Background and Aims

Glycaemic parameters and quality of life (QOL) are important outcomes defined in clinical trials in individuals with type 1 diabetes (TID).

This study aims to explore the demographic and psychosocial factors that predict glycaemic outcomes i.e glycated haemoglobin (HbA1c) and time in range (TIR), and QOL in adolescents on contemporary therapy.

Methods

Adolescents and young adults with T1D and HbA1c <10.5% were eligible. Baseline demographic characteristics, glycaemic (HbA1c, TIR) and psychosocial measures using validated questionnaires (hypoglycaemia awareness, fear of hypoglycaemia, QOL and diabetes distress) were collected. TIR (3.9 to 10mmol/l) was obtained from masked sensor (Enlite® 3, Medtronic). Linear regression analyses were used to determine predictors of glycaemic control and QOL.

Results

Data were analyzed from 120 participants (46% males; 81% CSII; 66% CGM; 18% impaired hypoglycaemia awareness) with (mean±SD) age 15.1 ± 3.0 years, diabetes duration 7.1 ± 4.3 years and HbA1c 7.9 ± 1.0%. The median [IQR] TIR was 55.4% [44.1, 62.1].

A strong bivariate correlation was noted between HbA1c and TIR (p<0.001). Every 1% increase in HbA1c was associated with 7.9% reduction in TIR.

Lower fear of hypoglycaemia predicted improved HbA1c (p=0.025) although there was no correlation between HbA1c and other demographic and psychosocial measures. There was no correlation between TIR with any demographic and psychosocial measures (p>0.05).

Lower fear of hypoglycaemia (p=0.007) and diabetes distress (p<0.001) predicted an improved QOL.

Conclusions

The study provides a snapshot of the predictors of glycaemic outcomes and QOL in adolescents with T1D on contemporary therapy.

Background and Aims

Type 1 Diabetes (DM1) in childhood and adolescence is a chronic disease that affects health related quality of life (HRQOL). HRQOL instruments can be used to evaluate the effect on the quality of life depending on therapy such as continuous subcutaneous insulin infusion (CSII) or multiple doses of insulin (MDI).

A study was designed to assess the differences in HRQOL in two groups of children and teenagers with DM1 according to treatment modality.

Methods

157 children and teenagers aged 8 to 18 years followed in 8 Pediatrics Diabetes Units in Spain, filled up two self-reported HRQOL instruments. These HRQOL instruments were the Spanish version of DISABKIDS Chronic generic measure (DCGM-12) and the DISABKIDS Diabetes Module. The DCGM-12 assesses the HRQOL globally in chronic conditions. The Diabetes Module is divided in an Impact and a Treatment scale. Sociodemographic and glycemic control data were recorded.

Results

There were not significant differences in sociodemographic factors, glycemic control, and HRQOL score between the two groups.

Conclusions

The patients with CSII therapy had slightly better HRQOL score in DCGM-12 and in both specific scales of DM1 than the MDI group, but these differences were not statistically significant.

Background and Aims

Embodied conversational agents (ECAs) have the potential to deliver self-management support to people with type 2 diabetes (T2D). We evaluated the acceptability of an ECA, ‘Laura’ (see figure) for delivering self-management support in the ‘My Diabetes Coach (MDC)’ smartphone app.

Methods

In a randomised controlled trial, participants allocated to use the MDC app completed a 6-month post-baseline survey assessing attitudes to and interactions with Laura. In-depth qualitative interviews further explored users’ experiences of Laura. Using an explanatory mixed-methods approach, we analysed survey responses with descriptive statistics and integrated these findings with a thematic analysis of the interview data.

Results

Of the 67 survey respondents, 33 (50%) were women, aged 57±9 years. Most (77%) endorsed positive descriptions of Laura (e.g. competent) and their reactions, following interactions with her (e.g. motivated). Fewer respondents (35%) described Laura negatively (e.g. boring) and a minority (12%) reported negative reactions to interactions with Laura (e.g. frustration). Interview participants (N=19) included 8 (42%) women, aged 60±8 years. Four themes emerged regarding Laura’s acceptability: 1) Laura’s perceived role as a “friendly coach”; 2) Laura’s “value add” in providing motivational and emotional support; 3) Laura’s “human-like” nature being preferred to a non-human character; 4) Dissonance in Laura’s speech and body language is frustrating.

Conclusions

Overall, these findings suggest that an ECA is an acceptable means for delivering T2D self-management support. Improving acceptability will require a better understanding of the role that users expect an ECA to play in self-management and perfecting the ECA’s ‘natural’ communication.

Background and Aims

To assess the acceptability, relevance, usability and usefulness of a novel brief self-administered injection technique assessment tool.

Methods

The tool was developed using an iterative process in conjunction with people with diabetes and healthcare professionals. Focus groups and one-to-one interviews were held with three separate groups consisting of adults with type 1 diabetes, type 2 diabetes or healthcare professionals to elicit views and refine the tool ready for broader distribution to the target audience. Questions addressed ease of understanding, relevance, included questions and potential missing questions, feelings about diabetes and any discomfort or judgement felt when completing the tool.

Results

Five healthcare professionals and sixteen people with diabetes participated. Questions were reported to be clinically relevant by healthcare professionals and simple to complete. People with diabetes reported the tool to be ‘about the right length’, with the questions relevant and easy to read and follow. Adding ‘sometimes’ to response options was felt beneficial to more accurately reflect real-life diabetes management, along with clarification of medication type (i.e., different types of insulin and non-insulin medications). Overall, all groups felt this would be a useful tool to help people using injectable therapies refresh their technique for optimal dosing.

Conclusions

The tool was well-received by participants who made several suggestions for wording changes and clarification of individual questions. The resulting eleven item tool will be distributed to a wider target audience for reliability and psychometric analyses prior to final potential amendments and broader use.

Background and Aims

Clinical use of diabetes technologies could have significant impact on management of pediatric type 1 diabetes and could create both beneficial and adverse psychological reactions. However, there was no Turkish scale to describe satisfaction with diabetes technology and explore the psychosocial experiences of children with Type 1 diabetes.

Aim: To investigate the validity and reliability of Turkish adaptation of Diabetes Technology Questionnaire (DTQ).

Methods

Cross-cultural adaptation and psychometric testing was used in the study. The DTQ was forward and back translated, cross-culturally adapted and validated using international guidelines. Once tested for feasibility and comprehension, a Turkish sample of 209 type 1 diabetic children and adolescents (8-18 years old) using diabetes technology were administered DTQ and Sociodemographic Information Form. Language, content, and surface validity was performed to assess the validity. Test-retest analysis, Cronbach's alpha internal consistency analysis and item total score correlation analyses performed for reliability of the scale.

Results

Mean age and HbA1C of the participants were 12,68±2,79 and 7,83±1,38 respectively. The content validity index was 0,98. Internal consistency was high (α = 0,89) for the overall scale. Test–retest data were obtained from 30 children with Type 1 diabetes, two weeks after the initial assessment. Test–retest reproducibility had acceptable reliability (r=0,76, p˂0,001),with kappa coefficients showing substantial agreement for most items. The average inter-item correlation for the scale was 0.88.

Conclusions

This study showed that DTQ was conceptually equivalent to the original and similarly valid and reliable measure for Turkish speaking population.

Background and Aims

Summer camps for children with diabetes combine a traditional camping experience but in a medically safe environment. Our aim was to close monitoring the effect of a summer camp in diabetes management, and directly compare the week of summer camp with one week before and one week after with the use of technology.

Methods

Summer camps for children with diabetes combine a traditional camping experience but in a medically safe environment. Our aim was to close monitoring the effect of a summer camp in diabetes management, and directly compare the week of summer camp with one week before and one week after with the use of technology.

Results

Eight patients (4 boys) with a mean age of 11.91±3.07 years were included in the final analysis. Mean Blood Glucose (BG) measurements and mean sensor measurements did not differ significantly, however, coefficient of variation (SD/mean) for BG was significantly lower and percentage of BG in range (70-180 mg/dl) was significantly higher during camp compared to the week after. Insulin daily dose during camp was significantly reduced compared to both the week before and after, however mean carbohydrate consumed were also reduced. Both ratios of carbs to total daily insulin dose and carbs to bolus daily dose were significantly higher during the summer camp, indicating higher insulin sensitivity.

