OBJECTIVE: Achieving optimal glycemic control for many individuals with type 1 diabetes (T1D) remains challenging, even with the advent of newer management tools, including continuous glucose monitoring (CGM). Modern management of T1D generates a wealth of data; however, use of these data to optimize glycemic control remains limited. We evaluated the impact of a CGM-based decision support system (DSS) in patients with T1D using multiple daily injections (MDI). RESEARCH DESIGN AND METHODS: The studied DSS included real-time dosing advice and retrospective therapy optimization. Adults and adolescents (age >15 years) with T1D using MDI were enrolled at three sites in a 14-week randomized controlled trial of MDI + CGM + DSS versus MDI + CGM. All participants (N = 80) used degludec basal insulin and Dexcom G5 CGM. CGM-based and patient-reported outcomes were analyzed. Within the DSS group, ad hoc analysis further contrasted active versus nonactive DSS users. RESULTS: No significant differences were detected between experimental and control groups (e.g., time in range [TIR] +3.3% with CGM vs. +4.4% with DSS). Participants in both groups reported lower HbA1c (-0.3%; P = 0.001) with respect to baseline. While TIR may have improved in both groups, it was statistically significant only for DSS; the same was apparent for time spent <60 mg/dL. Active versus nonactive DSS users showed lower risk of and exposure to hypoglycemia with system use. CONCLUSIONS: Our DSS seems to be a feasible option for individuals using MDI, although the glycemic benefits associated with use need to be further investigated. System design, therapy requirements, and target population should be further refined prior to use in clinical care.
OBJECTIVE: Achieving optimal glycemic control for many individuals with type 1 diabetes (T1D) remains challenging, even with the advent of newer management tools, including continuous glucose monitoring (CGM). Modern management of T1D generates a wealth of data; however, use of these data to optimize glycemic control remains limited. We evaluated the impact of a CGM-based decision support system (DSS) in patients with T1D using multiple daily injections (MDI). RESEARCH DESIGN AND METHODS: The studied DSS included real-time dosing advice and retrospective therapy optimization. Adults and adolescents (age >15 years) with T1D using MDI were enrolled at three sites in a 14-week randomized controlled trial of MDI + CGM + DSS versus MDI + CGM. All participants (N = 80) used degludec basal insulin and Dexcom G5 CGM. CGM-based and patient-reported outcomes were analyzed. Within the DSS group, ad hoc analysis further contrasted active versus nonactive DSS users. RESULTS: No significant differences were detected between experimental and control groups (e.g., time in range [TIR] +3.3% with CGM vs. +4.4% with DSS). Participants in both groups reported lower HbA1c (-0.3%; P = 0.001) with respect to baseline. While TIR may have improved in both groups, it was statistically significant only for DSS; the same was apparent for time spent <60 mg/dL. Active versus nonactive DSS users showed lower risk of and exposure to hypoglycemia with system use. CONCLUSIONS: Our DSS seems to be a feasible option for individuals using MDI, although the glycemic benefits associated with use need to be further investigated. System design, therapy requirements, and target population should be further refined prior to use in clinical care.
Authors: Pavel S Roshanov; Natasha Fernandes; Jeff M Wilczynski; Brian J Hemens; John J You; Steven M Handler; Robby Nieuwlaat; Nathan M Souza; Joseph Beyene; Harriette G C Van Spall; Amit X Garg; R Brian Haynes Journal: BMJ Date: 2013-02-14
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Authors: Lutz Heinemann; G Alexander Fleming; John R Petrie; Reinhard W Holl; Richard M Bergenstal; Anne L Peters Journal: Diabetes Care Date: 2015-04 Impact factor: 19.112
Authors: Scott M Blackman; Dan Raghinaru; Saleh Adi; Jill H Simmons; Laurie Ebner-Lyon; H Peter Chase; William V Tamborlane; Desmond A Schatz; Jennifer M Block; Jean C Litton; Vandana Raman; Nicole C Foster; Craig R Kollman; Stephanie N DuBose; Kellee M Miller; Roy W Beck; Linda A DiMeglio Journal: Pediatr Diabetes Date: 2014-02-04 Impact factor: 4.866
Authors: Nichole S Tyler; Clara M Mosquera-Lopez; Leah M Wilson; Robert H Dodier; Deborah L Branigan; Virginia B Gabo; Florian H Guillot; Wade W Hilts; Joseph El Youssef; Jessica R Castle; Peter G Jacobs Journal: Nat Metab Date: 2020-06-01