An effective and cost-saving structured education program teaching dynamic glucose management strategies to a socio-economically deprived cohort with type 1 diabetes in a VIRTUAL setting.
CGMS
deprivation
diabetes
education
hypoglycemia
literacy
Journal
Pediatric diabetes
ISSN: 1399-5448
Titre abrégé: Pediatr Diabetes
Pays: Denmark
ID NLM: 100939345
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
revised:
16
05
2022
received:
24
12
2021
accepted:
07
06
2022
pubmed:
12
6
2022
medline:
19
10
2022
entrez:
11
6
2022
Statut:
ppublish
Résumé
Compare the clinical and cost-effectiveness of an established face to face (F2F) structured education program to a new remote (VIRTUAL) program teaching dynamic glucose management (DynamicGM) to children and young people with type 1 diabetes (CYPD) using continuous glucose monitoring (CGM). To ascertain the most effective DynamicGM strategies predicting time in range (TIR) (3.9-10.0 mmol/L) and incorporating these into a user-friendly teaching aid. Effectiveness of the F2F and VIRTUAL programs were ascertained by comparing the mean change (Δ) from baseline to 6 months in HbA1c, TIR and severe hypoglycemia. Delivery cost for the two programs were evaluated. Factors predicting TIR in the combined cohort were determined and incorporated into a user-friendly infographic. First 50 graduates per group were evaluated. The mean difference in Δ HbA1c, Δ TIR and Δ episodes of severe hypoglycemia between VIRTUAL and F2F groups were 1.16 (p = 0.47), 0.76 (p = 0.78) and -0.06 (p = 0.61) respectively. Delivery cost per 50 CYPD for VIRTUAL and F2F were $5752 and $7020, respectively. The strongest predictors of TIR (n = 100) were short bursts of exercise (10-40 min) to lower hyperglycemia (p < 0.001), using trend arrow adjustment tools (p < 0.001) and adjusting pre-meal bolus timing based on trend arrows (p < 0.01). These strategies were translated into a GAME (Stop highs), SET (Stay in target), MATCH (Prevent lows) mnemonic. Teaching DynamicGM VIRTUALLY is just as effective as F2F delivery and cost saving. Short bursts of exercise and using CGM trend arrows to adjust insulin dose and timing improves TIR.
Substances chimiques
Blood Glucose
0
Glycated Hemoglobin A
0
Hypoglycemic Agents
0
Insulin
0
Glucose
IY9XDZ35W2
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1045-1056Informations de copyright
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019;42(8):1593-1603.
Danne T, Phillip M, Buckingham BA, et al. ISPAD clinical practice consensus guidelines 2018: insulin treatment in children and adolescents with diabetes. Pediatr Diabetes. 2018;1(19):115-135.
Abraham MB, Jones TW, Naranjo D, et al. ISPAD clinical practice consensus guidelines 2018: assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2018;1(19):178-192.
Heise T, Meneghini L. Insulin stacking versus therapeutic accumulation: understanding the differences. Endocr Pract. 2014;20:75-83.
Rabasa-Lhoret R, Bourque J, Ducros F, Chiasson J-L. Guidelines for Premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (Ultralente-Lispro). Diabetes Care. 2001;24(4):625-630.
Moser O, Tschakert G, Mueller A, et al. Effects of high-intensity interval exercise versus moderate continuous exercise on glucose homeostasis and hormone response in patients with type 1 diabetes mellitus using novel ultra-long-acting insulin. PLoS One. 2015;10(8):e0136489.
Campbell MD, Walker M, Trenell MI, et al. Large pre-and postexercise rapid-acting insulin reductions preserve glycemia and prevent early- but not late-onset hypoglycemia in patients with type 1 diabetes. Diabetes Care. 2013;36(8):2217-2224.
Thorell A, Hirshman M, Nygren J, et al. Exercise and insulin cause GLUT-4 translocation in human skeletal muscle. Am J Physiol. 1999;277(4):E733-E741.
Group TDR. In CN (DirecNet) S. the effects of aerobic exercise on glucose and Counterregulatory hormone concentrations in children with type 1 diabetes. Diabetes Care. 2006;29(1):20-25.
Riddell MC, Zaharieva DP, Tansey M, et al. Individual glucose responses to prolonged moderate intensity aerobic exercise in adolescents with type 1 diabetes: the higher they start, the harder they fall. Pediatr Diabetes. 2019;20(1):99-106.
Pemberton JS, Kershaw M, Dias R, et al. 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. Pediatr Diabetes. 2021;22(2):249-260.
Slattery D, Amiel SA, Choudhary P. Optimal prandial timing of bolus insulin in diabetes management: a review. Diabet Med. 2018;35(3):306-316.
Lawson ML, Heffernan E, Richardson CA, Courtney JM, Bradley BJ. Evaluation of a novel tool to adjust insulin boluses based on continuous glucose monitoring trend arrows and insulin sensitivity in children and youth with type 1 diabetes. Can J Diabetes. 2016;40(5):S16.
ACDC (Association of Children's Diabetes Clinicians). A Practical Approach to the Management of Continuous Glucose Monitoring (CGM) / Real-Time Flash Glucose Scanning (FGS) in Type 1 Diabetes Mellitus in Children and Young People Under 18 years [Internet]. 2019. http://www.a-c-d-c.org/wp-content/uploads/2012/08/CGM-FGS-Practical-Approach-ACDC-Guideline-3.pdf [Accessed March 10, 2020]
Ponder SW, McMahon KL. Sugar surfing: basics for diabetes educators. AADE Pract. 2019;7(5):18-22.