Conclusions

Summer camps for children with T1DM consists an amusing yet safe environment where better glycemic control and higher insulin sensitivity can be achieved.

Background and Aims

Knowledge about how Do-it-Yourself Artificial Pancreas Systems (DIYAPS) impact upon the lives of those that build and use them remains limited. Until now, only a few have been able to give voice to their experiences in a research context. In this study we present data that addresses and details the lived experiences of people using DIYAPS.

Methods

An online survey with 34 items was distributed to DIYAPS users recruited through the Facebook groups “Looped” (and regional sub-groups) and via Twitter. Participants were posed two open-ended questions in the survey about their personal DIY APS stories; including perceived changes in clinical outcomes and quality of life (QoL) and difficulties encountered in the process. All answers were analysed using thematic content analysis.

Results

In total, 886 adults responded to the survey and there were a combined 656 responses to the two open-ended items. Knowledge of DIYAPS was largely obtained via exposure to communication within the diabetes online community (DOC). The DOC was also a primary source of practical and emotional support. Dramatic improvements in clinical and QoL outcomes were consistently reported. The emotional impact on everyday life was, with very few exceptions, extremely positive. Acquisition of the requisite equipment to initiate DIYAPS was sometimes a barrier.

Conclusions

Responses from users of DIYAPS acquired in this study provide new insights regarding the contours of this evolving phenomenon, highlighting factors inspiring people to adopt such solutions and underlining the transformative impact effective closed-loop systems bring to bear on the everyday lives of people with diabetes.

Background and Aims

Studies showed that improvements in self-management and self-efficacy directly influence self-care behavior which has proven to be the most important human factor in diabetes treatment when it comes to improving glycemic control. Nevertheless, many people struggle to manage their disease. Digital devices in combination with personal telephone coaching can support patients with type 2 diabetes (T2DM) and improve self-management, self-efficacy, clinical and economic outcomes.

Methods

In cooperation with a private health insurance company, a 2-arm randomized telemedically assisted lifestyle intervention study has been set up. 113 patients with T2DM, divided into an intervention group and a control group, have participated in the study so far. Participants of the control group receive care as usual. Participants of the intervention group additionally receive a blood glucose meter, a pedometer and a tablet in combination with individual telephone coaching from diabetes specialists. All recorded values from the devices (e.g. fasting blood glucose, hypo- and hyperglycaemia, steps) are automatically transferred daily to the Personal Coach. After 3, 6 and 12 months as well as one year after the end of the intervention, changes in self-management, self-efficacy, health-related quality of life as well as economic parameters are recorded in addition to parameters such as the HbA1c value, the body mass index (BMI) and the steps taken.

Results

First results after three months already showed promising improvements in glycemic control, physical activity and diabetes self-management.

Conclusions

At the ATTD 2020 we will present the first results of the 12-month data.

Background and Aims

After 30 years of diabetes, an equilibrium state must be achieved regarding T1D management. A change in this state implies a lot of effort, creativity and work for physician’s side and acceptance, understanding and learning for patient’s side.

This study aims to show a 5 years’ experience in introducing technology in T1D management in patients with 30+ year’s duration of diabetes, materialized in a model of efficiency of this process.

Methods

Over 38 patients were part of this study. Process started with an evaluation both of, medical, knowledge and understanding, control and lifestyle situation. Communication is the central part of the process the binder which allow transition through the stages of the process. Permanent learning and transformation of equilibrium status supervised by physician allow overcoming resistance to change.

All the process is illustrated bellow:

Results

After implementing CGMS with/without Pump in all our patients with long diabetes duration, and with a carefull follow up of the entire process, we were able to develop a model that helps implementing this kind of technology.

Following this model and after the treatment change we have obtained a 1.3% reduction of HbA1c and significantly less hypoglicemic events RR 34% (p<0.01). Patients' acceptance of the new treatment increased in time by 92%.

Conclusions

Overcoming resistance to change and transitioning to technology-based management is a major problem for patients with long-term diabetes.
The proposed model has proven its effectiveness not only in achieving this transformation and reaching glycemic targets but also in changing their lifestyle.

Background and Aims

The advantages of technology-based management are important, but until a technological system will be able to autocorrect all the variations that occur in T1DM, the human factor plays a very important role.

This study quantifies through an innovative indicator the general condition of a patient with T1DM, both from a medical point of view and a life with diabetes perspective, aiming to generate a useful tool for determining the best candidate and the best moment to start technology in T1DM management.

Methods

We quantified 22 factors in order to calculate this indicator: HbA1c, TIR, Hypoglycemia, Compliance, Self-control, Weight, Disease understanding and knowledge, News updates, Family, Economical, Social, Education, Depression, Retinopathy, Renal, Neuropathy, BP, LDLc, eGFR, Urea, Triglycerides.

The ROMPEDET method was used to calculate the general status quantification indicator (GSQI) of a patient with T1D. GSQI will be calculated based on a Cobb - Douglas type function::

Results

Data was acquired through clinical and biological evaluation and specific questionnaires, on a group of 84 patients (38 on CGMS and CSII and 46 on MDI and SMBG).

GSQI was tested and revealed accuracy in over 97%of cases.

GSQI calculated shows that management using technology offers a better level of satisfaction than conventional management. On certain subgroups, there is an initial decrease of GSQI followed by an improvement, with the maximum after 2 years.

Conclusions

GSQI is a reliable indicator evaluating a map of diabetes status and diabetes interference in daily life, allowing the physician to choose the perfect moment for technological management transition.

Background and Aims

Target-optimised glycaemic management is important to minimise the risk of complications in type 2 diabetes (T2DM), impacting quality of life and healthcare expenditure. This work evaluates the current situation in Europe with regard to numbers treated with insulin, the proportion not achieving glycaemic target and therefore in need to advance insulin therapy.

Methods

We quantified the burden of insulin treated T2DM populations not at target for France, Germany, Italy, Netherlands, Spain and UK based on the available evidence, both from an epidemiological and economic perspective.

Results

In the six European countries, more than 64% of people with T2DM on insulin therapy have a HbA1c above the target of 7%. Studies report that up to 77% of persons with T2DM treated with basal insulin/basal insulin supported oral therapy (BOT) are above this target. Evidence on individuals on multiple daily injections (MDI, ≥2 injections per day) is more fragmented, although existing studies report similar or worse glycaemic control compared to those on BOT. We estimate that at least 2 million persons with T2DM on insulin therapy, both BOT and MDI, are above target, with an estimated economic impact of more than €28 billion per year in Europe.

Conclusions

When considering insulin therapy in the population with T2DM in Europe, approximately two-thirds do not achieve appropriate glycaemic control, increasing the risk of diabetes complications and related costs. Improving insulin therapy by various technological advancements may be a reasonable approach to decrease the epidemiological and economic burden of insulin treated individuals with T2DM.

Background and Aims

Factitious disorders are quite common in diabetology and dermatology. They should be looked out for in patients with problematic hypoglycemia. We demonstrate a case of a pancreas transplantation candidate, in whom hypoglycemia and dermatitis factitia were found.

Methods

A 36 years old blind woman with a 6 years lasting type 1 diabetes was admitted for evaluation as an isolated pancreas transplantation candidate, due to a history of severe hypoglycemia refractory to insulin pump treatment.

Results

Clarke hypoglycemia score was 5. The patient reported continuous glucose monitoring intolerance due to skin problems. Upon admission, multiple large superficial skin lesions on legs, abdomen, arms, neck and lower back were found, all reachable by patient hands. Previous dermatology and immunology assessments stated staphylococcus folliculitis or abscessing dermatitis. Wound specialist raised a suspicion on factitious etiology, supported by patient’s history of two psychiatric diagnoses. Moreover, pump download showed repeated cumulation of large boluses which the patient denied, total daily insulin dose was up to 79 units (1,3U/kg/day). After patient confrontation and maximum bolus setting adjustment, no further severe hypoglycemia occurred; during hospitalization, the patient was euglycemic on 0,5U/kg/day and tolerating continuous glucose sensors. Skin lesions were treated with an inert local dressing with silicone and covered with adhesive non-removable bandages to prevent manipulation or scratching. After a few days, signs of healing occurred.

