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  • 1
    Online Resource
    Online Resource
    The road from intermittently scanned glucose monitoring to hybrid closed-loop systems: Part A. Keys to success: subject profiles, choice of systems, education
    SAGE Publications ; 2019
    In:  Therapeutic Advances in Endocrinology and Metabolism Vol. 10 ( 2019-01), p. 204201881986539-
    Details
    In: Therapeutic Advances in Endocrinology and Metabolism, SAGE Publications, Vol. 10 ( 2019-01), p. 204201881986539-
    Abstract: Managing type 1 diabetes (T1DM) is challenging and requires intensive glucose monitoring and titration of insulin in order to reduce the risk of complications. The use of continuous glucose monitoring (CGM) systems, either flash or intermittently scanned glucose monitoring (isCGM) or real-time (RT) CGM, has positively affected the management of type 1 diabetes with the potential to lower HbA1c, enhance time spent in range, reduce frequency and time spent in hypoglycemia and hyperglycemia, lower glycemic variability, and improve quality of life. In recent years, both CGM and pump technology have advanced, with improved functional features and integration, including low glucose suspend (LGS), predictive low glucose suspend (PLGS), and hybrid closed-loop (HCL) systems. In this review, we highlight the benefits and limitations of use of isCGM/RT-CGM for open-loop control and recent progress in closed-loop control systems. We also discuss different subject profiles for the different systems, and focus on educational aspects that are key to successful use of the systems.
    Type of Medium: Online Resource
    ISSN: 2042-0188 , 2042-0196
    URL: Article
    DOI: 10.1177/2042018819865399
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 2
    Online Resource
    Online Resource
    The road from intermittently scanned continuous glucose monitoring to hybrid closed-loop systems. Part B: results from randomized controlled trials
    SAGE Publications ; 2019
    In:  Therapeutic Advances in Endocrinology and Metabolism Vol. 10 ( 2019-01), p. 204201881987190-
    Details
    In: Therapeutic Advances in Endocrinology and Metabolism, SAGE Publications, Vol. 10 ( 2019-01), p. 204201881987190-
    Abstract: Advances in diabetes technology have been exponential in the last few decades. With evolution in continuous glucose monitoring (CGM) systems and its progressive automation in control of insulin delivery, these advances have changed type 1 diabetes mellitus (T1DM) management. These novel technologies have the potential to improve glycated haemoglobin (HbA1c), reduce hypoglycaemic events, increase time spent in range and improve quality of life (QoL). Our aim was to evaluate the sustained effects in free-living unsupervised conditions of CGM systems (intermittently scanned and real time) and insulin delivery [from multiple daily injections, via sensor-augmented pump therapy and (predictive) low-glucose insulin suspension to hybrid closed-loop systems] on glucose control and QoL in adults and children with T1DM. Methods: We performed a systematic review of randomized controlled trials (RCTs), using PubMed and the Cochrane library up to 30 May 2019. Inclusion of RCTs was based on type of intervention (comparing glucose-monitoring devices and insulin-delivery devices), population (nonpregnant adults and children with T1DM), follow-up (outpatient setting for at least 8 weeks) and relevant outcomes [HbA1c, time in range (TIR), time in target, time in hypoglycaemia and QoL]. Exclusion of RCTs was based on intervention (exercise, only overnight use). The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were used to score the quality of the papers and for the final selection of the articles. Results: Our search resulted in 214 articles, of which 19 were eligible. Studies on advanced use in adults and children with T1DM reported increased TIR (all 9 studies); decreased time in hypoglycaemia (13 out of 15 studies); lowered HbA1c levels (5 out of 15 studies); improved QoL (10 of 16 studies) and treatment satisfaction (7 studies). Conclusions: Recent technologies have dramatically changed the course of T1DM. They are proving useful in controlling glycaemia in patients with T1DM, without increasing the treatment burden.
