7. Diabetes Technology: <i>Standards of Medical Care in Diabetes—2021</i>

,

doi:10.2337/dc21-s007

Cited by 181 publications

(94 citation statements)

References 201 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A digital solution has the potential to deliver guidance and support anywhere and anytime it may be needed. Preliminary efforts to this effect have shown promise to the point that diabetes care standards already recognize the potential benefits of “connected care” [ 17 - 21 ].…”

Section: Introductionmentioning

confidence: 99%

Improved Glycemic Control With a Digital Health Intervention in Adults With Type 2 Diabetes: Retrospective Study

Zimmermann¹,

Venkatesan²,

Rawlings³

et al. 2021

JMIR Diabetes

View full text Add to dashboard Cite

Background Traditional lifestyle interventions have shown limited success in improving diabetes-related outcomes. Digital interventions with continuously available support and personalized educational content may offer unique advantages for self-management and glycemic control. Objective In this study, we evaluated changes in glycemic control among participants with type 2 diabetes who enrolled in a digital diabetes management program. Methods The study employed a single-arm, retrospective design. A total of 950 participants with a hemoglobin A1c (HbA1c) baseline value of at least 7.0% enrolled in the Vida Health Diabetes Management Program. The intervention included one-to-one remote sessions with a Vida provider and structured lessons and tools related to diabetes management. HbA1c was the primary outcome measure. Of the 950 participants, 258 (27.2%) had a follow-up HbA1c completed at least 90 days from program start. Paired t tests were used to evaluate changes in HbA1c between baseline and follow-up. Additionally, a cluster-robust multiple regression analysis was employed to evaluate the relationship between high and low program usage and HbA1c change. A repeated measures analysis of variance was used to evaluate the difference in HbA1c as a function of the measurement period (ie, pre-Vida enrollment, baseline, and postenrollment follow-up). Results We observed a significant reduction in HbA1c of –0.81 points between baseline (mean 8.68, SD 1.7) and follow-up (mean 7.88, SD 1.46; t257=7.71; P<.001). Among participants considered high risk (baseline HbA1c≥8), there was an average reduction of –1.44 points between baseline (mean 9.73, SD 1.68) and follow-up (mean 8.29, SD 1.64; t139=9.14; P<.001). Additionally, average follow-up HbA1c (mean 7.82, SD 1.41) was significantly lower than pre-enrollment HbA1c (mean 8.12, SD 1.46; F2, 210=22.90; P<.001) There was also significant effect of program usage on HbA1c change (β=–.60; P<.001) such that high usage was associated with a greater decrease in HbA1c (mean –1.02, SD 1.60) compared to low usage (mean –.61, SD 1.72). Conclusions The present study revealed clinically meaningful improvements in glycemic control among participants enrolled in a digital diabetes management intervention. Higher program usage was associated with greater improvements in HbA1c. The findings of the present study suggest that a digital health intervention may represent an accessible, scalable, and effective solution to diabetes management and improved HbA1c. The study was limited by a nonrandomized, observational design and limited postenrollment follow-up data.

show abstract

Section: Introductionmentioning

confidence: 99%

Improved Glycemic Control With a Digital Health Intervention in Adults With Type 2 Diabetes: Retrospective Study

Zimmermann¹,

Venkatesan²,

Rawlings³

et al. 2021

JMIR Diabetes

View full text Add to dashboard Cite

show abstract

“…A recent telehealth program that included remote monitoring of CGM demonstrated statistically significant reductions in HbA 1c levels among 594 patients with type 2 diabetes. 10 Project Extension for Community Health Outcomes (ECHO) successfully used remote learning as a venue for subspecialists to train primary care physicians to treat a range of conditions, including complex diabetes care, 11 and could be an alternative strategy for integrating CGM usage into primary care practice.…”

mentioning

confidence: 99%

Broadening Access to Continuous Glucose Monitoring for Patients With Type 2 Diabetes