Conclusions

In summary, device data download and mental health assessment should be a routine way of factitious disorders screening in transplant candidates, in whom healthcare professionals suspect self-harm.

Background and Aims

Users of Medtronic Continuous Subcutaneous Insulin Infusion (CSII) pumps can upload clinical data onto the carelink website where it can be viewed by the user’s physician. More frequent uploads allow physicians’ to see more up to date information as well as suggesting greater interaction with the resource by patients’. While the overall impact of pumps on glycaemic control has been investigated, it has yet to be seen whether upload frequency has any bearing on the outcome. Thus, the aim of this study is to investigate the relationship between upload frequency and glycaemic control.

Methods

This was a retrospective cross-sectional study of Medtronic pump users attending the Centre of Endocrinology, Diabetes and Metabolism, Galway University Hospital. A HbA1c value taken before commencing pump therapy and the most recent HbA1c were recorded. This change in HbA1c was then correlated with the average time between technology uploads.

Results

There were 24 patients in the cohort, 13 male 11 female. The mean age was 44.46. The pearson correlation between the change in HbA1c and the average time between uploads returned a coefficient of .44, p-value of .024. This suggests that an increased time between uploads (less frequent) is positively correlated with the change in HbA1c.

Conclusions

The results of the pearson correlation support an increased frequency of technology uploads improving a patient’s HbA1c in the long term. The size of the cohort is a limiting factor, a larger study should be done to further investigate any relationship.

Background and Aims

Multidisciplinary education is essential for T1D management. We evaluated the effects of a multidisciplinary program for initiation and follow-up of SAP with PLGS (Minimed 640G®) on glycemic parameters in adults with T1D.

Methods

All patients that went through a 6 week initiation program and with more than 6 months follow-up of SAP-PLGS Therapy at our clinic were invited. Time in range 70-180 mg/dL (TIR) and times bellow 70 and 54 mg/dL (TBR70 and TBR54, respectively) for the last month were obtained from the pump system. A1c was measured by DCA assay. Frequency of controls by medic, nurse and dietitian was obtained from our clinical registries. Data was analyzed using parametric tests.

Results

78 subjects were included with mean age 34.3 ± 14.0 years, 16.8 ± 9.6 years of disease duration and BMI 24.8 ± 3.2 kg/m2. TIR was 70.1 ± 9.7%, TBR70 3.5 ± 2.1% and TBR54 0.7 ± 0.9%, with no significant differences according to length of follow-up. Current measured A1c was 6.77 ± 1.1% compared with 7.20 ± 0.94% on initiation (p= 0.027). Frequency of controls with any healthcare professional was 5.8 ± 1.6 times per semester, with significantly more nurse controls when comparing patients with TIR>70% vs. TIR<70% (2.6 vs 1.9 controls/semester, p=0.04).

Conclusions

Adults with T1d on SAP-PLGS can successfully achieve consensus TIR, TBR70 and TBR54 goals with 6 controls/semester by a HCP in a multidisciplinary team. This highlights the importance of team follow-up for successful therapy.

Background and Aims

As the leading charity for people with diabetes in the UK, Diabetes UK became increasingly aware of the growing number of people with type 1 diabetes using DIY closed loop systems. Healthcare professionals have expressed concern about their professional role in this clinical setting..

Methods

Diabetes UK has developed this position through knowledge and insight gathered from our Care Team and through:

*Discussions with the diabetes community using this technology

*Discussions with clinicians who have patients using this technology

*Discussions with the Diabetes UK Council of HCPs

*Insights for the Association of British Clinical Diabetologists (ABCD) and Diabetes Technology Network (DTN)

Results

This positon includes reccomendations to the NMC and GMC to provide professinoal support. It also calls for greater suppoort and understanding of this technology and appropriate disclosure by users with thier HCPs. Users must be compentent in decission making and using pumps and CGM. Users must be aware that online support is not regulated and accessed at their own risk.

Conclusions

We look forward to a regulated and CE marked closed loop system being available for all who would benefit. However currently with a lack of regulation and no published high quality research trials to support their use or provide assurance this is a difficult intervention for HCPs to promote. Any individuals using DIY closed loop systems do so at their own risk but should not be restricted in access to well educated HCPs..

Background and Aims

Prediabetes is a chronic condition that affects over 33% of US adults. Regular physical activity can reduce the conversion from prediabetes to diabetes. Recently, electronic wearable devices have gained popularity. However, the utility of motivational interviews (MI) in using those devices is questionable. We aim to present the development process of a culturally adopted MI to increase physical activity among an ethnic minority of Arabic-speaking residents of East Jerusalem with prediabetes to be used in a randomized controlled trial (RCT) aimed at increasing physical activity among prediabetes.

Methods

A literature review by graduate students found that concepts such as enjoyment of exercise and self-efficacy were positively associated with physical activity. Specific barriers to exercise in patients with prediabetes included perceived difficulty of engaging in exercise, failing to find enjoyable activity and feelings of tiredness. Accordingly, and while consulting with main stakeholders, a telephone-based MI was developed to identify patients’ stage of change, promote participants' autonomous motivation for behavior change and locate enjoyable activity.

Results

The process resulted in a draft prototype of a standardized protocol, which included questionnaire and guided answers that was continuously tested and changed during four months of development. Under the supervision of a faculty member and a primary care physician working with the target population a standardized manual was developed. The protocol will be used in a future RCT.

Conclusions

The proposed MI protocol could support the future examination of these devices to help decrease the risk of development of T2DM in patients with prediabetes.

Background and Aims

Apps and online resources for diabetes self-management are overwhelmingly diverse. Therefore, the task of choosing the most trustworthy and best resources for one’s needs and preferences is challenging. We present interview results regarding how various stakeholders choose diabetes self-management resources.

Methods

We conducted semi-structured interviews with stakeholders (n=11) in Norway (2 participants with diabetes; 2 informal caregivers (e.g. family); 2 researchers; 2 policymakers; 2 healthcare professionals (HCPs); 1 developer) and analysed responses using thematic analysis. We asked how they choose apps and online resources to use, recommend or develop, including which characteristics they consider favourable.

Results

Policymakers and HCPs prefer apps and online resources with quality-assured information. Researchers choose apps based on scientists’ and developers’ recommendations, focusing on apps that function on multiple platforms and contain quality content. The developer chooses efficient and easy-to-use apps based on reports on trends and projects. Informal caregivers were influenced by peer recommendations, focusing on apps with remote-monitoring and tailorability, e.g.: “We have mainly chosen apps when we could influence the development or develop ourselves … we have probably not gone for apps that are verified then, but they're verified through widespread use by users”. Participants with diabetes choose resources that address their self-management foci; do not request access to private information; and provide automatic data-recording and blood-glucose graphs.

Conclusions

The various stakeholders have different foci when choosing diabetes apps and online resources. Researchers and health authorities should disseminate evidence-based guidelines on stakeholder-specific platforms to assist stakeholders to develop, recommend or use validated and trustworthy self-management resources.

Background and Aims

Smoking is an acknowledged risk factor for vascular disorders, and vascular complication is a main outcome of diabetes. Hence, we investigated the impact of cigarette smoke on blood vessels in diabetes, postulating that smoking might aggravate diabetic vascular impairment.

Methods

Sprague–Dawley rats were divided into four groups: control, cigarette smoke-exposed, diabetic, and cigarette smoke-exposed diabetic groups. Streptozotocin-induced diabetic rats were exposed to cigarette smoke by inhalation at total particulate matter concentration of 200 μg/L for 4 h/day, 5 day/week for a total of 4 weeks.