    Type of Medium: Online Resource
    ISSN: 2042-0188 , 2042-0196
    URL: Article
    DOI: 10.1177/2042018819871903
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 3
    Online Resource
    Online Resource
    A Review of Current Evidence with Continuous Glucose Monitoring in Patients with Diabetes
    SAGE Publications ; 2008
    In:  Journal of Diabetes Science and Technology Vol. 2, No. 4 ( 2008-07), p. 718-727
    Details
    In: Journal of Diabetes Science and Technology, SAGE Publications, Vol. 2, No. 4 ( 2008-07), p. 718-727
    Abstract: Devices that measure glucose on a near-continuous basis may provide a better insight into glycemic profiles, allowing patients with diabetes to make therapeutic adjustments to improve metabolic control, thereby reducing the risk of diabetic complications. Motivated and technologically adept patients with brittle diabetes, hypoglycemia unawareness, diabetic pregnancy, or who use pumps might benefit. Current evidence of continuous glucose monitoring (CGM) on health outcome in patients with diabetes is critically reviewed. No data are available on chronic complications or mortality. Therefore, surrogate endpoints need to be investigated, particularly HbA1c, number of hypo- and hyperglycemic episodes, time within normal, high, or low glucose concentrations, glycemic variability, and quality of life. Randomized controlled trials (RCTs) using CGM in a retrospective way did not show metabolic improvement. In contrast, most RCTs applying real-time CGM showed a decrease in HbA1c, reduced glycemic variability, and a diminished number and length of hypo- and hyperglycemic events. Using accurate, real-time CGM devices improves quality of life by reducing the fear of unexpected hypoglycemic events. These beneficial effects were observed despite the fact that in most studies no clear treatment algorithm based on CGM results was provided to the patients. However, most trials were too short in duration, with a variable use of CGM, and were performed in small study samples. In conclusion, real-time CGM systems can improve metabolic control, reduce hypoglycemic episodes, and improve quality of life. Whether this holds true for longer time periods and in the majority of patients remains to be proven. In the long term, CGM might help to reduce chronic diabetes complications and perhaps also mortality, thereby reducing health care costs.
    Type of Medium: Online Resource
    ISSN: 1932-2968 , 1932-2968
    URL: Article
    DOI: 10.1177/193229680800200426
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2008
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  • 4
    Online Resource
    Online Resource
    Glucose Control in the ICU : A Continuing Story
    SAGE Publications ; 2016
    In:  Journal of Diabetes Science and Technology Vol. 10, No. 6 ( 2016-11), p. 1372-1381
    Details
    In: Journal of Diabetes Science and Technology, SAGE Publications, Vol. 10, No. 6 ( 2016-11), p. 1372-1381
    Abstract: In the present era of near-continuous glucose monitoring (CGM) and automated therapeutic closed-loop systems, measures of accuracy and of quality of glucose control need to be standardized for licensing authorities and to enable comparisons across studies and devices. Adequately powered, good quality, randomized, controlled studies are needed to assess the impact of different CGM devices on the quality of glucose control, workload, and costs. The additional effects of continuing glucose control on the general floor after the ICU stay also need to be investigated. Current algorithms need to be adapted and validated for CGM, including effects on glucose variability and workload. Improved collaboration within the industry needs to be encouraged because no single company produces all the necessary components for an automated closed-loop system. Combining glucose measurement with measurement of other variables in 1 sensor may help make this approach more financially viable.
