| |1. Cannabidiol (CBD) Use in Type 2 Diabetes: A Case ReportЧт, 23 дек 2021[−]
|Cannabidiol (CBD) oil has been gaining popularity as a natural alternative for numerous disease states. CBD is a phytocannabinoid obtained from the Cannabis sativa plant. Unlike its relative tetrahydrocannabinol (THC), CBD does not activate CB1 receptors in the brain and therefore lacks psychotropic effects ( 1). Instead, this substance is thought to work on the G-protein coupled receptor, endothelial cannabinoid receptor, and serotonin-1A receptors, among others.||↑|2. Parent Perspectives on Educational and Psychosocial Intervention for Recent-Onset Type 1 Diabetes in Their School-Age Child: A Qualitative StudyЧт, 23 дек 2021[−]
OBJECTIVEThe recent-onset period of type 1 diabetes (T1D) in early school-age children should include comprehensive, parent-focused T1D education as well as family-centered resources and support to help with adjustment. Here, we present parent/caregiver perspectives on specific areas of concern during the recent-onset period of T1D and their preferred timing for different topics related to T1D education.
METHODSParents/caregivers of 5- to 9-year-old children with T1D completed a card-sorting task and qualitative interview to describe ongoing areas of concern and preferred educational topics during the first year after T1D diagnosis.
RESULTSThirteen parents/caregivers (aged 35.1 ± 6.9 years) of a child with T1D (aged 8.9 ± 0.8 years, 11.3 ± 7.0 months post-diagnosis) completed the card-sorting task, and 11 completed the qualitative interview. Parents/caregivers endorsed four preferred stages of education: basic education and T1D survival skills during month 1 post-diagnosis, application and practice of T1D skills from months 1–3, access to community supports to cope with anxiety and distress from months 3–6, and support to build autonomy and manage burnout beyond month 6 post-diagnosis. Parents/caregivers endorsed four main themes for ongoing concerns: anxiety, autonomy, distress, and support.
CONCLUSIONParents endorsed four time points for education and psychosocial services within the first year of a T1D diagnosis. Parents/caregivers may benefit the most from psychosocial interventions 3–6 months post-diagnosis, once they have had sufficient time to develop basic T1D management skills. These findings support the need for regular parent psychosocial screening and access to scalable psychosocial interventions in the first year post-diagnosis of T1D.
|↑|3. Injection Technique: Development of a Novel Questionnaire and User GuideСр, 22 дек 2021[−]
OBJECTIVEApproximately 200 million people worldwide use injectable therapies as part of diabetes management. There appears to be a significant gap between insulin injection technique recommendations and injection practice for many. We aimed to develop and validate a novel, brief, self-administered injection technique assessment questionnaire.
RESEARCH DESIGN AND METHODSAn iterative codesign process was conducted. Focus groups and interviews with adults (or parents of children) with type 1 or type 2 diabetes and health care providers (HCPs) elicited views and refined the tool for broader distribution to the target audience. Questions addressed ease of understanding; relevance; included items and potential missing questions; feelings about diabetes; and any discomfort or judgment felt when completing the tool. A user guide was developed with cognitive interviewing performed to ensure relevance, acceptability, readability, and understanding. Statistical analyses included propensity score matching to identify a subset of the Worldwide Injection Technique Questionnaire with similar characteristics. Boruta feature selection, Cram?r’s V, and multiple correspondence analysis were conducted.
RESULTSHCPs and 16 people with diabetes participated in the initial focus groups and interviews. Questions were reported as clinically relevant, simple to complete, “about the right length,” relevant, and easy to understand. A total of 267 participants completed the survey reviewing the questionnaire. A further 16 participants underwent cognitive interviews. The complete resource was then reviewed by another 23 people with diabetes as a final check for completeness and usability. Statistical analyses demonstrated high validity and reliability.
CONCLUSIONThis novel resource is clinically relevant, acceptable, and easy to use as both a clinical tool and a self-assessment tool for people using injectable therapies for diabetes.
