Continuous Glucose Monitoring in Adults with Type 1 Diabetes: Real-World Data from the German/Austrian Prospective Diabetes Follow-Up Registry

Sandig, Dirk; Grimsmann, Julia M.; Reinauer, Christina; Melmer, Andreas; Zimny, Stefan; Müller-Korbsch, Michael; Forestier, Nicole; Zeyfang, Andrej; Bramlage, Peter; Danne, Thomas; Meißner, Thomas; Holl, Reinhard W.

doi:10.1089/dia.2020.0019

Cited by 33 publications

(50 citation statements)

References 43 publications

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“…The significant association between time spent on CGM and a decreasing trend in HbA1c at the population level supports the pivotal role of CGM in T1D management. Real‐world data consistently show that children and adults with T1D who use CGM have better control than cohorts on SMBG 6,17 . However, there is not enough evidence to delineate the minimal time on CGM that shows proven usefulness.…”

Section: Discussionmentioning

confidence: 99%

Use of continuous glucose monitoring and its association with type 1 diabetes control in children over the first 3 years of reimbursement approval: Population data from the ČENDA registry

et al. 2021

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Objective Increased access to modern technologies is not always accompanied by a decrease in HbA1c. The aim of this study was to identify changes in the proportion of continuous glucose monitoring (CGM) users since 2017, when general reimbursement for CGM became effective in Czechia, and to test whether HbA1c is associated with the percentage of time spent on CGM. Research design and methods All T1D children in the Czech national ČENDA registry (3197 children) were categorized according to their time spent on CGM and associations with age, sex, center size, and HbA1c were tested with calendar year as a stratification factor. Results The proportion of children with any CGM use increased from 37.9% in 2017 to 50.3% in 2018 and 74.8% in 2019. Of the CGM users, 16%, 28%, and 41% of the children spent >70% of their time on CGM over the 3 years of the study period, with an overrepresentation of children in the <10 years age group versus the older age groups (p < 0.001). The proportion of CGM users differed among centers and was positively associated with a large center size (>100 patients) (p < 0.001). HbA1c was negatively associated with the time spent on CGM (p < 0.001). Conclusions A rapid increase in CGM use was reported over the 3 years after general reimbursement. HbA1c was associated with time spent on CGM, a continuing decrease was observed in the >70% category. Reimbursement for CGM likely contributes to the improvement of T1D control at the population level.

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Section: Discussionmentioning

confidence: 99%

Use of continuous glucose monitoring and its association with type 1 diabetes control in children over the first 3 years of reimbursement approval: Population data from the ČENDA registry

et al. 2021

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“…These results provide useful benchmarking data for a variety of combinations of diabetes technologies. Time in range in children with type 1 diabetes using treatment strategies based on nonautomated insulin delivery systems in the real world Cherubini V 1 , Bonfanti R 2 , Casertano A 3 , De Nitto E 4 , Iannilli A 1 , Lombardo F 5 , Maltoni G 6 , Marigliano M 7 , Bassi M 8 , Minuto N 8 , Mozzillo E 3 , Rabbone I 9 , Rapini N 10 , Rigamonti A 2 , Salzano G 5 , Scaramuzza A 11 , Schiaffini R 10 , Tinti D 9 , Toni S 4 , Zagaroli L 1 , Zucchini S 6 , Maffeis C 7 , Gesuita R 12 1 Department of Women's and Children's Health, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy; 2…”

Section: Discussionmentioning

confidence: 99%

“…The relevance of the three highlighted articles is the illustration of ''how we are actually doing right now'' with the best available therapies outside of hybrid closed-loop control. Sandig et al (7), using the DPV registry, and Cherubini et al (8), in an Italian collaboration, provide complementary time-in-range outcomes in cohorts of adults and children, respectively, with type 1 diabetes using either isCGM or rtCGM in combination with insulin pump or injection regimens. Both studies found the combination of insulin pump plus rtCGM provided the highest time-in-range and lowest time-below-range, although it should be stressed that these are not controlled trials designed to test the superiority or noninferiority of one modality of treatment over another.…”

Section: Commentmentioning

confidence: 99%

“…Switzerland; 6 Department of General Internal Medicine, Endocrinology and Diabetology, Helios Clinic Schwerin, Schwerin, Germany; 7 Wilhelminenspital, 5th Medical Clinic, University of Vienna, Vienna, Austria; 8 Diabetes Center Bad Aibling, Bad Aibling, Germany; 9 Department of Internal Medicine, Medius-Clinic, Ostfildern-Ruit, Germany; 10 Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany; 11 Diabetes Center for Children and Adolescents, Kinder-und Jugendkrankenhaus AUF DER BULT, Hannover, Germany Diabetes Technol Ther 2020; 22: 602-612…”

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confidence: 99%

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Practical Diabetes Technology: Overcoming Barriers in the Real World

