Comparative Effectiveness and Safety of Methods of Insulin Delivery and Glucose Monitoring for Diabetes Mellitus

Yeh, Hsin Chieh; Brown, Todd T.; Maruthur, Nisa M.; Ranasinghe, Padmini D; Berger, Zackary; Suh, Yong; Wilson, Lisa M; Haberl, Elisabeth B; Brick, Jessica; Bass, Eric B.; Golden, Sherita Hill

doi:10.7326/0003-4819-157-5-201209040-00508

Cited by 458 publications

(377 citation statements)

References 63 publications

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“…This included effectiveness studies comparing real-time CGM to BGM in adults, adolescents, and children with T1DM (45). While methods of GM did not affect patient quality of life, A1C was lowered by 0.3% in patients who used CGM compared with (29) Freemantle Diabetes Study (183) QuED (184)…”

Section: Current Status Of Gmmentioning

confidence: 99%

American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

et al. 2016

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Section: Current Status Of Gmmentioning

confidence: 99%

American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

et al. 2016

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“…Minimally invasive real-time continuous glucose monitoring complements advances in insulin delivery and is progressing toward accurate, insulin-dosing approved, factory calibrated systems [13]. However, data from systematic reviews and meta-analysis on effectiveness of insulin pump therapy and continuous glucose monitoring have been mixed, particularly in the pediatric population [14–16]. Clinical benefits of continuous glucose monitoring including combined use of insulin pump are conditioned on high regular use [16,17].…”

Section: Introductionmentioning

confidence: 99%

“…However, data from systematic reviews and meta-analysis on effectiveness of insulin pump therapy and continuous glucose monitoring have been mixed, particularly in the pediatric population [14–16]. Clinical benefits of continuous glucose monitoring including combined use of insulin pump are conditioned on high regular use [16,17]. Although insulin pump therapy and continuous glucose monitoring may be beneficial in terms of glycemic control, quality of life, and hypoglycemia [12], the majority of young people with type 1 diabetes still do not meet treatment targets especially among adolescents [18,19].…”

Section: Introductionmentioning

confidence: 99%

Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes

Tauschmann

Hovorka

2017

Expert Opinion on Drug Delivery

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Introduction: Nocturnal glucose control remains challenging in children and adolescents with type 1 diabetes due to highly variable overnight insulin requirements. The issue may be addressed by glucose responsive insulin delivery based on real-time continuous glucose measurements.Areas covered: This review outlines recent developments of glucose responsive insulin delivery systems from a paediatric perspective. We cover threshold-based suspend application, predictive low glucose suspend, and more advanced single hormone and dual-hormone closed-loop systems. Approaches are evaluated in relation to nocturnal glucose control particularly during outpatient randomised controlled trials.Expert opinion: Significant progress translating research from controlled clinical centre settings to free-living unsupervised home studies have been achieved over the past decade. Nocturnal glycaemic control can be improved whilst reducing the risk of hypoglycaemia with closed-loop systems. Following the US regulatory approval of the first hybrid closed-loop system in non-paediatric population, large multinational closed-loop clinical trials and pivotal studies including paediatric populations are underway or in preparation to facilitate the use of closed-loop systems in clinical practice.

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“…29 This meta-analysis did not include many studies using modern analogues, and only included those with problematic hypoglycemia at baseline, which may account for the larger reduction in SH than seen in other meta-analyses which included studies with lower baseline rates of hypoglycemia and shorter follow-up duration. 30,31 The improvement in hypoglycemia frequency does not appear to be at the expense of glycemic control. Several meta-analysis 29,32 and CSII retrospective audits 33,34 have shown that when compared to MDI, CSII improves metabolic control by an additional 0.3-0.7% reduction in HbA1c, with the greatest HbA1c reduction seen in those with poorest metabolic control at baseline.…”

Section: Better Insulin Deliverymentioning

confidence: 99%

Technology to Reduce Hypoglycemia

Yeoh

Choudhary

2015

J Diabetes Sci Technol

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Hypoglycemia remains a major limiting factor toward the intensification of treatment for diabetes mellitus 1 and is a major cost to patients and to health care systems. 2 Hypoglycemia is often divided into mild or nonsevere hypoglycemia episodes (NSHE), where the person is able to selftreat, and severe hypoglycemia (SH), where external assistance is required. It is difficult to set a biochemical threshold for hypoglycemia, as the glucose threshold at which symptoms of hypoglycemia can be detected vary between individuals and even from day to day within the same person.3 The ADA workgroup on hypoglycemia offers some consensus guidelines, defining an alert value of ≤70 mg/dl, measured through self-monitored blood glucose (SMBG) or subcutaneous continuous glucose monitoring (CGM), as indicative of the potential for developing hypoglycemia. 4 All those treated with insulin secretagogues (sulphonylureas, glinides) and insulin therapy are at risk of hypoglycemia, and this risk is increased in the presence of endogenous insulin deficiency, longer duration of diabetes and longer duration of insulin therapy.5 Epidemiological data suggest that people with type 1 diabetes (T1D) with optimal glycemic control experience up to 2 mild episodes/week, with 20-30% experiencing episodes severe enough to require external help in any given year.6 A small proportion of these people, usually with impaired awareness of hypoglycemia, contribute to more than half of the incidence of SH, having recurrent disabling and sometimes life threatening events. 7CGM studies designed to study normative data suggest that while hypoglycemia is common in all insulin-treated people with diabetes, compared to subjects with type 2 diabetes (T2D), T1D subjects had twice as many hypoglycemic episodes per day, with more hours per day in the hypoglycemic range.8 However, although the incidence per patient of NSHE and SH is lower in T2D, due to the greater prevalence of T2D, the majority of episodes of SH occur in people with T2D. 9 In the US, rates of admissions for hypoglycemia have increased in recent years to 105 admissions per 100 000 person-years. 10 Antecedent hypoglycemia has been shown to blunt symptom and counter-regulatory hormonal responses to subsequent hypoglycemia.11 Over time, recurrent hypoglycemia eventually leads to a reduction in the ability to detect hypoglycemia and mount a hormonal response to it, known as impaired awareness of hypoglycemia (IAH) which can increase the risk of SH 6-fold. 12 In the T1D Exchange clinic registry, ≥ 1 SH events occurred in ~6% of over 9000 participants within 12 months, and was not associated with baseline glycated hemoglobin (HbA1c) levels. 13 Undoubtedly, SH has substantial clinical consequences on morbidity (both physical and psychological) and mortality. The more subtle effects of SH and hypoglycemia unawareness are often AbstractHypoglycemia is a major barrier toward achieving glycemic targets and is associated with significant morbidity (both psychological and physical) and mortality. This article re...

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Comparative Effectiveness and Safety of Methods of Insulin Delivery and Glucose Monitoring for Diabetes Mellitus

Abstract: Agency for Healthcare Research and Quality.

Cited by 458 publications

References 63 publications

American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes

Technology to Reduce Hypoglycemia

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