|↑|4. Global Well-Being Is Associated With A1C and Frequency of Self-Monitoring of Blood Glucose in Predominately Latinx Youth and Young Adults With Type 1 DiabetesВт, 21 дек 2021[−]
|Youth and young adults (YYAs) with type 1 diabetes do not consistently meet A1C targets set forth by national and international guidelines ( 1, 2). Diabetes care is further compromised for YYAs because they are at high risk of failure to transition from a pediatric to an adult endocrinologist ( 1, 3). Additionally, people from minority racial/ethnic groups have poorer A1C, increased diabetes complications, and worse diabetes-related outcomes compared with those from nonminority groups ( 4– 6). Youth from lower socioeconomic backgrounds have poorer diabetes-specific outcomes compared with those of higher socioeconomic backgrounds ( 7). Unfortunately, consistent with the medical field at large, research in type 1 diabetes consistently underrepresents YYAs of low socioeconomic status (SES) and racial/ethnic minority groups ( 8). Contributing factors to the disparities in A1C and type 1 diabetes–specific outcomes remain largely unexplored.||↑|5. Clinical Application of Time in Range and Other MetricsВт, 25 мая 2021[−]
|Time in range (TIR) and other continuous glucose monitoring (CGM)-derived metrics have been standardized in international consensus conferences. TIR correlates closely with A1C; a TIR of 70% correlates to an A1C of 6.7–7%. Evidence is emerging on the association of TIR with long-term diabetes complications, and each 10% increase in TIR shows a substantial decrease in risk for long-term complications. Application of TIR to clinical practice can be easily done with a stepped approach to the analysis and interpretation of CGM-derived metrics and the ambulatory glucose profile report. Clinician education and partnership with patients are crucial for successful implementation of TIR and all CGM-derived metrics in clinical practice.||↑|6. Time in Range in Pregnancy: Is There a Role?Вт, 25 мая 2021[−]
|Continuous glucose monitoring (CGM) is being used with increasing frequency as an adjunct to self-monitoring of blood glucose in pregnancy, and novel targets based on CGM data are becoming standardized. This adoption of CGM is the result of its improving accuracy, patient preference, and evolving data demonstrating associations of novel targets such as time in range (TIR) with pregnancy and neonatal outcomes. A greater understanding of the relationship of various CGM metrics to outcomes in pregnancy complicated by diabetes is needed. It is clear that TIR parameters need to be uniquely lower for pregnant women than for nonpregnant individuals. CGM technology is also an integral part of hybrid closed-loop insulin delivery systems. These insulin delivery systems will be a significant advance in the management of diabetes during pregnancy if they can achieve the pre- and postprandial targets required for pregnancy and optimize TIR.||↑|7. Time in Range as a Research Outcome MeasureВт, 25 мая 2021[−]
|Time in range (TIR) is gaining ground as an outcome measure in type 1 diabetes trials. However, inclusion of TIR raises several issues for trial design. In this article, the authors begin by defining TIR and describing the current international consensus around TIR targets. They then expand on evidence for the validity of TIR as a primary clinical trial outcome before concluding with some practical, ethical, and logistical implications.||↑|8. Associations of Time in Range and Other Continuous Glucose Monitoring–Derived Metrics With Well-Being and Patient-Reported Outcomes: Overview and TrendsВт, 25 мая 2021[−]
|Time in glucose ranges is increasingly relevant for research and clinical practice. Whereas the clinical validity of these metrics has been demonstrated with regard to long-term complications, their associations with patient-reported outcomes such as well-being, diabetes distress, and fear of hypoglycemia remain an open research question. This article reviews existing evidence on links between times in glycemic ranges and patient-reported outcomes. It also describes a novel research approach of using ecological momentary assessment to analyze on a more granular level in real time possible associations of these parameters of glycemic control and patient-reported outcomes. Such an approach could further our understanding of how glucose and patient-reported outcomes may be interconnected.||↑|9. Beyond A1C: Time in Range and Other Metrics PrefaceВт, 25 мая 2021[−]
|Continuous glucose monitoring (CGM) and the metrics surrounding its use have become increasingly integrated into the world of diabetes management. However, these tools require that people have access to the devices and providers who can help interpret them. I remember when I first heard about time in range (TIR) as a concept from Dr. Richard M. Bergenstal. Initially, I was a bit dubious. I was used to looking at my beloved “spaghetti graphs” and viewing the individual colorful linear representations of each day layered on top of each other; I knew how to analyze data my way. But over time, I became a convert. It was important to aggregate data into a standard format to make it more universally acceptable. And inherent in TIR is nearly everything that is needed to understand a patient’s diabetes status—both what is working well and what needs addressing. Other metrics contribute to the analysis, and each person can develop his or her own approach to evaluating and using the data.||↑|11. Beyond A1C—Standardization of Continuous Glucose Monitoring Reporting: Why It Is Needed and How It Continues to EvolveВт, 25 мая 2021[−]
|Continuous glucose monitoring (CGM) systems are becoming part of standard care for type 1 diabetes, and their use is increasing for type 2 diabetes. Consensus has been reached on standardized metrics for reporting CGM data, with time in range of 70–180 mg/dL and time below 54 mg/dL recognized as the key metrics of focus for diabetes management. The ambulatory glucose profile report has emerged as the standard for visualization of CGM data and will continue to evolve to incorporate other elements such as insulin, food, and exercise data to support glycemic management.||↑|12. Beyond A1C: A Practical Approach to Interpreting and Optimizing Continuous Glucose Data in YouthВт, 25 мая 2021[−]
|Despite significant pharmacological and technological advances in the treatment of type 1 diabetes, the majority of youth in the United States do not meet the American Diabetes Association’s recommended A1C goal. Understanding and managing glycemic variability is important in children and adolescents. Because A1C provides an incomplete picture of day-to-day glycemic fluctuations, continuous glucose monitoring (CGM)-derived metrics are a promising addition to address glycemic management challenges in youth with diabetes. In this article, we discuss how to develop practical strategies to optimize the use of CGM in the pediatric population, interpret the valuable data it provides, and develop personalized and actionable treatment goals.||↑|13. Feasibility of Implementing a Pediatric Diabetes Clinic via TelehealthВт, 16 мар 2021[−]
OBJECTIVEIn response to the coronavirus disease 2019 (COVID-19) pandemic and social distancing guidelines, our pediatric diabetes team rapidly changed the format of conducting diabetes clinic from in person to telehealth. We compared the actual number and rate of completed, canceled, and no-show visits between an 8-week period in 2019, when we exclusively conducted visits in person and the same 8-week period in 2020, during the COVID-19 quarantine, when we exclusively conducted visits via telehealth.
