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  • 1
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    The Association Between HbA1c and Time in Hypoglycemia During CGM and Self-Monitoring of Blood Glucose in People With Type 1 Diabetes and Multiple Daily Insulin Injections: A Randomized Clinical Trial (GOLD-4)
    American Diabetes Association ; 2020
    In:  Diabetes Care Vol. 43, No. 9 ( 2020-09-01), p. 2017-2024
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 43, No. 9 ( 2020-09-01), p. 2017-2024
    Abstract: According to recent guidelines, individuals with type 1 diabetes should spend & lt;4.0% of time per day with glucose levels & lt;3.9 mmol/L ( & lt;70 mg/dL) and & lt;1.0% per day with glucose levels & lt;3.0 mmol/L ( & lt;54 mg/dL). RESEARCH DESIGN AND METHODS In the GOLD randomized crossover trial, 161 individuals with type 1 diabetes treated with multiple daily insulin injections (MDI) were randomized to continuous glucose monitoring (CGM) or conventional therapy with self-monitoring of blood glucose (SMBG) and evaluated over 16 months. We estimated the association between time spent in hypoglycemia and various mean glucose and HbA1c levels. RESULTS Time spent in hypoglycemia ( & lt;3.9 mmol/L and & lt;3.0 mmol/L) increased significantly with lower mean HbA1c and mean glucose levels during both CGM and conventional therapy. During CGM, 24 (57.1%) individuals with HbA1c & lt;7.5% ( & lt;58 mmol/mol) had & lt;1.0% time spent in hypoglycemia & lt;3.0 mmol/L and 23 (54.8%) had & lt;4.0% time spent in hypoglycemia & lt;3.9 mmol/L. During CGM, mean time spent in hypoglycemia for individuals with mean HbA1c 7.0% (52 mmol/mol) was estimated to be 5.4% for & lt;3.9 mmol/L and 1.5% for & lt;3.0 mmol/L. The corresponding values during SMBG were 9.2% and 3.5%, respectively. Individuals with mean glucose levels of 8 mmol/L spent 4.9% units more time with glucose levels & lt;3.9 mmol/L and 2.8% units more time & lt;3.0 mmol/L during SMBG compared with CGM. CONCLUSIONS Reaching current targets for time in hypoglycemia while at the same time reaching HbA1c targets is challenging for patients with type 1 diabetes treated with MDI both with CGM and SMBG monitoring. However, CGM is associated with considerably less time in hypoglycemia than SMBG at a broad range of HbA1c levels and is crucial for patients with MDI treatment if they are to have a chance to approach hypoglycemia targets.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc19-2606
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2020
    detail.hit.zdb_id: 1490520-6
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  • 2
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    Evaluation of Effects of Continuous Glucose Monitoring on Physical Activity Habits and Blood Lipid Levels in Persons With Type 1 Diabetes Managed With MDI: An Analysis Based on the GOLD Randomized Trial (GOLD 8)
    SAGE Publications ; 2022
    In:  Journal of Diabetes Science and Technology
    Details
    In: Journal of Diabetes Science and Technology, SAGE Publications
    Abstract: People with type 1 diabetes generally view it easier to exercise when having continuous information of the glucose levels. We evaluated whether patients with type 1 diabetes managed with multiple daily insulin injections (MDI) exercised more after initiating continuous glucose monitoring (CGM) and whether the improved glycemic control and well-being associated with CGM translates into improved blood lipids and markers of inflammation. Method: The GOLD trial was a randomized cross-over trial over 16 months where patients used either CGM or capillary self-monitoring of blood glucose (SMBG) over six months, with a four-month wash-out period between the two treatment periods. We compared grade of physical activity, blood lipids, apolipoproteins, and high-sensitivity C-reactive protein (hsCRP) levels during CGM and SMBG. Results: There were 116 patients with information of physical activity estimated by the International Physical Activity Questionnaire (IPAQ) during both CGM and SMBG. No changes were found during CGM or SMBG, IPAQ scores 3305 versus 3878 ( P = .16). In 136 participants with information of blood lipid levels with no change in lipid-lowering medication during the two treatment periods, HbA1c differed by 4.2 mmol/mol (NGSP 0.39%) between SMBG and CGM treatment ( P 〈 .001). No significant changes existed in low-density lipoprotein, high-density lipoprotein, triglycerides, total cholesterol, apolipoprotein A1, apolipoprotein B1, or hsCRP, during CGM and SMBG. Conclusion: Although many patients experience it easier to perform physical activity when monitoring glucose levels with CGM, it does not influence the amount of physical activity in persons with type 1 diabetes. Blood lipids, apolipoprotein, and hsCRP levels were similar during CGM and SMBG.
