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.