Messer

Weinzimer

2021

Diabetes Technology & Therapeutics

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T his is the third ATTD yearbook article on practical diabetes technology. This article is versatile in highlighting literature that does not fit squarely into therapyspecific categories. The first year focused on real-world outcomes and use, practical challenges, and economics (1). The second year highlighted articles on access, education, and decision support (2). Even 2 years ago, real-world data on new devices were limited, with few articles broaching the translation of devices from clinical trials to commercial use. Today, personal diabetes technologies such as insulin pumps, continuous glucose monitors, flash glucose monitors, or advanced sensor-augmented pump systems are the new standard of care for many individuals with diabetes. The glycemic benefits to commercial users are now more firmly embedded in extant literature (3-5). The purpose of this article, therefore, is not only to review real-world glycemic outcomes but also to explore individual and macrolevel barriers and facilitators that impact successful use of diabetes devices. This is important because optimal use of diabetes devices is often what leads to improved control. This is where the proverbial rubber meets the road.Articles were reviewed through the lens of addressing real-world concerns: Who is using and who is discontinuing devices? Who is not able to use devices? What are the personal and system-level barriers inhibiting or facilitating device use? We included original research articles retrieved from PubMed dating from July 2019 to June 2020, using search terms related to insulin pump, hybrid closed loop (HCL), continuous glucose monitor (CGM), flash/intermittently scanned CGM (isCGM), real-time CGM (rtCGM), and telemedicine. Important context terms included ''real-world use,'' ' 'barriers,'' ''discontinuation,'' reimbursement,'' ''cost-effectiveness,'' ''practical,'' ''clinical care,'' and ''education.'' Over 700 article titles were reviewed for pertinence and possible inclusion in this article. Thirty-eight articles were selected to be reviewed in-depth, and 10 were selected for discussion in this article.The articles are broken down into the following three themes: (1) benchmarks in the real world, (2) person-level barriers and device discontinuation, and (3) system-level barriers and implications. Barriers are multifaceted conditions that affect both the uptake of device use and the quality of device use, both of which predict glycemic control.

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“…Also, it allows the prediction of early HbA1c response to a management strategy, which can be easier to understand than various continuous glucose monitoring (CGM) measures. 20,21 Although the original model was constructed using data from individuals with both type 1 and type 2 diabetes, they were all adult patients enrolled in randomized controlled trials and data were retrospectively analyzed. Moreover, given the adult population studied previously, it is unclear whether the model applies to children with diabetes, a group that would benefit the most from avoiding frequent laboratory HbA1c measurements.…”

Section: Introductionmentioning

confidence: 99%

Personal Glycation Factors and Calculated Hemoglobin A1c for Diabetes Management: Real-World Data from the Diabetes Prospective Follow-up (DPV) Registry

Grimsmann

Karges

et al. 2021

Diabetes Technology & Therapeutics

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Background: Glycated hemoglobin A1c (HbA1c) is a key biomarker in the glycemic management of individuals with diabetes, but the relationship with glucose levels can be variable. A recent kinetic model has described a calculated HbA1c (cHbA1c) that is individual specific. Our aim was to validate the routine clinical use of this glucose metric in younger individuals with diabetes under real-life settings. Materials and Methods: We retrieved HbA1c and glucose data from the German-Austrian-Swiss-Luxembourgian diabetes follow-up (DPV) registry, which covers pediatric individuals with type 1 diabetes (T1D). The new glycemic measure, cHbA1c, uses two individual parameters identified by data sections that contain continuous glucose data between two laboratory HbA1c measurements. The cHbA1c was prospectively validated using longitudinal HbA1c data. Results: Continuous glucose monitoring data from 352 T1D individuals in 13 clinics were analyzed together with HbA1c that ranged between 4.9% and 10.6%. In the prospective analysis, absolute deviations of estimated HbA1c (eHbA1c), glucose management indicator (GMI), and cHbA1c compared with laboratory HbA1c were (median [interquartile range]): 1.01 (0.50, 1.75), 0.46 (0.21, 084) and 0.26 (0.12, 0.46), giving an average bias of 0.6, 0.4 and 0.0, respectively, in National Glycohemoglobin Standardization Program (NGSP) % unit. For eHbA1c and GMI only 25% and 54% of subjects were within -0.5% of laboratory HbA1c values, whereas 82% of cHbA1c were within -0.5% of laboratory HbA1c results. Conclusions: Our data show the superior performance of cHbA1c compared with eHbA1c and GMI at reflecting laboratory HbA1c. These data indicate that cHbA1c can be potentially used instead in laboratory HbA1c, at least in younger individuals with T1D.

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Continuous Glucose Monitoring in Adults with Type 1 Diabetes: Real-World Data from the German/Austrian Prospective Diabetes Follow-Up Registry

Cited by 33 publications

References 43 publications

Use of continuous glucose monitoring and its association with type 1 diabetes control in children over the first 3 years of reimbursement approval: Population data from the ČENDA registry

Use of continuous glucose monitoring and its association with type 1 diabetes control in children over the first 3 years of reimbursement approval: Population data from the ČENDA registry

Practical Diabetes Technology: Overcoming Barriers in the Real World

Personal Glycation Factors and Calculated Hemoglobin A1c for Diabetes Management: Real-World Data from the Diabetes Prospective Follow-up (DPV) Registry

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