Welcome to the ATTD 2023 Interactive Program
IS086 - Global Registry data: Diabetes Technology impact (ID 302)
Abstract
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Global registries reflect the current status of type 1 diabetes and the real-life impact that the adoption of diverse diabetes therapies have beyond randomized clinical trials. With the rapid adoption of diabetes related-technology worldwide, firstly continuous glucose monitoring and more recently closed-loop systems, it is expected a drastic change in the achievement of recommended targets for children and adolescents with type 1 diabetes. International registries such as SWEET (Better control in Pediatric and Adolescent diabetes: Working to create centers of reference) or large national prospective registries like DPV (Diabetes-Patienten-Verlaufsdokumentation; Germany and Austria), T1D Exchange (US), ADDN (Australasian Diabetes Database Network (Australia) or the SWEDIABKIDS (Swedish Childhood Diabetes) registries have reported a drastic increase in technology use. The SWEET registry has shown a significant decrease in HbA1c on a background of increasing pump and sensor use for 10 years within this registry. Nevertheless, there is still room for improvement as only 21% of children and adolescents with type 1 diabetes achieved the current ISPAD/ADA HbA1c<7.0% (53 mmol/L) target in another description within the SWEET Registry from 2021 (with data for the period 2017-2019) while 37% achieved the former ISPAD/ADA HbA1c<7.5% (58 mmol/L) target. This percentage is however significantly higher that the one described by the T1D Exchange for the period 2017-2018, where only 17% of youth with diabetes achieved the ISPAD/ADA HbA1c<7.5% (58 mmol/L). Reports from the different registries associate a positive effect of technology use (pump and/or sensor) on HbA1c. The decrease in HbA1c in large registries have been accompanied by a lower number of diabetes ketoacidosis and severe hypoglycemic episodes. During the next few years a potential improvement in diabetes outcomes is also expected in parallel with an increasing use of closed loop systems. On the other hand, there is still a paucity of registry-derived data regarding other parameters such as time in range, economic measurements/analyses and quality of life/patient-reported outcomes (PROs) which might help to visibilize the impact of technology in pediatric diabetes.IS087 - Psychological impact of technology: What is most relevant? (ID 303)
Abstract
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The clinical benefits to using diabetes technology are now well established. However, to optimise these clinical gains, user ‘buy in’ and engagement are essential. The psychological impacts of using diabetes technology can both motivate and hinder effective and sustained technology use. Hence, alongside clinical trials to assess efficacy, it is vital to draw upon users’ perspectives to better understand acceptability. With a focus on closed-loop technology, this presentation will showcase how qualitative methodology can help illuminate and understand how diabetes technology can impact users’ quality of life in ways which cannot be captured through questionnaire designs. Drawing upon findings from interviews with a diversity of user groups (young people, parents of children with type 1 diabetes and pregnant women), the presentation will highlight the transformative impact closed-loop technology can have on users’ sense of self and their confidence and ability to undertake everyday activities and engage in meaningful relationships with others. The presentation will also highlight how qualitative methods can capture unintended psychological consequences to technology use, such as excessive anxiety leading to over interaction with the system in certain individuals. Hence, it will be argued that consulting users and learning about their lived experience can help inform decisions about technology rollout and support identification of those who might benefit from bespoke input and psychological support to make optimal use of technology in everyday life.
IS088 - Diabetes technology access in low and middle low-income countries: Now or later (ID 304)
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Emerging diabetes technologies, including insulin pumps, continuous glucose monitors, and automated insulin delivery systems, can improve the quality of life and glycemia of people living with diabetes mellitus. Diabetes technologies are not available to all people living with diabetes across the globe secondary to issues with manufacturing, marketing and registration, pricing and reimbursement, procurement and supply, prescribing, dispensing, and patient use. There are also well described socioeconomic and racial disparities in the use of diabetes technology even in high income countries with access to these devices. Given the continued challenge of access to blood glucose meters, blood glucose strips and insulin in low and middle income countires, is now the time to make access to diabetes technologies in low and middle income countries a priority? Benefits of using diabetes technology on quality of life and glycemia (HbA1c and time in range) and current access to and use of diabetes technology in low and middle income countires will be reviewed in the context of the 2022 ISPAD Clinical Practice Consensus Guideline Chapter on the management of the child, adolescent, and young adult with diabetes in limited resource settings.