    Type of Medium: Online Resource
    ISSN: 1932-2968 , 1932-2968
    URL: Article
    DOI: 10.1177/1932296816648713
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 5
    Online Resource
    Online Resource
    Higher Derived Time in Range With IDegLira Versus Insulin Glargine U100 in People With Type 2 Diabetes
    SAGE Publications ; 2023
    In:  Journal of Diabetes Science and Technology
    Details
    In: Journal of Diabetes Science and Technology, SAGE Publications
    Abstract: Derived time in range (dTIR), calculated from self-monitored blood glucose (SMBG-dTIR) profiles, has demonstrated correlation with risk of cardiovascular and microvascular complications. This post hoc analysis of the DUAL V and DUAL VIII trials aimed to compare dTIR with an insulin degludec/liraglutide fixed-ratio combination (IDegLira) versus insulin glargine 100 units/mL (glargine U100) in people with type 2 diabetes (T2D). Materials and Methods: Nine-point SMBG profiles were taken more than 24 hours at baseline and end of trial (EOT: 26 weeks [DUAL V] and 104 weeks [DUAL VIII] ) and used to derive the percentage of readings within target range (70-180 mg/dL). Estimated treatment differences (ETDs, IDegLira–glargine U100) were analyzed using analysis of covariance, with treatment as fixed effects and baseline response as a covariate. Results: ETDs for change from baseline to EOT in dTIR were significantly greater with IDegLira versus glargine U100 in DUAL V (4.18%, P = .027) and DUAL VIII (5.17%, P = .001). The proportions of people achieving ≥70% dTIR at EOT with IDegLira and glargine U100, respectively, were 62% and 60% in DUAL V ( P = .7541), and 50% and 26% in DUAL VIII ( P 〈 .0001). The proportion achieving a ≥5% increase in dTIR from baseline to EOT with IDegLira and glargine U100 was 63% in both groups in DUAL V ( P = .9043), and 44% and 25%, respectively, in DUAL VIII ( P 〈 .0001). Conclusions: IDegLira was associated with significantly greater increases in dTIR versus basal insulin alone in people with T2D. Trial ID(s): ClinicalTrials.gov, NCT01952145 (DUAL V); ClinicalTrials.gov, NCT02501161 (DUAL VIII)
    Type of Medium: Online Resource
    ISSN: 1932-2968 , 1932-2968
    URL: Article
    DOI: 10.1177/19322968221149041
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 6
    Online Resource
    Online Resource
    The Impact of Baseline User Characteristics on the Benefits of Real-Time Versus Intermittently Scanned Continuous Glucose Monitoring in Adults With Type 1 Diabetes: Moderator Analyses of the ALERTT1 Trial
    SAGE Publications ; 2022
    In:  Journal of Diabetes Science and Technology
    Details
    In: Journal of Diabetes Science and Technology, SAGE Publications
    Abstract: ALERTT1 showed that switching from intermittently scanned continuous glucose monitoring (isCGM) without alerts to real-time CGM (rtCGM) with alert functionality improved time in range (TIR; 70-180 mg/dL), glycated hemoglobin (HbA1c), time 〈 54 mg/dL, and Hypoglycemia Fear Survey version II worry subscale (HFS-worry) score after six months in adults with type 1 diabetes (T1D). Moderator analyses aimed to identify certain subgroups that would benefit more from switching to rtCGM than others. Methods: Post hoc analyses of ALERTT1 evaluated the impact of 14 baseline characteristics on the difference (delta) in mean TIR, HbA1c, time 〈 54 mg/dL, and HFS-worry score at six months between rtCGM and isCGM. Therefore, the delta was allowed to depend on each of these variables by including interactions in the moderator analysis model. Analyses were performed separately for each variable; variables with P 〈 .10 in the univariable analysis were combined into a single model. Results: Univariable analyses showed no dependency of delta TIR, HbA1c, or time 〈 54 mg/dL on variables other than CGM type. Only delta HFS-worry score depended on baseline HbA1c ( P = .0059), indicating less worries with rtCGM in people with baseline HbA1c 〈 6.5% or ≥8%. Given P 〈 .10 for dependency of delta TIR on insulin therapy type (favoring multiple daily injections), baseline HbA1c, and baseline TIR, these variables were combined into a multivariable analysis; interactions were not statistically significant. Conclusions: Except for HFS-worry score, no interactions between 14 baseline characteristics and the six-month intervention effect of rtCGM on TIR, HbA1c, or time 〈 54 mg/dL were observed, supporting the conclusion of ALERTT1 that switching from isCGM without alerts to rtCGM with alert functionality is beneficial for a wide range of people with T1D.