Peek

Thomas

2021

JAMA

View full text Add to dashboard Cite

Persons from racial and ethnic minority populations, those in low-income groups, and other socially marginalized groups are disproportionately affected by type 2 diabetes and experience higher disease prevalence, poorer glycemic control, higher rates of diabetes complications, and higher prevalence of comorbid conditions. 1,2 Achieving glucose targets that will reduce the risk of diabetes complications, particularly among high-risk groups, is critical to improve the health and well-being of those with diabetes and to reduce health care utilization and expenditures. Yet, diabetes control remains elusive. Self-monitoring of blood glucose, while still a standard part of diabetes self-management, has not been shown to result in self-adjustments to insulin in primary care settings. This represents a significant opportunity gap because 30% of patients with type 2 diabetes are treated with some form of insulin. 3 Real-time continuous glucose monitoring (CGM), which measures glucose levels in subcutaneous interstitial fluid as frequently as every 5 minutes, has been shown to improve diabetes control, reduce hypoglycemia, and be cost-effective for patients with type 1 diabetes. 4,5 Less research has been conducted among patients with type 2 diabetes, but clinical trials involving patients using intensive insulin regimens (eg, basal/ bolus insulin) have shown reductions in hemoglobin A 1c (HbA 1c ) levels and shorter intervals of hypoglycemia. 6,7 Several questions remain: Can the results of clinical trials of patients with type 2 diabetes be translated into usual care settings? Can patients with type 2 diabetes who use less intensive insulin regimens benefit from CGM? Can CGM be feasibly implemented in primary care settings, where most of type 2 diabetes management occurs? In this issue of JAMA, the randomized clinical trial (RCT) reported by Martens et al 8 and the observational study reported by Karter et al 9 provide new data that help provide answers to these questions.Martens et al 8 conducted an RCT of CGM (n = 116) vs blood glucose meter (BGM) monitoring (n = 59) among adults with type 2 diabetes who were taking basal insulin without prandial insulin and were recruited from primary care practices. At 8 months, the mean HbA 1c level improved from 9.1% to 8.0% in the CGM group and from 9.0% to 8.4% in the control group (adjusted difference, −0.4% [95% CI, −0.8% to −0.1%]). This effect size may have been greater if the control group had received usual care rather than instructions on how to self-titrate insulin based on BGM data. Compared with the BGM group, the time in range, or the amount of time spent in the target blood glucose range (70-180 mg/dL), was 3.6 hours per day higher, the mean glucose level was

show abstract

“…Health care professionals and people with diabetes and cardiometabolic conditions are embracing technology that facilitates increased utilization of diabetes and chronic disease education and ultimately contributes to improved outcomes. 1 The diabetes care and education specialist must have the ability and latitude to support individual use of devices for self-management and have the capacity to identify and recommend innovative clinical systems, including telehealth, electronic health records (EHR), mobile applications, and other digital health technologies that enable and support device use and self-management. Combined, these technologies create opportunities for the diabetes care and education specialist to engage in person-centered and contextualized care and education while providing tailored feedback to address and mitigate therapeutic inertia.…”

Section: Adces Positionmentioning

confidence: 99%

“…ADCES promotes standards for best practices in technology-enabled diabetes and cardiometabolic services. 1-8 ADCES supports the diabetes care and education specialist by serving as the source for professional education on established and emerging technologies. Through Danatech, created by ADCES, the Association maintains a repository of resources that can be used in diverse practice settings to develop and increase expertise, improve efficiency, reduce duplication of effort, and support technology integration.…”

mentioning

confidence: 99%

From the Association of Diabetes Care & Education Specialists: The Role of the Diabetes Care and Education Specialist as a Champion of Technology Integration

Scalzo

2021

The Science of Diabetes Self-Management and Care

View full text Add to dashboard Cite

It is the position of the Association of Diabetes Care & Education Specialists that diabetes care and education specialists should play a central role in establishing and maintaining technology-enabled care in a variety of practice settings to optimize outcomes for people with diabetes and cardiometabolic conditions. The objectives of this position statement are to outline the role of diabetes care and education specialists as leaders in technology integration and to describe the resources and guidance the Association has developed to facilitate success in this role.

show abstract

7. Diabetes Technology: Standards of Medical Care in Diabetes—2021

Cited by 181 publications

References 201 publications

Improved Glycemic Control With a Digital Health Intervention in Adults With Type 2 Diabetes: Retrospective Study

Improved Glycemic Control With a Digital Health Intervention in Adults With Type 2 Diabetes: Retrospective Study

Broadening Access to Continuous Glucose Monitoring for Patients With Type 2 Diabetes

From the Association of Diabetes Care & Education Specialists: The Role of the Diabetes Care and Education Specialist as a Champion of Technology Integration

Contact Info

Product

Resources

About