    Type of Medium: Online Resource
    ISSN: 1932-2968 , 1932-2968
    URL: Article
    DOI: 10.1177/19322968221101916
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2467312-2
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  • 3
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    The majority of people with type 1 diabetes and multiple daily insulin injections benefit from using continuous glucose monitoring: An analysis based on the GOLD randomized trial ( GOLD‐5 )
    Wiley ; 2021
    In:  Diabetes, Obesity and Metabolism Vol. 23, No. 2 ( 2021-02), p. 619-630
    Details
    In: Diabetes, Obesity and Metabolism, Wiley, Vol. 23, No. 2 ( 2021-02), p. 619-630
    Abstract: To identify responders to continuous glucose monitoring (CGM) in relation to reductions in HbA1c and percentage of time spent in hypoglycaemia after initiation of CGM for individuals with type 1 diabetes treated with multiple daily insulin injections. Materials and Methods We analysed data from 142 participants in the GOLD randomized clinical trial. We evaluated how many lowered their HbA1c by more than 0.4% ( 〉 4.7 mmol/mol) or decreased the time spent in hypoglycaemia over 24 hours by more than 20 or 30 minutes, and which baseline variables were associated with those improvements. Results Lower reduction of HbA1c was associated with greater reduction of hypoglycaemia (r = −0.52; P   〈  .0001). During CGM, 47% of participants lowered their HbA1c values by more than 0.4% ( 〉 4.7 mmol/mol) than with self‐measurement of blood glucose, and 47% decreased the time spent in hypoglycaemia by more than 20 minutes over 24 hours. Overall, 78% either reduced their HbA1c by more than 0.4% ( 〉 4.7 mmol/mol) or the time spent in hypoglycaemia by more than 20 minutes over 24 hours, but only 14% improved both. Higher HbA1c, a lower percentage of time at less than 3.0 or 3.9 mmol/L, a lower coefficient of variation (CV) and a higher percentage of time above 13.9 mmol/L ( P = .016) were associated with greater HbA1c reduction during CGM. The variables associated with a greater reduction of time in hypoglycaemia were female sex, greater time with glucose levels at less than 3.0 mmol/L, higher CV, and higher hypoglycaemia confidence as evaluated by a hypoglycaemic confidence questionnaire. Conclusion The majority of people with type 1 diabetes managed by multiple daily insulin injections benefit from CGM; some experienced reduced HbA1c while others reduced the time spent in hypoglycaemia. These factors need to be considered by healthcare professionals and decision‐makers for reimbursement and diabetes guidelines.
    Type of Medium: Online Resource
    ISSN: 1462-8902 , 1463-1326
    URL: Issue
    URL: Article
    DOI: 10.1111/dom.v23.2
    DOI: 10.1111/dom.14257
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2004918-3
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  • 4
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    Sustained Intensive Treatment and Long-term Effects on HbA1c Reduction (SILVER Study) by CGM in People With Type 1 Diabetes Treated With MDI
    American Diabetes Association ; 2021
    In:  Diabetes Care Vol. 44, No. 1 ( 2021-01-01), p. 141-149
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 44, No. 1 ( 2021-01-01), p. 141-149
    Abstract: Continuous glucose monitoring (CGM) reduces HbA1c and time spent in hypoglycemia in people with type 1 diabetes (T1D) treated with multiple daily insulin injections (MDI) when evaluated over shorter time periods. It is unclear to what extent CGM improves and helps to maintain glucose control, treatment satisfaction, diabetes distress, hypoglycemic concerns, and overall well-being over longer periods of time. RESEARCH DESIGN AND METHODS The GOLD trial was a randomized crossover trial performed over 16 months of CGM treatment in people with T1D treated with MDI. People completing the trial (n = 141) were invited to participate in the current SILVER extension study in which 107 patients continued CGM treatment over 1 year along with the support of a diabetes nurse every 3 months. RESULTS The primary end point of the change in HbA1c over 1.0–1.5 years of CGM use compared with previous self-monitoring of blood glucose during GOLD showed a decrease in HbA1c of 0.35% (95% CI 0.19–0.50, P & lt; 0.001). Time spent in hypoglycemia & lt;3.0 mmol/L (54 mg/dL) and & lt;4.0 mmol/L (72 mg/dL) decreased from 2.1% to 0.6% (P & lt; 0.001) and from 5.4% to 2.9% (P & lt; 0.001), respectively. Overall well-being (World Health Organization 5-item well-being index, P = 0.009), treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire, P & lt; 0.001), and hypoglycemic confidence (P & lt; 0.001) increased, while hypoglycemic fear (Hypoglycemia Fear Survey–Worry, P = 0.016) decreased and diabetes distress tended to decrease (Problem Areas in Diabetes Scale, P = 0.06). From randomization and screening in GOLD, HbA1c was lowered by 0.45% (P & lt; 0.001) and 0.68% (P & lt; 0.001) after 2.3 and 2.5 years, respectively. CONCLUSIONS The SILVER study supports beneficial long-term effects from CGM on HbA1c, hypoglycemia, treatment satisfaction, well-being, and hypoglycemic confidence in people with T1D managed with MDI.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc20-1468
