Laurel H. Messer, United States of America

University of Colorado School of Medicine Barbara Davis Center for Diabetes

Moderator Of 1 Session

ORAL PRESENTATION SESSION
Session Type
ORAL PRESENTATION SESSION
Channel
Berlin
Date
21.02.2020, Friday
Session Time
09:00 - 10:00

Presenter Of 5 Presentations

SATISFACTION AND REDUCTION IN DIABETES BURDEN WITH PREDICTIVE LOW GLUCOSE SUSPEND (PLGS) IN INDIVIDUALS WITH TYPE 1 DIABETES (T1D)

Session Name
HUMAN FACTOR IN THE USE OF DIABETES TECHNOLOGY
Session Type
E-POSTER VIEWING (EXHIBITION HOURS)
Date
20.02.2020, Thursday
Session Time
09:30 - 15:30
Channel
E-Poster Area
Lecture Time
09:56 - 09:57

Abstract

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). abstract_figure.jpg

Conclusions

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

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Satisfaction and Reduction in Diabetes Burden with Basal-IQ Predictive Low Glucose Suspend

Session Type
INDUSTRY SESSION
Date
20.02.2020, Thursday
Session Time
16:40 - 18:00
Channel
London
Lecture Time
16:50 - 17:10

EVALUATION OF CGM USE FEATURES IN ADOLESCENTS WITH TYPE 1 DIABETES (T1D): A REPORT FROM THE CGM INTERVENTION IN TEENS AND YOUNG ADULTS (CITY) STUDY

Abstract

Background and Aims

To describe use of continuous glucose monitoring (CGM) by adolescents and young adults with T1D enrolled in the CITY trial.

Methods

Participants (N=153) were randomized to CGM (Dexcom G5) or blood glucose (BG) monitoring for 26 weeks, with CGM users receiving educational support. Data on use of CGM are reported for the CGM group (n=74, mean age 18 ± 3 years, 45% female).

Results

At 26-weeks, 86% of participants were using CGM with average use 6.4 (3.5, 7.0) days/week (median, Q1, Q3). Median daily blood glucose (BG) checks in this group was 2.0 (1.8, 3.0) with 98% regularly using CGM readings without a confirmatory BG for insulin dosing (table). Most participants utilized low and high alerts (91% and 84%, respectively), with median low alert setting at 70 mg/dl (70, 80) and median high alert setting at 270 mg/dl (240, 300). The mobile app was used to view CGM data by 81% of participants and 62% of these users shared CGM data via remote monitoring. Most were sharing with one (59%) or two (28%) people: parents/guardians (91%), siblings (13%) and significant others (9%).

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Conclusions

In the CITY trial, the majority of adolescents/young adults were using CGM regularly after 6-months, in contrast to previous descriptions of CGM use in this age group. Participants maintained high use of the mobile app, alerts and share features, possibly related to close follow up and education after CGM initiation. Future analyses should assess use of which features predict glycemic improvements.

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Practical implementation of diabetes technology

Session Type
PLENARY SESSION
Date
21.02.2020, Friday
Session Time
13:00 - 14:30
Channel
Auditorium A
Lecture Time
13:52 - 13:59

Skin in the game: Preserving skin integrity for sustained device use

Session Type
PARALLEL SESSION
Date
22.02.2020, Saturday
Session Time
10:30 - 12:00
Channel
Rome
Lecture Time
11:30 - 11:50

Abstract

Background and Aims

Diabetes devices--insulin infusion sets, patch pumps, flash and continuous glucose sensors--all involve adhesive patches adhered to the user’s skin. Wear is often for an extended amount of time (3-14 days), and requires continued, repeated exposure to chemical and mechanical agents. As a result, exposure to adhesives lead to acute and chronic skin problems that may impede comfortable use of diabetes devices. The aim of this presentation is to delineate types of skin complications associated with diabetes devices, and discuss strategies to optimize skin protection, adhesion, removal, and healing.

Methods

Review of current literature was undertaken to determine types of common skin reactions to diabetes devices, and recommendations for treatment and sustained device use

Results

Skin complications from device use can be delineated into two primary categories: Contact irritation and contact allergy. Contact irritation causes direct damage to skin via chemical or mechanical agents, and results in a non-immune inflammatory response. Contact allergy is a hypersensitization of the immune response to a chemical agent in the adhesive. It can be immediate (Type 1 hypersensitivity, IgE mediated) or delayed (Type 4 sensitivity T-cell mediated). Contact allergy has been documented in response to isobornyl acrylate, colophonium, ethyl cyanoacrylate and N,N-dimethylacrylamide. Different devices contain different agents in their adhesives.

Conclusions

To minimize complications from contact dermatitis, clinicians should discuss prophylactic strategies with users, including skin preparation and chemical/physical barriers. Adhesive problems can be addressed with overpatches and tackifiers. Sensor removal agents and techniques are important for healing. For contact allergy, it may be possible to use a skin protecting layer between the native adhesive ad skin, however complete avoidance of the offending agent is often indicated. Overall, device manufacturers should increase transparency about chemical agents found in device adhesives, and careful skin care may reduce incidence of complications.

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