Foster-Powell K, Holt SHA, Brand-Miller JC. International table of gylcemic index and glycemic load values: 2002. Am J Clin Nutr. 2002;76(1):5-56.
McTavish L, Wiltshire E. Effective treatment of hypoglycemia in children with type 1 diabetes: a randomized controlled clinical trial. Pediatr Diabetes. 2011;12:381-387.
Gehr B, Holder M, Kulzer B, et al. SPECTRUM: a training and treatment program for continuous glucose monitoring for all age groups. J Diabetes Sci Technol. 2017;11(2):284-289.
Schlüter S, Freckmann G, Heinemann L, Wintergerst P, Lange K. Evaluation of the spectrum training programme for real-time continuous glucose monitoring: a real-world multicentre prospective study in 120 adults with type 1 diabetes. Diabet Med. 2021;38(2):e14467.
RCPCH (Royal College of Paediatrics and Child Health). National Paediatric Diabetes Audit Annual report 2017-2018 [Internet]. 2019. https://www.rcpch.ac.uk/sites/default/files/2019-05/NPDA-national-report-2017-18_v2-updated-2019-05-30_0.pdf [Accessed March 10, 2020]
Zhai YK, Zhu WJ, Cai YL, Sun DX, Zhao J. Clinical- and cost-effectiveness of telemedicine in type 2 diabetes mellitus: a systematic review and meta-analysis. Medicine (Baltimore). 2014;93(28):e312.
Hou C, Carter B, Hewitt J, Francisa T, Mayor S. Do Mobile phone applications improve glycemic control (HbA1c) in the self-management of diabetes? A systematic review, meta-analysis, and GRADE of 14 randomized trials. Diabetes Care. 2016;39(11):2089-2095.
Rondags SMPA, De Wit M, Twisk JW, Snoek FJ. Effectiveness of HypoAware, a brief partly web-based psychoeducational intervention for adults with type 1 and insulin-treated type 2 diabetes and problematic hypoglycemia: a cluster randomized controlled trial. Diabetes Care. 2016;39(12):2190-2196.
Hermanns N, Ehrmann D, Finke-Groene K, Kulzer B. Trends in diabetes self-management education: where are we coming from and where are we going? A narrative review. Diabet Med. 2020;37(3):436-447.
Låg T, Saele RG. Does the flipped classroom improve student learning and satisfaction? A systematic review and meta-analysis. AERA Open. 2019;5(3):1-17. doi:10.1177/2332858419870489
Chang YY, Dai YT. The efficacy of a flipping education program on improving self-management in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Int J Chron Obstruct Pulmon Dis. 2019;14:1239.
Moser O, Riddell MC, Eckstein ML, et al. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association. Pediatr Diabetes. 2020;21(8):1375-1393.
N.H.S (National Health Service). NHS Terms and Conditions (AfC) pay scales - Hourly [Internet]. Available from https://www.nhsemployers.org/pay-pensions-and-reward/agenda-for-change/pay-scales/hourly [Accessed May 1, 2020]
Noh MAM, Shamsudin WNK, Nudin ALA, et al. The use of infographics as a tool for facilitating learning. Int Colloq Art Des Educ Res (i-CADER 2014). 2015;559-567. https://link.springer.com/chapter/10.1007/978-981-287-332-3_57 [Accessed June 18, 2022]
Improving Digital Literacy | Royal College of Nursing [Internet]. Available from https://www.rcn.org.uk/professional-development/publications/pub-006129 [Accessed December 24, 2021]
Peters CJ, Viner RM, Hindmarsh PC. The impact of race and socioeconomic factors on paediatric diabetes. EClinicalMedicine. 2021 Dec;1:42.
Gradel AKJ, Porsgaard T, Lykkesfeldt J, et al. Factors affecting the absorption of subcutaneously administered insulin: effect on variability. J Diabetes Res. 2018;2018:1205121.
Joyner MJ, Casey DP. Regulation of increased blood flow (hyperemia) to muscles during exercise: a hierarchy of competing physiological needs. Physiol Rev. 2015;95(2):549-601.
Duckworth WC, Bennett RG, Hamel FG. Insulin degradation: Progress and potential*. Endocr Rev. 1998;19(5):608-624.
Tagougui S, Taleb N, Legault L, et al. A single-blind, randomised, crossover study to reduce hypoglycaemia risk during postprandial exercise with closed-loop insulin delivery in adults with type 1 diabetes: announced (with or without bolus reduction) vs unannounced exercise strategies. Diabetologia. 2020;63(11):2282-2291.
Braffett BH, Dagogo-Jack S, Bebu I, et al. Association of insulin dose, cardiometabolic risk factors, and cardiovascular disease in type 1 diabetes during 30 years of follow-up in the DCCT/EDIC study. Diabetes Care. 2019;42(4):657-664.
Beck RW, Bergenstal RM, Cheng P, et al. The relationships between time in range, hyperglycemia metrics, and HbA1c. J Diabetes Sci Technol. 2019;13(4):614-626.
Gonzalez JT, Fuchs CJ, Betts JA, Van Loon L. Glucose plus fructose ingestion for post-exercise recovery-greater than the sum of its parts? Nutr. 2017;9(4):344.
Ponder SW. Sugar Surfing [Internet] 2020 Available from https://www.sugarsurfing.com/ [Accessed April 1, 2020]