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2021
    detail.hit.zdb_id: 1490520-6
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  • 5
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    Beta‐blockers, hypertension, and stroke outcomes
    Wiley ; 2018
    In:  The Journal of Clinical Hypertension Vol. 20, No. 3 ( 2018-03), p. 573-574
    Details
    In: The Journal of Clinical Hypertension, Wiley, Vol. 20, No. 3 ( 2018-03), p. 573-574
    Type of Medium: Online Resource
    ISSN: 1524-6175 , 1751-7176
    URL: Issue
    URL: Article
    DOI: 10.1111/jch.2018.20.issue-3
    DOI: 10.1111/jch.13234
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2058690-5
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  • 6
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    The exaggerated blood pressure response to exercise in the sub‐acute phase after stroke is not affected by aerobic exercise
    Wiley ; 2018
    In:  The Journal of Clinical Hypertension Vol. 20, No. 1 ( 2018-01), p. 56-64
    Details
    In: The Journal of Clinical Hypertension, Wiley, Vol. 20, No. 1 ( 2018-01), p. 56-64
    Abstract: The prevalence of an exaggerated exercise blood pressure (BP) response is unknown in patients with subacute stroke, and it is not known whether an aerobic exercise program modulates this response. The authors randomized 53 patients (27 women) with subacute stroke to 12 weeks of twice‐weekly aerobic exercise (n = 29) or to usual care without scheduled physical exercise (n = 24). At baseline, 66% of the patients exhibited an exaggerated exercise BP response (peak systolic BP ≥210 mm Hg in men and ≥190 mm Hg in women) during a symptom‐limited ergometer exercise test. At follow‐up, patients who had been randomized to the exercise program achieved higher peak work rate, but peak systolic BP remained unaltered. Among patients with a recent stroke, it was common to have an exaggerated systolic BP response during exercise. This response was not altered by participation in a 12‐week program of aerobic exercise.
    Type of Medium: Online Resource
    ISSN: 1524-6175 , 1751-7176
    URL: Issue
    URL: Article
    DOI: 10.1111/jch.2018.20.issue-1
    DOI: 10.1111/jch.13157
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2058690-5
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  • 7
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    Can and Should the EU's Eastern Partnership Be Saved?
    Elsevier BV ; 2014
    In:  SSRN Electronic Journal
    Details
    In: SSRN Electronic Journal, Elsevier BV
    Type of Medium: Online Resource
    ISSN: 1556-5068
    URL: Article
    DOI: 10.2139/ssrn.2469729
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
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  • 8
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    NT-proBNP as a predictor of death and cardiovascular events in patients with type 2 diabetes
    Springer Science and Business Media LLC ; 2022
    In:  Diabetology & Metabolic Syndrome Vol. 14, No. 1 ( 2022-05-03)
    Details
    In: Diabetology & Metabolic Syndrome, Springer Science and Business Media LLC, Vol. 14, No. 1 ( 2022-05-03)
    Abstract: Existing risk prediction scores based on clinical and laboratory variables have been considered inaccurate in patients with Type 2 Diabetes Mellitus (T2DM). Circulating concentrations of natriuretic peptides have been used to aid in the diagnosis and to predict outcomes in heart failure. However, there is a growing body of evidence for the use of natriuretic peptides measurements, mainly N-terminal pro-B-type natriuretic peptide (NT-proBNP), as a tool in risk stratification for individuals with T2DM. Studies have demonstrated the ability of NT-proBNP to improve outcomes prediction when incorporated into multivariate models. More recently, evidence has emerged of the discriminatory power of NT-proBNP, demonstrating, as a single variable, a similar and even superior ability to multivariate risk models for the prediction of death and cardiovascular events in individuals with T2DM. Natriuretic peptides are synthesized and released from the myocardium as a counter-regulatory response to increased cardiac wall stress, sympathetic tone, and vasoconstriction, acting on various systems and affecting different biological processes. In this article, we present a review of the accumulated knowledge about these biomarkers, underscoring the strength of the evidence of their predictive ability for fatal and non-fatal outcomes. It is likely that, by influencing the functioning of many organs, these biomarkers integrate information from different systems. Although not yet recommended by guidelines, measurement of natriuretic peptides, and particularly NT-proBNP, should be strongly considered in the risk stratification of individuals with T2DM.