Results

Diabetes caused structural change of aorta, but additional cigarette smoke exposure did not induce further alteration. Collagen, a marker for fibrosis, was increased in media of diabetic aorta, and this increase was augmented by cigarette smoke. Cigarette smoke induced endothelial nitric oxide synthase (eNOS) uncoupling in the diabetic group. Malondialdehyde was increased and glutathione was decreased in blood from diabetes, but these effects were not exaggerated by cigarette smoke. Cigarette smoke caused NADPH oxidase (NOX) 2 expression in diabetic aorta and enhanced diabetes-induced NOX4 expression in aorta.

Conclusions

Taken together, cigarette smoke exposure can aggravate vascular fibrosis and induce eNOS uncoupling in diabetes under experimental condition, suggesting that smoking might exacerbate diabetic vascular impairments.

Background and Aims

Data regarding the effect of CGM use on glycemic control in children with a dual diagnosis of type 1 diabetes mellitus (T1DM) and attention-deficit/hyperactivity disorder (ADHD) are limited. The aims of the study were to compare CGM use and various aspects of diabetes control among children with T1DM in the following groups: those without ADHD, those with medically treated ADHD and those with untreated ADHD.

Methods

In this cross-sectional study of 111 children with T1DM, 15 had untreated ADHD, 12 had treated ADHD and 84 did not have ADHD (Control Group). Glycemic data were downloaded from glucometers, pumps, and continuous glucose monitoring systems. HbA1c levels, hospitalizations, severe hypoglycemic and diabetes ketoacidosis events were retrieved from the medical files.

Results

Untreated ADHD patients used CGM significantly less than treated ADHD and Control Groups (27%, 75%, 58% respectively), although most of them had approval to use CGMs. Mean HbA1c levels were highest in the untreated ADHD group: 8.6±1.2%, 8.3±1.1%, and 7.8±1.0% respectively (p=0.009). Time in range (70-180 mg/dl) was lower and mean glucose was higher in this group. Untreated ADHD had more hospitalizations compared to the treated ADHD and the control group.

Conclusions

In this study untreated ADHD patients with T1DM used CGM less than treated ADHD patients and had worse diabetes control. Healthcare providers should be aware of the difficulties facing children with T1DM and ADHD in coping with the current intensive treatment of diabetes and encourage the use of advanced technology in those patients.

Background and Aims

Stress is a known risk factor for poor control in T1D. Current evidence suggests it prevents patients from engaging in self-control behaviors, worsening metabolic outcomes. The relationship between diabetes stress and self-management behaviors in patients on SAP remains unclear

Objective: to evaluate levels of stress associated to SAP therapy and its correlation to metabolic goals in T1D patients.

Methods

T1D patients on SAP therapy with PLGS for more than 6 months were included. Stress association to living with diabetes and to using SAP was assessed using a self-administered questionnaire. Levels of stress were categorized as high (HS), moderate (MS) and low or absent (LAS). Metabolic control was assessed using time in range (TIR). Data was analyzed using parametric tests.

Results

Seventy-six subjects were included. Mean age 34.3 ± 14.1 y.o., 59% female, 16.7 ± 9.7 years of disease duration. Baseline TIR was 70.1 ± 9.8% and time below 70 mg / dL was 3.6 ± 2.1%. Patient’s stress levels were: HS = 6%, MS = 24% and LAS = 70%; whilst Metabolic goals as by TIR were HS=73%, MS=70% and LAS = 69% (p = 0.709).

Conclusions

The achievement of metabolic outcomes appears to be irrespective of the stress experienced by the patient on SAP therapy. The influence of systematic training and follow-up program, as well as the association between stress, technology and the achievement of goals should continue to be investigated to determine whether stress can be originated in an effort for self-care or due to the burden of technology itself.

Background and Aims

Diabetes type 1 (DT1) patient adherence and empowerment is needed to accomplish with self-management education to prevent acute complications and more importantly long term. The use of the smartphone has skyrocketed in all groups,providing a more accessible platforms to improve clinical outcomes and non-clinical through digital interventions. Although many reviews have proven clear evidence of the contribution of mHealth in diabetes management,specifically,DT1,further research needs to be undertaken. The main objective of this scoping review is to analysis evidence-based features and outcomes that demonstrate positive effects and improvements in self-management of DT1 patients due to educational interventions in mobile health applications.

Methods

We conducted a review of literature published since 1999 in Pubmed database following Joanna Briggs methodology using key search terms:mobile app for diabetes,behavioral change,DT1.

Results

We identified total of 88 articles through database searching. After the screening, we included 23 descriptive supporting studies in the scoping review targeting DT1, eligible for analysis. Most of the studies reported positive outcomes after use of mobile health applications with slightly improvement of clinical outcomes:HbA1c(66%), blood pressure(12%) and triglycerides(9%). The most prevalent features in mHealth were (1)monitoring blood glucose level and insulin, (2)nutrition,(3)physical exercise,(4)body weight,(5)appointments management,(6)social media and (7)interactive feedback. Although clinical guidelines widely refer to the importance of motivation and activation, personalized empowerment features should be included in apps for assessment of potential in the self-management.

Conclusions

The evidence indicates the potential of mHealth apps to improve health outcomes. However, these digital solutions must be designed integrating evidence-based behavioral change theoretical foundations to proof effectiveness.

Background and Aims

Basal-IQ (Tandem Diabetes) is a PLGS system that demonstrated high user satisfaction in clinical trials. It is unknown whether users experience sustained satisfaction and reduced diabetes burden in the real-world.

Methods

Participants with T1D completed the Diabetes Burden and Device Assessment (DBDA) 11 item, 10 point Likert scale survey prior to Basal-IQ use, and at 2, 4, 6 months after start. The DBDA includes a Satisfaction factor (trust, ease of use, etc.) and Diabetes Burden factor (hypoglycemia fear, poor sleep, etc.). Linear regression tested for change in scores from baseline to midpoint (2 or 4 months) and midpoint to 6 months, adjusted for baseline covariates.

Results

541 participants (mean±sd age 36.7±16.9 years, HbA1c 7.2±1.1%) completed surveys: 300 Tandem pump users, 159 other pump users, 82 multiple daily injections (MDI) users. Both factors demonstrated adequate internal consistency (alpha = 0.70-0.86). From baseline to midpoint, satisfaction significantly increased in previous MDI users [mean 2.32 points (Bonferroni adjusted CI: 1.8, 2.84), p<0.001] and non-Tandem pump users [1.13 points (CI: 0.64, 1.62), p<0.001], with no increase in Tandem users (p=1). The satisfaction sustained at 6 months with no significant change from midpoint (Figure 1A). From baseline to midpoint, Diabetes Burden was significantly reduced for previous MDI users [-1.60 points (CI: -2.18, -1.02), p<0.001], non-Tandem pump users [-0.91 ( -1.46, -0.36), p<0.001] and Tandem pump users [-0.89 (-1.4, -0.37), p<0.001], and sustained through 6 months (Figure 1B).

Conclusions

In the real-world, Basal-IQ users with T1D reported high satisfaction and decreased diabetes burden over previous insulin modality.

Background and Aims

The international consensus regarding clinical targets for CGM recommended that the majority of PWT1D should reach a TIR (70-180 mg/dL) of >70% of the total time. However, it is unclear how often these targets are achieved and what factors are associated with the achievement of TIR targets. The aim of this prospective observational study was to assess the feasibility and associated factors of reaching recommended TIR targets.

Methods

PWT1D using a flash glucose monitoring (FlashGM) system for 3 months with >80% of sensor data available were included. Diabetes self-management with MDI was performed during this 3-month period. FlashGM data were downloaded and assessed for the percentage of PWT1D achieving the recommended glycaemic targets. A forward stepwise linear regression was performed to model variables explaining achievement of TIR targets (p≤0.05).

Results

81 PWT1D (40 females, age 43±15 years, BMI 25±3 kg/m², HbA_1c 57±9 mmol/mol, diabetes duration 18±13 years, pre-investigation FlashGM use 302±225 days) were included. The following number/percentage of PWT1D reached the recommendations:

TIR was associated with the number of scans per day (β=0.50, p<0.001), c-peptide status (β=0.32, p=0.004) and BMI (β=-0.29, p=0.007).