METHODSWe used electronic health record data for all patients, as well as Dexcom continuous glucose monitoring data collected for a subset of youths during the COVID-19 quarantine and the immediate pre–COVID-19 period.
RESULTSAlthough there was a difference in the absolute number of in-person versus telehealth visits canceled during these two time periods, there was no difference in the rates of completed, canceled, and no-show visits completed in person or via telehealth. This finding suggests that, despite a rapid shift to a completely new health care delivery model, our providers completed a similar rate of patient care via telehealth during the COVID-19 quarantine and that telehealth may be a feasible method for providing diabetes care. However, our results also suggested that youths’ glucose management was less optimal during the quarantine period.
CONCLUSIONCOVID-19 presented an opportunity to adopt and test the feasibility of using a telehealth delivery model for routine diabetes care. Yet, to make telehealth a viable treatment delivery alternative will likely involve the uptake of new clinic procedures, investment in institutional infrastructure, and team-based flexibility.
|↑|14. Use of Flash Continuous Glucose Monitoring Is Associated With A1C Reduction in People With Type 2 Diabetes Treated With Basal Insulin or Noninsulin TherapyСр, 10 фев 2021[−]
|BACKGROUNDGlycemic control is suboptimal in many individuals with type 2 diabetes. Although use of flash continuous glucose monitoring (CGM) has demonstrated A1C reductions in patients with type 2 diabetes treated with a multiple daily injection or insulin pump therapy regimen, the glycemic benefit of this technology in patients with type 2 diabetes using nonintensive treatment regimens has not been well studied.METHODSThis retrospective, observational study used the IBM Explorys database to assess changes in A1C after flash CGM prescription in a large population with suboptimally controlled type 2 diabetes treated with nonintensive therapy. Inclusion criteria were diagnosis of type 2 diabetes, age||↑|15. Exploring Why People With Type 2 Diabetes Do or Do Not Persist With Glucagon-Like Peptide-1 Receptor Agonist Therapy: A Qualitative StudyВт, 02 фев 2021[−]
OBJECTIVEDespite the demonstrated benefits of glucagon-like peptide 1 (GLP-1) receptor agonist therapy, adherence and persistence with this therapy is often challenging. The purpose of this study was to expand current understanding of patients’ experiences, motivations, and challenges relevant to their persistence with GLP-1 receptor agonist therapy.
DESIGN AND METHODSThis noninterventional, cross-sectional, qualitative study used face-to-face interviews with 36 adults with type 2 diabetes who had been treated with at least one GLP-1 receptor agonist medication. Inclusion criteria were: ?18 years of age, diagnosed with type 2 diabetes, and currently treated with a GLP-1 receptor agonist for ?1 month at the time of screening (“continuers”) or discontinued use of a GLP-1 receptor agonist ?1 year of screening but with a total ?1 month of treatment (“discontinuers”). Interviews were conducted using a semi-structured qualitative interview guide that included open-ended questions and probes to obtain both spontaneous and prompted input from participants about their current and past treatment experiences with GLP-1 receptor agonist therapy.
RESULTSAmong continuers (n= 16), the most commonly identified facilitators supporting the decision to continue were the observations of improved glucose control (50%) and weight loss (55%). Among discontinuers (n= 20), the most commonly identified challenges leading to treatment discontinuation were side effects (55%) and high cost (50%). Continuers were more likely than discontinuers to receive clinically relevant information from their health care team, including facts about GLP-1 receptor agonist medications, likely treatment benefits, the importance of gradual dose titration, and the need to adjust diet after initiation.
CONCLUSIONAlthough cost is a major obstacle to treatment continuation, it can only be resolved through changes in ongoing reimbursement coverage and policies. However, many other obstacles could potentially be addressed (e.g., reducing side effects with gradual dosage titration and setting appropriate expectations regarding efficacy) through more collaborative patient-clinician interactions before initiating therapy.