    Type of Medium: Online Resource
    ISSN: 1758-5996
    URL: Article
    DOI: 10.1186/s13098-022-00837-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2518786-7
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  • 9
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    Managing the global commons
    Cambridge University Press (CUP) ; 1982
    In:  International Organization Vol. 36, No. 3 ( 1982), p. 511-536
    Details
    In: International Organization, Cambridge University Press (CUP), Vol. 36, No. 3 ( 1982), p. 511-536
    Abstract: When should internationally shared resources be subdivided and property and management rights to parts of the resource be distributed among nation states? Subdivision leads to inefficient exploitation and to an arbitrary division of benefits under three conditions: when property rights cannot be economically enforced; when the size and the value of the resource are unknown; and when exploitation involves external economies. The efficient use of such common property resources requires private or public regulation. Voluntary private regulation is likely to be effective only when few users are involved. In other cases, public regulation is called for. Some attributes of an intergovernmental organization designed to achieve efficient, equitable, and stable exploitation are presented. Current proposals for managing ocean resources, the orbit-spectrum resource, and Antarctica are considered.
    Type of Medium: Online Resource
    ISSN: 0020-8183 , 1531-5088
    URL: Article
    DOI: 10.1017/S0020818300032628
    RVK:
    PR 1000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 1982
    detail.hit.zdb_id: 1481046-3
    SSG: 3,6
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  • 10
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    Treatment Satisfaction and Well-Being With CGM in People With T1D: An Analysis Based on the GOLD Randomized Trial
    SAGE Publications ; 2023
    In:  Journal of Diabetes Science and Technology
    Details
    In: Journal of Diabetes Science and Technology, SAGE Publications
    Abstract: The GOLD trial demonstrated that continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D) managed with multiple daily insulin injections (MDI) improved not only glucose control but also overall well-being and treatment satisfaction. This analysis investigated which factors contributed to improved well-being and treatment satisfaction with CGM. Methods: The GOLD trial was a randomized crossover trial comparing CGM versus self-monitored blood glucose (SMBG) over 16 months. Endpoints included well-being measured by the World Health Organization–Five Well-Being Index (WHO-5) and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire (DTSQ) as well as glucose metrics. Multivariable R 2 -decomposition was used to understand which variables contributed most to treatment satisfaction. Results: A total of 139 participants were included. Multivariable analyses revealed that increased convenience and flexibility contributed to 60% (95% confidence interval [CI] = 50%-69%) of the improvement in treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire change version [DTSQ c] ) observed with CGM, whereas perceived effects on hypoglycemia and hyperglycemia only contributed to 6% (95% CI = 2%-11%) of improvements. Significant improvements in well-being (WHO-5) by CGM were observed for the following: feeling cheerful ( P = .025), calm and relaxed ( P = .024), being active ( P = .046), and waking up fresh and rested ( P = .044). HbA1c reductions and increased time in range (TIR) were associated with increased treatment satisfaction, whereas glycemic variability was not. HbA1c reduction showed also an association with increased well-being and increased TIR with less diabetes-related distress. Conclusions: While CGM improves glucose control in people with T1D on MDI, increased convenience and flexibility through CGM is of even greater importance for treatment satisfaction and patient well-being. These CGM-mediated effects should be taken into account when considering CGM initiation.
    Type of Medium: Online Resource
    ISSN: 1932-2968 , 1932-2968
    URL: Article
    DOI: 10.1177/19322968231183974
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2467312-2
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