Conclusions

Only few PWT1D achieve recommended glucose targets. However, those who performed more scans accompanied with a higher c-peptide level as well as a lower BMI more often achieved the recommended glycaemic targets.

Background and Aims

Prevalence of Diabetes mellitus has reached epidemic proportions globally of which developing countries are likely to bear maximum burnt in 21^st century. Along with this, elderly population is gaining very sizable proportion and is going to increase in future. Aging causes physical, physiological, and psychological changes leading to changed needs and the diabetes in conjunction adds to various health problems. Elderly diabetics are also likely prone to frailty. Looking at their specialized nutritional and psychosocial needs, the study of elderly diabetics was done to assess their nutritional status and psychosocial behavior.

Methods

For a case controlled study ,45 diabetic elderly (age<60 years) of both the genders was selected from various areas through geriatric health camps held in Bhopal city of India along with control group of 45 non-diabetic elderly. To compare nutritional health assessment, mini nutritional assessment chart and anthropometrics measures like BMI, and waist circumference, clinical frailty scale, were used. Biochemical parameters like serum protein, cholesterol and HbA1c were assessed and correlated with anthropometric and behavioral measures (Geriatric Depression Scale) in both the groups.

Results

Results analyzed in line with Indian lifestyle and dietary habits shows that 77% of diabetic elderly have high waist circumference and 63% are overweight or obese ,82% suffers from hypercholesterolemia quite higher to control group. 65% of Diabetics are. mild to moderately frail. A positive correlation with HbA1c and depression score (r= -988)was found.

Conclusions

Elderly Indian diabetics are having central obesity with higher cholesterol levels and are likely to be more prone to frailty and depression.

Background and Aims

The prevalence of diabetes is rising, especially in the older population. Few adults living with type 2 diabetes achieve optimal glycaemic management. Older People with Type 2 diabetes - Individualising Management wIth a SpecialisEd community team Safety and feasibility study (OPTIMISES), was a pilot study to trial a new person-centred model of care, involving intermittent flash glucose monitoring and home-based diabetes management support, delivered by a community-based diabetes educator linked to a hospital-based endocrinologist via Telehealth.

Methods

Individuals with type 2 diabetes (aged> 65, community dwelling) were recruited. Those who completed the four month intervention were questioned about their subjective experiences of care through a semi-structured, face-to-face interview. Open coding of all interview transcripts were independently conducted by three investigators. Emergent themes were discussed and mapped as a team.

Results

Forty-two participants were interviewed, 60% male, mean age 75.7 (±7.3; range 65-90) years and mean duration of diabetes 15.2 (±8.9) years. Two themes emerged: (1) Many participants did not fully understand their diabetes, management and the implications of diabetes on their health and wellbeing (2) Participants valued the individualised approach provided through this new model of care, appreciated the technology elements but emphasised the importance of human connectedness, that is, building trust and rapport, required for person-centred care.

Conclusions

Flash glucose monitoring and telehealth technology are useful tools to enhance self-management but are less important to participants than the human connection that develops through open communication and a person-centred approach to diabetes care.

Background and Aims

In NHS Ayrshire and Arran we look after 225 children and young people with Type 1 diabetes. We have been delivering small group education sessions with families commencing Freestyle Libre Flash Glucose Monitoring System who meet the criteria set by the Scottish Diabetes Group. Our aims are to ensure our young people and families make the best use of the Freestyle Libre device, make changes to their diabetes management based on the data they receive and give them the opportunity for peer support.

Methods

Families are invited to attend 2 education sessions, one delivered by the company representative and one delivered by the healthcare team. Lesson plans and teaching materials have been created. An evaluation was carried out from January 2019 – June 2019

Results

Forty-four families participated in education session 1, thirty-three attended session 1 and 2, seven attended session 2 only. Thirty-six (90%) evaluations have been returned. A 6-point scale was used, with 6 being “very useful” and 1 being “not useful”, 61% of the families responded with 6/6, 28% with 5/6 and 10% with 4/6 – consequently all families scored the session positively. All families were happy with group format, reported they learned something new and felt the information given, teaching methods and resources used were “just right”.

Conclusions

Offering group education session for families commencing libreview has been a positive experience. The families have all found the sessions useful and learned a lot from attending. We are now planning an evaluation with families on their perceived benefits of libre.

Background and Aims

Hypoglycemia reduction and improvement of its perception is a goal for pump therapy. We evaluated the time spent bellow hypoglycemia treshold and awareness of it in adults with T1D on SAP with PLGS (Minimed 640G®) in real life.

Methods

All patients that went through a 6 week initiation program and with more than 6 months of SAP-PLGS Therapy at our clinic were invited. Times bellow 70 and 54 mg/dL (TBR70 and TBR54) for the last month were obtained from the pump, and it was compared to TBR70 from a CGM used for applying for pump coverage. Current Clarke questionnaire was self-administered and it was compared with results obtained before initiation. Proper statistic tests, according to comparison sample size, were used.

Results

78 subjects were included with mean age 34.3 ± 14.0 years and 16.8 ± 9.6 years of disease duration. Current TBR70 for the whole sample was 3.6 ± 2.1% and TBR54 0.7 ± 0.8%, with no significant differences according to length of follow-up. In the 29 patients that we could obtain previous CGM data, pre pump TBR was 12.6 ± 6.4% compared to 3.1 ± 1.6 on the most recent follow-up on pump therapy (p<0.001). When examining the whole sample and classifying by Clarke test, 60.0% of patients have good recognition, 15.4% are undetermined and 25.6% have hypoglycemia unawareness compared with 29.9%, 29.9% and 40.2%, respectively, at inititation (p=0.001).

Conclusions

Adults with T1D on SAP-PLGS succesfully reduce TBR to consensus goals and improve hypoglycemia perception with management by a multidisciplinary team.

Background and Aims

Musculoskeletal disorders (MSKDs) can interfere with the use of technology as frozen shoulder (FS) alters the mobility required for flash glucose monitoring (FGM) and carpal tunnel syndrome (CTS), trigger finger (TF) or tendinitis (TEN) impair the dexterity which is necessary to manage CSII. We analyzed the prevalence and consequences of MSKDs.

Methods

Clinical data were collected over 20 months in a French outpatient facility, from the charts of consecutive patients with T1D for 20 years or more. Complications included diabetic retinopathy, nephropathy, neuropathy and CVD.

Results

Among 80 patients (men: 50%, age: 51.5±13.7 years, diabetes duration: 32.4±9.8 years, HbA1c: 7.6±1.0%, FGM: 91.3%, CSII: 62.5%), 38 had no MSKD (MSKD-) and 42 (52.5%) had at least 1 MSKD (MSKD+) including 19 with only 1 MSKD (1MSKD) and 23 with at least 2 MSKDs (2+MSKDs).The most frequent MSKDs were FS (25.0%), TEN (23.8%), TF (20.0%), CTS (18.8%). Those MSKDs were often combined. The age at diagnosis of first MSKD was 45.0±9.8 years for 2+MSKDs, 50.3±11.9 years for 1MSKD. T1D complications (prevalence 61.3%) were present in respectively 42.1%, 68.4% and 87.0% of MSKD-, 1MSKD and 2+MSKDs patients. The use of FGM in those patients was respectively: 97.4%, 89.5% and 82.6%, the use of CSII: 71.1%, 68.4% and 43.5%.

Conclusions

MSKDs are very frequent in patients with long-standing T1D. Diagnosis at a younger age could mean a higher risk for 2+MSKDs. MSKD+ patients seem to use technology less frequently. Large prospective studies should now focus on this understudied T1D complication.

Background and Aims

Diabetic wounds are an important area of medical challenges. Wound healing is a dynamic and complex immuno-biochemical process. Impaired wound healing is a common occurrence among diabetics and patients receiving glucocorticoid therapy. Nitric Oxide is a free radical human factor with diverse biological roles. The role of NO in both normal and chronic wound is not clear; this study was designed at gaining further insights into the role of NO in wound healing.

