Introduction Continuous glucose monitoring (CGM) can guide treatment for people with type 1 (T1D) and type 2 diabetes (T2D). The ANSHIN study assessed the impact of non‐adjunctive CGM use in adults with diabetes using intensive insulin therapy (IIT). Materials and Methods This single‐arm, prospective, interventional study enrolled adults with T1D or T2D who had not used CGM in the prior 6 months. Participants wore blinded CGMs (Dexcom G6) during a 20‐day run‐in phase, with treatment based on fingerstick glucose values, followed by a 16‐week intervention phase and then a randomized 12‐week extension phase with treatment based on CGM values. The primary outcome was change in HbA1c. Secondary outcomes were CGM metrics. Safety endpoints were the number of severe hypoglycaemic (SH) and diabetic ketoacidosis (DKA) events. Results Of the 77 adults enrolled, 63 completed the study. Those enrolled had mean (SD) baseline HbA1c of 9.8% (1.9%), 36% had T1D, and 44% were ≥65 years old. Mean HbA1c decreased by 1.3, 1.0 and 1.0 percentage points for participants with T1D, T2D or age ≥65, respectively (p < .001 for each). CGM‐based metrics including time in range also improved significantly. SH events decreased from the run‐in period (67.3 per 100 person‐years) to the intervention period (17.0 per 100 person‐years). Three DKA events unrelated to CGM use occurred during the total intervention period. Conclusions Non‐adjunctive use of the Dexcom G6 CGM system improved glycaemic control and was safe for adults using IIT.
Background and Purpose: Aging is associated with cognitive impairment, which interferes with safe driving ability. Cognitively-impaired drivers may present as confused and belligerent, creating challenges in differentiating these drivers from intoxicated or metabolically-impaired drivers. The Driver Orientation Screen for Cognitive Impairment (DOSCI) was developed to assist identification of disorientation and was piloted in the Iowa Department of Transportation. This study examined the feasibility, acceptability, and usefulness of the DOSCI at licensing agency offices, and to investigate the association between DOSCI performance and driver licensing outcomes. Methods: A sample of 2,510 DOSCI screens from 2,399 individuals was assessed. Data included the acceptability of the DOSCI among staff and clients, time to complete assessments, DOSCI outcomes, and final driver license status. Results: On a 5-point scale, mean score was 4.76 (SD=0.67) for Ease of Administration, 4.67 (SD=0.80) for Acceptance by Client, and 3.81 (SD=1.57) for Useful in Assessment. Clients who failed the assessment had significantly higher odds of not receiving a driver’s license than clients who passed (OR=2.556). Conclusion: The DOSCI was quick to administer, well-accepted, and was associated with licensing outcome. The tool has potential to contribute to traffic injury prevention by identifying potentially impaired drivers requiring closer examination in a licensing agency setting.
Remote monitoring of CGM data of children and youth attending diabetes camp has been shown to reduce overall and nocturnal hypoglycemia, compared to treatment decisions based on self-monitored blood glucose (SMBG) values. However, some diabetes camps still require regular SMBG testing. We compared at-home versus at-camp glucose control where CGM data were used as the basis for diabetes treatment decisions. Thirty-four campers with T1D (mean±SD age 12±3 years, A1C 7.5±1.2%) were eligible for inclusion if they were using Control-IQ technology (Tandem Diabetes Care) prior to and during their attendance at Camp Buck, a diabetes-focused facility near Lake Tahoe. At camp, their CGM data (Dexcom G6) were integrated with the CampViews EMR system (Nevada-California Diabetes Association). CGM data from at-home and at-camp intervals were compared. As shown in the Table, mean glucose and overall time in range (TIR, 70-180 mg/dL) improved at camp, with statistical significance in the overnight (10PM-6AM) interval. Although time in Level 1 hypoglycemia increased at camp, there were no significant changes between at-home and at-camp levels of Level 2 hypoglycemia. CGM data can be used nonadjunctively in the camp setting to maintain or improve glycemic control. Centralized remote monitoring of glucose data allows camp attendees and staff to safely reduce or eliminate SMBG testing. Disclosure S.E.Gleich: Research Support; Dexcom, Inc. H.R.Tecca: Employee; Dexcom, Inc. N.D.Gibson-north: None. S.B.Andrade: Employee; Dexcom, Inc. J.Welsh: Employee; Dexcom, Inc. E.Schuster: Employee; Dexcom, Inc. T.C.Walker: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc.
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