs (VA) clinical care. The automated insulin pump (AIP) delivers insulin automatically based on CGM readings. In randomized clinical trials the closed-loop system has shown to improve glycemic control in children and younger adults with type 1 diabetes mellitus (T1DM) while preventing hypoglycemia. However, its safety and efficacy is less well known in older veterans with T1DM. In this VA pilot study, we aimed to assess AIP technology in the real world of an older population of veterans with T1DM followed in the outpatient setting. Thirty-seven patients with T1DM new to AIP seen at the Malcom Randall VA Medical Center in Gainesville, Florida, were evaluated between March and December of 2018 on an Medtronic Minimed 670G Insulin Pump System. We collected demographic as well as clinical data before and after the initiation of AIP, including standard insulin pump/CGM information (sensor wear, time in target glucose range, time in automated mode, other). At the time of the initiation of AIP, the mean (SD) age of patients was 59.1 (14.4) years; 35 identified as male and 2 as female. The mean (SD) duration of T1DM was 25.3 (12.0) years. Patients transitioned from either insulin injections or other non-AIP pump to AIP safely-there was no increase in hypoglycemia, and the mean (SD) hemoglobin A In this real-world study, AIP use was both safe and viable as a tool for T1DM management with older veterans. This technology further engaged veterans in monitoring their blood sugars and achieving more optimal glycemic control. Future long-term, larger studies are much needed in this setting.
Sections du résumé
BACKGROUND
BACKGROUND
Advancements in diabetes technology now allow insulin pump and continuous glucose monitor (CGM) technology to be a part of usual US Department Veterans Affairs (VA) clinical care. The automated insulin pump (AIP) delivers insulin automatically based on CGM readings. In randomized clinical trials the closed-loop system has shown to improve glycemic control in children and younger adults with type 1 diabetes mellitus (T1DM) while preventing hypoglycemia. However, its safety and efficacy is less well known in older veterans with T1DM. In this VA pilot study, we aimed to assess AIP technology in the real world of an older population of veterans with T1DM followed in the outpatient setting.
METHODS
METHODS
Thirty-seven patients with T1DM new to AIP seen at the Malcom Randall VA Medical Center in Gainesville, Florida, were evaluated between March and December of 2018 on an Medtronic Minimed 670G Insulin Pump System. We collected demographic as well as clinical data before and after the initiation of AIP, including standard insulin pump/CGM information (sensor wear, time in target glucose range, time in automated mode, other).
RESULTS
RESULTS
At the time of the initiation of AIP, the mean (SD) age of patients was 59.1 (14.4) years; 35 identified as male and 2 as female. The mean (SD) duration of T1DM was 25.3 (12.0) years. Patients transitioned from either insulin injections or other non-AIP pump to AIP safely-there was no increase in hypoglycemia, and the mean (SD) hemoglobin A
CONCLUSION
CONCLUSIONS
In this real-world study, AIP use was both safe and viable as a tool for T1DM management with older veterans. This technology further engaged veterans in monitoring their blood sugars and achieving more optimal glycemic control. Future long-term, larger studies are much needed in this setting.
Identifiants
pubmed: 35136338
doi: 10.12788/fp.0156
pii: fp-38-11s-s04
pmc: PMC8820195
doi:
Types de publication
Journal Article
Langues
eng
Pagination
S4-S8Informations de copyright
Copyright © 2021 Frontline Medical Communications Inc., Parsippany, NJ, USA.
Déclaration de conflit d'intérêts
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Références
N Engl J Med. 2019 Oct 31;381(18):1707-1717
pubmed: 31618560
Endocr Pract. 2019 May;25(5):477-484
pubmed: 30865545
Ther Adv Endocrinol Metab. 2019 Aug 30;10:2042018819871903
pubmed: 31516690
BMJ. 2018 Apr 18;361:k1310
pubmed: 29669716
Lancet. 2018 Aug 11;392(10146):477-486
pubmed: 30129464
Diabetes Technol Ther. 2018 Nov;20(11):738-743
pubmed: 30256132
Expert Rev Med Devices. 2019 Oct;16(10):845-853
pubmed: 31540557
J Clin Endocrinol Metab. 2018 Jan 1;103(1):105-114
pubmed: 29190340
Diabetes Technol Ther. 2020 Nov;22(11):812-821
pubmed: 32348159
Diabetologia. 2016 Sep;59(9):1795-805
pubmed: 27364997
Diabetes Technol Ther. 2019 Jun;21(6):356-363
pubmed: 31095423
Diabetes Metab. 2018 Sep;44(4):313-319
pubmed: 29602622
Lancet. 2018 Oct 13;392(10155):1321-1329
pubmed: 30292578
Curr Med Res Opin. 2018 Jan;34(1):171-177
pubmed: 29019269
JAMA. 2016 Oct 4;316(13):1407-1408
pubmed: 27629148
Diabetes Care. 2017 Jul;40(7):832-838
pubmed: 28039172
Diabetes Care. 2018 Aug;41(8):1600-1607
pubmed: 29661916
JAMA. 2020 Jun 16;323(23):2397-2406
pubmed: 32543682
Diabetes Care. 2020 Jan;43(Suppl 1):S77-S88
pubmed: 31862750