Methods

In this research 14 Sprague Dawley (SD) male rats were assigned into two treatment and control groups. Rats in the diabetic group (n=8) were injected with STZ (65mg/kg i.p.) 9 days before wounding. In the second study steroid-treated rats (n=6) were given cortisone acetate (CA: 10 mg i.m.). Rats received full-thickness dermal wounds. The wound area was measured by the VIA technique. Urine samples were collected 24-hrs before and post-wounding. Urine NO was measured by NO Analyzer. Student-t-test was used for statistical analysis.

Results

Post wound increase in urinary NO3- output was significantly reduced in both diabetic (47%) and CA-treated (40%) rats compared to the control group (136%, P≤ 0.0001). Furthermore, NO3- output in diabetic and CA-treated rats fell within pre-wound baseline levels by day 13, while that of normal controls remained elevated (54%) for the entire 30-day post-wound period.

Conclusions

These results suggest that impaired wound lack normal levels of endogenous NO may be due to reduced activity of immune cells such as macrophages during wound healing as shown by injection of LPS and increased level of NO.

Background and Aims

An emerging group of adults with type 1 diabetes are building and using their own artificial pancreas systems (e.g. AndroidAPS, OpenAPS, Loop). These systems are currently not endorsed by regulatory bodies. We explored the experiences of adults with type 1 diabetes with these ‘user-led’ systems, to understand: 1) perceived differences in experience compared to their previous diabetes management, 2) challenges encountered, and 3) how they overcome these.

Methods

We conducted semi-structured telephone interviews with 23 Australian adults (age 25-64 years; 10 women; previously 21 using insulin pump, 23 using continuous glucose monitoring), with experience (1-34 months) of user-led systems. Interviews were recorded, transcribed, and analysed thematically.

Results

Compared to their previous diabetes management, participants reported a range of benefits including more stable glucose levels, better sleep quality and reduced psychological burden. The challenges reported included technical and financial issues (associated with building their system), being unable to seek support from healthcare professionals or industry, and their own/others’ perceptions of risk. Participants overcame challenges through the empowerment gained from building their own systems, and seeking out support from others (e.g. peers using ‘user-led’ systems and family members). Peer support was important for technical support and building confidence (via modelled behaviour and the reassurance of having a 24/7 online community).

Conclusions

Australian adults experience several benefits from user-led diabetes technologies, however these are juxtaposed by the challenges of building their own systems. Participants are able to navigate these challenges due to support (especially from peers), and the empowerment gained from building/using their own systems.

Background and Aims

Psychosocial factors affect diabetes management. To investigate associations between psychosocial factors and HbA1c in people with type 1 diabetes treated with an insulin pump, we will conduct a systematic literature review.

Methods

We will search MEDLINE, Embase, CINAHL and PsycINFO for original studies (N>50) reporting associations between psychosocial factors and HbA1c in non-pregnant people (age≥18 years) with type 1 diabetes using an external insulin pump with or without continuous glucose monitoring. All identified references will be screened in doublet and eligibility will be determined according to preset criteria. The screening process will be reported according to PRISMA guidelines. Included references will undergo systematic data extraction and quality assessment. We expect to find studies of different designs using different measures of psychosocial factors, and accordingly we plan to undertake a narrative evidence synthesis and conclusion.

Results

Database searches resulted in 1778 unique references. The screening process is currently ongoing.

Conclusions

The results of this ongoing systematic literature review, which will be ready for reporting in February 2020, will provide guidance on psychosocial factors that should be addressed in order to provide optimal care for people with insulin pump treated type 1 diabetes.

Background and Aims

Little is known about the glycaemic control of professional athletes with type 1 diabetes (T1D), particularly in ultra-endurance events. Using the latest technologies we investigated factors related to glycaemic management in a professional cycling team with T1D (Team Novo Nordisk; TNN) over a 7-day UCI World Tour stage race.

Methods

Six male professional cyclists with T1D (age 29±3 years, duration T1D 13±7 years, HbA_1c 6.4±0.6%) cycled 3-7 hours/day, covering 127-219 km on seven consecutive days during the Tour of California. Time spent in pre-specified glycaemic ranges was assessed using CGM (Dexcom G6). Insulin dosage and timing was recorded using NovoPen® Echo Plus (Novo Nordisk, Bagsværd, Denmark) smart insulin pens.

Results

Overall, TNN placed 14^th of 19 teams, ahead of three World Tour teams and with numerous individual successes, including TNN’s first top 10 rider on the final stage. Mean in-ride time in euglycaemia (3.9-10.0 mmol/L) was 63±11% with a low percentage of time in L1 (3.0-3.9 mmol/L; 0±1%) and L2 (<3.0 mmol/L; 0±0%) hypoglycaemia. Riders spent 25±9% of time in L1 (10.1-13.9 mmol/L) and 11±9% of time in L2 (>13.9 mmol/L) hyperglycaemia. Bolus insulin use was infrequent during races, despite high carbohydrate intake. In-ride carbohydrate intakes of this group of athletes (76±23 g∙h^-1) coincide with the contemporary nutrition guidelines for endurance athletes t₄₁=1.69, p=0.09.

Conclusions

Despite the many glycaemic challenges, the CGM data show that professional cyclists with T1D spent a high percentage of their time in target glycaemic range, with little time in hypoglycaemia over a World Tour stage race.

Background and Aims

“Citizen scientists” with T1D are helping to push the boundaries of uptake of diabetes treatments and technologies, as seen in the WeAreNotWaiting movement and in capturing and sharing data in health provision services to enhance access. I aim to show how this has provided additional evidence and approaches to treatment for healthcare professionals and explain why you should be working with us to do more.

Methods

A review of collaborations, experiments and interventions by “citizen scientists” to determine the type of evidence or data produced and relate this to the outcomes achieved.

Results

Specific examples show that work undertaken by "citizen scientists" has resulted in collaboration relating to clinical trials, changes in approach to delivering insulin, better understanding about what to expect with new treatments and changes in the approach to how policy is delivered at a national level.

Conclusions

“Citizen scientists” with T1D have a different drive and are able to take a different view from those working in the healthcare and academic professions, bringing additional skills to bear and providing useful insights that can be used to enhance existing approaches. They should be considered a key part of a holistic team and engaged with more frequently to help enhance uptake of new treatments and technologies.

Background and Aims

Last worldwide statistics on Diabetes Type II shows that 24% of newly diagnosed cases are adolescents. Adolescents’ compliance with self-management guidelines regarding blood glucose monitoring, medication adherence, diet, and physical activity presents a big challenge to healthcare providers. While mobile technologies promise to provide the necessary motivation for adolescents to self-manage, clinical evaluation of traditional mobile apps found no significant difference in hemoglobin A_1c (HbA_1c) level between treatment groups using mobile apps for Diabetes II and the control groups. Previous studies have found no significant difference in hemoglobin A_1c (HbA_1c) level between treatment groups using mobile apps for Diabetes II and the control groups. I

Methods

We reviewed 70 applications for Type II diabetes and found that 51-68% support glucose monitoring, dietary intake, and physical activity, while only 3-17% support gaming, social media, and personalization of the app design based on patient’s characteristics. Twenty-three patients in Qatar using the services of Qatar Diabetes Association were interviewed about technologies they use to support self-management.

Results

Adolescents complained that apps lack an understanding of patients, the Qatari culture and the problems facing adolescents to motivate users to change their behavior. The participants proposed future apps that 1) support personalized gaming; 2) adapt to the patient culture and character; 3) capitalize on social networking; 3) provide the right motivation to take actionable steps; and 4) integrate features across apps.

Conclusions

Mobile apps for Diabetes self-management require understanding the character of patients and using the knowledge to personalize gaming scenarios that motivate and is aligned with the Qatari culture.

Background and Aims

Several efforts have been made to find out the association of type 2 diabetes mellitus (T2DM) with increased risk of cognitive impairment, but still, the concept behind the T2DM-induced cognitive impairment is largely unknown. The present study is conducted to determine the relationship between the adverse level of glycated hemoglobin (hba1c) and impact on cognitive functions in patients with type 2 diabetes.