    Type of Medium: Online Resource
    ISSN: 1932-2968 , 1932-2968
    URL: Article
    DOI: 10.1177/19322968221128315
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 7
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    Online Resource
    NAFLD in type 1 diabetes: overrated or underappreciated?
    SAGE Publications ; 2021
    In:  Therapeutic Advances in Endocrinology and Metabolism Vol. 12 ( 2021-01), p. 204201882110555-
    Details
    In: Therapeutic Advances in Endocrinology and Metabolism, SAGE Publications, Vol. 12 ( 2021-01), p. 204201882110555-
    Abstract: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in western countries, affecting 25–30% of the general population and up to 65% in those with obesity and/or type 2 diabetes. Accumulation of visceral adipose tissue and insulin resistance (IR) contributes to NAFLD. NAFLD is not an innocent entity as it not only may cause nonalcoholic steatohepatitis and cirrhosis but also contribute to cardiovascular morbidity and mortality. More and more people with type 1 diabetes (T1D) are becoming overweight and present with features of IR, but the prevalence and impact of NAFLD in this population are still unclear. The utility of noninvasive screening tools for NAFLD in T1D is being explored. Recent data indicate that based upon ultrasonographic criteria NAFLD is present in 27% (ranging between 19% and 31%) of adults with T1D. Magnetic resonance imaging data indicate a prevalence rate of 8.6% (ranging between 2.1% and 18.6%). There are, however, multiple factors affecting these data, ranging from study design and referral bias to discrepancies in between diagnostic modalities. Individuals with T1D have a 7-fold higher risk of cardiovascular disease (CVD) and cardiovascular mortality is the most prominent cause of death in T1D. Patients with T1D and NALFD are also more prone to develop CVD, but the independent contribution of NAFLD to cardiovascular events has to be determined in this population. Furthermore, limited data in T1D also point towards a 2 to 3 times higher risk for microvascular complications in those with NAFLD. In this article, we will discuss epidemiological and diagnostic challenges of NAFLD in T1D, explore the link between IR and NAFLD and chronic complications, and examine the independent contribution of NAFLD to the presence of macro-, and microvascular complications.
    Type of Medium: Online Resource
    ISSN: 2042-0188 , 2042-0196
    URL: Article
    DOI: 10.1177/20420188211055557
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 8
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    Online Resource
    Therapeutic approaches for non-alcoholic steatohepatitis
    SAGE Publications ; 2021
    In:  Therapeutic Advances in Endocrinology and Metabolism Vol. 12 ( 2021-01), p. 204201882110343-
    Details
    In: Therapeutic Advances in Endocrinology and Metabolism, SAGE Publications, Vol. 12 ( 2021-01), p. 204201882110343-
    Abstract: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have been reported as a novel worldwide epidemic, very often associated with obesity, metabolic syndrome, and type 2 diabetes. Both conditions have also been shown to be associated with a number of endocrine pathologies. Despite the epidemic, the complex pathophysiology and major complications, ranging from metabolic disturbances (diabetes and more) to cardiovascular disease, people with NASH are left with very few management options. The best and most approved therapeutic option is lifestyle intervention. Although pharmacotherapies based on pathophysiological background are in development, response rates appear modest, mainly for fibrosis treatment, which is the reason for lack of approved drug therapy. Previous drugs analyzed, such as pioglitazone and vitamin E, show weak efficacy. From different phase II trials, antidiabetic (injectable) drugs seem to be promising, both in mono- or bitherapy. Also, derivatives of peroxisome proliferator-activated receptors may have an interesting future, as well. For that reason, more focus should be given on prevention of this novel disease entity. In view of this booming epidemic, with a background of obesity and type 2 diabetes, and the important medical consequences, early recognition, prevention and intervention of NAFLD/NASH seems appropriate. In this review, we will focus on the different current and future therapeutic intervention options, taking into consideration the complex pathophysiology of this disease.
    Type of Medium: Online Resource
    ISSN: 2042-0188 , 2042-0196
    URL: Article
    DOI: 10.1177/20420188211034300
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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