Methods

Consenting adults (n=74) with type 2 diabetes, no prior cognitive impairment disorder, was prospectively observed using Cognitive Testing Interview Guide with their hba1c level. The primary outcome measure was to evolve the correlation between hba1c level, age and cognition demographics including vision, hearing, cognitive functioning, walking, self- care, communication, and general health.

Results

For the the18months time period between March 2017-August 2018, 596 people were enrolled in the study, 323 present detailed histories of disease and 119 were able to produce the current hba1c report. Finally, (n=74) completed cognitive tests. The incidence of complications in cognitive functions was significantly associated with the hba1c level. Each cognitive demographics vision, hearing, cognitive functioning, walking, self-care, communication, and general health were related to hba1c in type 2 diabetes patients (95% confidence interval P<0.0001).

Conclusions

Poor cognitive functions increase the risk of severe health issues which affects the day to day life of people with type 2 diabetes. As our study demonstrates highly significant (P<0.0001) results in every cognitive demographics which states the association of cognitive functions with T2DM.

Background and Aims

Leptin receptors (LEPR) and beta3 adrenoreceptors (ADRB3) are involved in metabolic control and weight gain. ADRB3 TRP64ARG and LEPR Q223R polymorphisms increase the risk of obesity and type 2 diabetes (T2D) development. However, there is no data on combine effects of these two polymorphisms on the risk of overweight and T2D in patients of different sex and age that defined the goal of the study.

Methods

150 patients with T2D and 90 non-diabetic patients were enrolled in the study. Genomic DNA was extracted and amplified by polymerase chain reaction. We assessed the relationship between ADRB3 TRP64ARG (rs4994) and LEPR Q223R (rs1137101) genotypes in patients of different sex, age (with cut-off 55 years), body mass index (BMI) and T2D.

Results

AG and GG genotypes in LEPR Q223R polymorphic site were associated with higher risk of T2D (OR=4.46, 95% CI 1.44-13.83, P=0.009) but not overweight in patients regardless of sexes and age (P=0,245). ADRB3 polymorphism was associated with increased risk of high BMI in females (P=0.01). At the same time rs4994 polymorphism (CT) demonstrated the protecting effect on T2D development (OR 2.27, 95%CI:1.02-5.05; P=0.044) mostly in females. CT genotype of ADRB3 TRP64ARG attenuated the effect of LEPR Q223R polymorphism on T2D risk in females (OR 0.1143, 95% CI 0.023-0.57; P=0.008) however this effect was more prominent in patients up to 55 years old.

Conclusions

ADRB3 TRP64ARG polymorphism was associated with overweight but decreased the risk of T2D development in females with LEPR Q223R polymorphisms under 55 years old.

Background and Aims

Devices which passively record insulin dose information have the potential to improve diabetes management over active methods of data collection (e.g. logbooks). This simulation study was conducted to understand how healthcare provider (HCP) access to passive insulin data influences prescribing and treatment confidence.

Methods

Multidisciplinary HCPs completed an online survey consisting of hypothetical insulin-injecting patient vignettes. “Patients” were created using a fractional factorial design from a set of real-world, clinical variables (e.g. HbA1c) and presented with a range of data collection methods. HCPs adjusted diabetes treatment and rated their level of confidence in each decision.

Results

Participants (n=208) were endocrinologists (40%), primary care physicians (40%) and diabetes educators (20%). Access to blood glucose, insulin adherence, and insulin dose data were rated most important for diabetes management. HCPs report that ~37% of patients do not log insulin dose information. HCPs considered passive insulin dose capture more trustworthy than other methods of collecting insulin dose data (p<0.05). Treatment confidence did not differ between data collection methods in simulation, however 88% of HCPs rated passive insulin data as being ‘useful’ or ‘extremely useful’. The most common concern regarding absence of insulin dose data was fear of incorrect adjustment (32% of HCPs). Insulin dose decreases correlated with presence of hypoglycemia and insulin logbook incompleteness.

Conclusions

HCPs were more likely to decrease insulin doses if insulin logbooks were not complete. In simulation, access to passive insulin dose data did not increase HCP treatment confidence, however passive insulin data was considered useful and more trustworthy than other data sources.

Background and Aims

Diabetes social media is being used to obtain knowledge about diabetes. It’s a strategy to deliver inexpensive and 24-hour information with a great potential to provide engagement. The aim is to describe an approach inside a type 1 diabetes (T1D) open Instagram profile with the purpose to embrace better outcomes empowering people and building a group belonging.

Methods

Indicators from the Instagram platform were reviewed. The media is administered by an endocrinologist with no conflicts of interest and emphasizing that regular care is always primary.

Results

21.100 followers reaching 13.000 every week. An every day good morning question “Have you already changed your needle today?” is published. Reach: 2.000/day. Usual feedback: “Now I understand that I need to change my needles.” “Before this post I couldn’t realize how many days I used the same needle’. Once a month there is a open box for empowerment. The top liked was: “Leave a message for a mom of a newly diagnosed kid with T1D.” 80 full of love and involvement messages were written: “Breath! It’s not simple, but it’s possible.” “Don’t be afraid. We are here to help you.” “Be sure that your kid with a great treatment can live a beautiful life.” “What is happening is not your fault.” “Be faith.” “You’re gonna learn how to dance in the rain.”

Conclusions

The bright side of diabetes social media is not just education. It’s the foundation of social identity in a non-stop authentic moral support engaging T1D community.

Background and Aims

The Hvidoere Childhood Diabetes Study Group has previously shown that a clear and consistent target setting by the diabetes team is strongly associated with HbA1c outcome in adolescents.

The aim of this study was to evaluate whether this finding can be confirmed, 14 years later, in children and adolescents from centres, that are part of an international diabetes registry, SWEET.

Methods

A questionnaire was sent out to 76 different SWEET centres across the world, of which a total of 53 paediatric centres were included (70%). The association between centre target value of HbA1c and mean HbA1c was adjusted for age, diabetes duration, sex, and gross domestic product.

Results

Of the 53 centres, 13.2% reported an HbA1c target between 6% and 6.5%, 32% had a target between >6.5% and 7%, 18.8% between >7% and 7.5 % and 3.8% between 8% and 8.5%. No specific target value was reported by 32.1% of all centres. Mean HbA1c across all centres (n=53) was 8.0 ± 1.0%. Adjusted regression analysis showed a positive association between HbA1c outcome and target value (p=0.005).

Conclusions

This international study demonstrates that a lower targeted HbA1c is associated with better metabolic control. It is unclear, whether low target values result in better metabolic control, or whether lower HbA1c values actually result in more ambitious target values. This target setting could play a role in explaining the differences in metabolic outcome between centres and could be a method to ameliorate this metabolic outcome.

Background and Aims

This study sought to examine the acceptability of “Nutrition and Diet” (N&D) apps by Medical Doctors (MDs) and nurses, explore their preferences on apps’ features and identify predictors of acceptance.

Methods

A 23 questions survey, which requires 15 minutes to be completed, was developed by an interdisciplinary team (dietitian, computer scientists, AI experts, MD, pharmacist, psychologist) and pilot-tested. It includes questions on demographic characteristics, adoption of “N&D” apps in assessing and tracking individuals’ dietary intake, criteria for selecting an app, and important features of future apps. After pilot-testing, the survey was launched.

Results

So far, 94 MDs and nurses (64 female/29 male/1 no answer; mean age (SD): 45(10) years; 46% Android/53% iOS/1% no answer; 79% see people living with diabetes), from 30 countries and 6 continents completed the survey. The majority (84%) do assess their patients’ intake. However, only 36% recommend “N&D” apps, and even fewer (17%) endorse them for dietary assessment purposes. From those who have not yet recommended an app, 28% do not know their existence. The most important criteria for selecting an app are to be easy to use (84%), costless (76%) and validated/certified (69%). Noteworthy criteria also include the support of automatic food image-based logging (60%) and automatic nutrient estimation (48%). The most significant barriers are lack of local food composition database support (47%) and no personalization (language/units) (44%).

Conclusions

Several issues need to be addressed before MDs and nurses integrate the recommendation of “N&D” apps to the dietary assessment of their clinical practice.

Background and Aims

In treating adolescents with Type I Diabetes Mellitus who are non-compliant with treatment, it is important to address both the medical aspects of management (blood sugar checks, insulin administration, carbohydrate counting) and the underlying social and psychological issues leading to noncompliance. Interventions that focus on emotional, social and family processes have shown good effects on Hb A1c control

Methods

We reviewed the multidisciplinary approach used to evaluate children with poorly controlled type 1 diabetes mellitus in an outpatient clinic setting. Patients and families were offered a variety of services depending on the needs and risk factors identified during the outpatient clinic visit; these included personal/group psychological therapy, social work evaluation and in rare cases, child protective service referrals.

Results

We identified 46 patients with Type I Diabetes Mellitus who were at least 10 years old with a HbA1c at 10% or above. Twenty five percent of them received psychology/psychiatry evaluation, 70% received social work evaluation to address social stressors and family conflicts while 5% were referred to child protective service

Conclusions

Exploring the psychological and social factors in pediatric diabetes is an essential step in improving adherence to optimal management and better disease outcome.

Background and Aims

Childhood obesity remains the most important risk factor of developing type 2 diabetes and cardiovascular diseases. In the U.S.A, the Center of Disease Control and Prevention (CDC) estimates that greater than one third of the children and adolescents were overweight or obese.

In recent years, cases of pediatric type 2 diabetes in children have been diagnosed more frequently at younger ages than previously seen.

Pediatric obesity and type 2 diabetes are more likely to continue into adulthood.

The objective of this study is to report the association of obesity in children 18 years old or younger with type 2 diabetes, dyslipidemia and hypertension.

Methods

The study population consisted of all patients seen in a pediatric endocrinology clinic. An analysis of ICD10 diagnosis codes was performed for a two- year period from 2015 to 2016, to evaluate the association of diagnoses of obesity and abnormal weight gain with type 2 diabetes and other co-morbidities.

Results

Of 189 overweight, obese or morbidly obese patients identified, twenty six patents (13%) had dyslipidemia, three (less than 1%) had type 2 diabetes and 3 (less than 1 %) had hypertension

Conclusions

Early diagnosis and management of diabetes, hypertension and dyslipidemia in obese children is essential. The pediatric obesity epidemic has allowed adult-type pathologies to evolve in the pediatric population.

Background and Aims

Adolescents with Type 1 Diabetes Mellitus demonstrate poorer adherence to treatment regimens than other pediatric age groups . Nonadherence is tightly linked to suboptimal glycemic control, increasing morbidity, and risk for premature mortality. The aim of this study is to investigate the reasons for noncompliance.

Methods

We identified 46 patients with Type I Diabetes Mellitus who were at least 10 years old with a HbA1c at 10% or above. We reviewed the problems identified related to poor compliance

Results

On average, patients had Type 1 Diabetes Mellitus for 5 years. The mean Hgb A1C at the first visit during the study period was 11.3%. About 24% of the patients were hospitalized for Diabetic Ketoacidosis during the study period. About 10% of the patients’ parents separated or divorced either 6 months before or during the study period ,15% of the patients moved and 10% of children changed schools during the study period. One patient experienced the death of a 1st degree relative during the study period. About 10% of the patients experienced other events categorized as life stressors during the study including having a parent with a chronic illness, having a sibling with a prolonged PICU stay, the birth of a sibling and failing classes.

Conclusions

Exploring the psychological and social factors in pediatric diabetes is an essential step in improving adherence to optimal management and better disease outcome.

Background and Aims

Carbohydrate counting (CHC) is a method to estimate the insulin bolus which aims is to reduce post-prandial glycemic excursion. CHC must be integrated into the nutritional education of type 1 diabetes and managed by multidisciplinary team.

In view of the growing importance of CHC in Hybrid Cloosed Loop Insulin Delivery Systems, we tried to understand if the educational effort of the caring team to train the patient to the use of CHC reaches the goal: long term use of this method.

Methods

Fifty-six children and adolescents with type 1 diabetes treated with insulin pump, and their parents, were enrolled for the study and answered the survey. They and their parents had been trained for CHC almost one year before the survey and, in post-training visits, learning was reinforced.

Results

One year after the CHC training, 6 patients (10,7%) dropped out insulin pump therapy. Twenty-three patients (41%) didn’t use CHC and 5 patients (9.5%) used it rarely. Between the “non users” 51% was not able in the counting, 14% didn’t trust of the bolus calculator, 20% thought they didn't need it, 15% considered it too complex.

Conclusions

This survey shows that CHC is not suitable for all patients. This could be a problem for Hybrid Cloosed Loop Systems that need the correct use of the bolus calculator. Such systems should minimize the patient's engagement in bolus management and so they could be used by a wider population of patients.

Background and Aims

Our aim is to present pitfalls created by youth patients on HCP way to manage their diabetes perfectly.

Methods

41 participants (22 girls) of diabetes summer camp were included into the study, age 9 to 18 (mean 13.4 ± 2,6). 82.9% (n=34) used CSII and 31.7% (n=13) used CGM or FGM constantly before the camp. During the camp 92.7% (n=38) patients were put on FGM, the remaining continued CGM. All prandial and correction boluses were to be determined by the participants with HCP supervision – to improve sense of “self-efficacy”. Children had the opportunity to consult with HCP throughout the whole camp (24/7 for 14 days).

Results

AVBG before and during the camp (163.1±31.3 vs. 158.4±27.9 mg/dl, p>0.05) and number of SMBG / day (8.1±2.9 vs. 8.1±3.3) did not differ. % of blood glucose <70 mg/dl increased from 6.9±5.4 to 9.4±5.6 (p=0.0247), as were glucose variability measured by CV (44.4±9.8% vs. 49.6 vs. 8.4%, p=0.0321). Detailed analysis of pump data indicated episodes of patient non-compliance that might have led to misinterpretation of the measurement followed by incorrect dosing of insulin, e.g. using ‘prime’ function or setting a ‘scheme’ basal rate as a bolus, causing hypoglycemia.

Conclusions

This is another evidence of the well‐known problem of decreased compliance in diabetes management during adolescence, here causing therapeutic failure during diabetes summer camp (no improvement in overall AVBG, deterioration of CV). It is important to address sense of self-efficacy among youths with diabetes to empower their motivation and enhance therapeutic adherence.

Background and Aims

White coat adherence (WCA) is defined as an increased adherence to treatment regimens in the days prior to the visit with a healthcare provider. Little is known on the effect of WCA on glucose control in adult patients with diabetes mellitus. Continuous glucose monitoring (CGM/FGM) provides a novel approach for a detailed analysis of a potential WCA effect on glycemia.

Methods

The present study is based on CGM/FGM-data of 279 patients with diabetes treated between January 2013 and July 2018 in a tertiary referral center. The analysis compares data from the 3 days prior to a visit (p1) with the preceding 25 days (p2). Patients were included in the analysis if CGM-/FGM-data were available for at least 50% of the two single time periods, resulting in a total of 817 data sets.

Results

Sensor use was higher during p1 than p2 (89.8±10.7% [53mmol/mol] vs 83.0±13.0%; p<0.001). Mean glucose [MG] and coefficient of variation [CV] were lower in p1 compared to p2 (MG 167.1±44.8 mg/dL vs 168.8±38.8 mg/dL, p=0.046; CV 33.4±8.7% vs 36.0±7.1%, p<0.001; respectively). Time in range (70-180mg/dL) was higher in p1 than p2 (60.2±22.1% vs 59.1±19.0%, p=0.014). Sensitivity-analysis showed a predominant WCA effect in patients with HbA_1c > 7% (53mmol/mol).

Conclusions

The present study reveals a statistically significant WCA effect on pre-visit glucose control. The absolute effect-size was comparably small, indicating that CGM/FGM data from the time period immediately before a clinical visit reliably reflects glycemic control of a longer pre-visit period.