Comparison of glycemic control between remote and in clinic initiation of advanced hybrid closed loop system MiniMed 780G in children and adolescents with type 1 diabetes

Introduction: The COVID-19 pandemic has prompted the consideration of alternative methods to provide consultations such as telephone, e-mail, and video conferencing. Sidra Diabetes Team developed remote pump training program using video conferencing. Objectives: The aim of the study was to evaluate glycemic control between Remote Initiation and In Clinic Initiation of Advanced Hybrid Closed Loop (AHCL) System MiniMed 780G (Medtronic, Northridge, US) in patients with Type 1 Diabetes (T1D). Methods: Prospective observational study of children aged 7 to 18 years with T1D who were offered to start the MiniMed 780G system either following the remote initiation program (Remote group) or the traditional in clinic initiation program (In Clinic group). Both programs followed same structured education protocol over four consecutive days, two hours per days. Remote program was performed using Skype “Meet Now” or Zoom Conferencing, while in clinic program was performed at the hospital. HbA1c, Time in Range, AHCL system characteristics were analyzed three months after AHCL initiation. Results: 13 patients (age 12.6±2.8 years, female:7) were included in the Remote group and 34 patients (age 11.7±2.1 years, female:18) in the In Clinic group. HbA1c of the Remote group decreased from 8.5 ±1.2% (69±13.1 mmol/mol) at baseline to 7.1±0.9% (54±9.8 mmol/ mol) at the end of the study (p=0.002), compared to the In Clinic group for which HbA1c decreased from 8.6±1.3% (70±14.2 mmol/ mol) to 7.0±1.1% (53±12.0 mmol/mol), (p=0.001), respectively). No significant difference of HbA1c levels, TIRs and SmartGuard use between groups was found at the end of the study. No DKA events and severe hypoglycemia in both groups was observed during the study. No severe hypoglycemia was observed in both groups. Conclusions: Remote Initiation Program for AHCL system should be offered to people with T1D as alternative to In-Clinic Initiation Program. Both programs can improve glycemic control in a safe manner without severe hypoglycemia and hyperglycemia.

Hybrid closed loop initiation using virtual pump training program in children and adolescents with type 1 diabetes previously treated with multiple daily injections

Introduction: Due to the COVID-19 restrictions in providing regular diabetes services at Sidra Medicine in Qatar, the traditional training and education was postponed, as the service was not considered critical in the current situation. Diabetes team developed an innovative “virtual pump training program”, using video conferencing Skype “Meet Now”. Aim: The aim of this study was to evaluate effectiveness of this program on glycemic control patients transiting to HCL system. Methods: Prospective observational study of children aged 7 to 18 years with Type 1 Diabetes (T1D) on Multiple Daily Injections (MDI), starting the MiniMed 670G system using Skype Meet Now with the following program: prerequisite technical session, patient's criteria for the program and pre-course requirements;pump training, one face to face practical session for sensor insertion and four consecutive online sessions: Day 1- Manual Mode, bolus wizard use, basal rates, Auto Mode and readiness;Day 2- Infusion set and reservoir change;Day 3- hypoglycemia, hyperglycemia, exercise and travel management;Day 4- Evaluation to initiate HCL system. Time in Range, Sensor Glucose, HCL system characteristics were analyzed in the first month of HCL initiation. Results: A total of 12 patients (Age 7-18 years) and their parents commenced MiniMed 670G using the virtual program and used the system for one month. Sensor wear of 91.2 ± 4.5% and Auto Mode usage of 88.5 ± 6.8% was noted in the first month HCL initiation. Time in Range (70-180 mg/dL) increased from 42.1 ± 10.2% at baseline to 74.2 ± 7.3% at the end of the study (p < 0.001). There was no severe hypoglycemia nor DKA during the study. The patients will be followed for the next 3 months. Conclusions: Virtual Pump Training Program in people with T1D on MDI, can be an effective tool to initiate an HCL system and to improve glycemic control in a safe manner without severe hypoglycemia and hyperglycemia.

Preprocedural Pool Testing Strategy for Dentistry during the COVID-19 Pandemic.

INTRODUCTION: Aerosol-generating procedures (AGPs) put the dental health care professionals (DHCPs) at a greater risk for acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In late June 2020, the Centers for Disease Control and Prevention advised elective dental procedures provision to asymptomatic patients while mandating strict infection control protocol and suggested the use of preprocedural testing as an adjunct. A cost-effective method for mass preprocedural testing is pool testing, which has specificity and sensitivity similar to polymerase chain reaction. This article aims to assess the outcomes and utility of incorporating preprocedural testing protocol for SARS-CoV-2 in dental clinics before providing AGPs. METHOD: The patients who were recommended AGPs where rubber dam placement was not possible were advised to undergo preprocedural testing for SARS-CoV-2. Pool testing strategy was employed, and patients were asked to get tested 48 h before the day of the procedure. RESULTS: Out of a total of 1,000 patients, who presented from June 2020 to late July 2020, 464 were recommended dental procedures. In 194 of 464, AGPs could not be performed under rubber dam isolation; therefore, the patients were advised to get a preprocedural pool test. In total, 111 patients deferred the procedure and testing. Out of 83 who got tested, 7 were positive for SARS-CoV-2, 5 of whom were tested in early June 2020 and 2 in late July 2020. CONCLUSION: Pool testing within its limitations can be a useful preprocedure test in asymptomatic low-risk patients for AGP in dentistry, especially when the disease prevalence is low or moderate (<10%). It has the potential of reducing testing costs significantly while conserving reagent and other resources. Preprocedure testing, however, also gives rise to certain ethical concerns that also need to be addressed. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by clinicians when deciding which preprocedure testing approach they wish to use when performing aerosol-generating procedures in asymptomatic patients with consideration of cost sensitivity and specificity values.

Role of respirators in controlling the spread of novel coronavirus (COVID-19) amongst dental healthcare providers: a review.

During the ongoing COVID-19 pandemic, healthcare professionals are at the forefront of managing the highly infectious coronavirus. As the most common route of transmission is via aerosols and droplet inhalation, it is critical for healthcare workers to have the correct personal protective equipment (PPE) including gowns, masks and goggles. Surgical masks are not effective in preventing the influenza and SARS, so they are unlikely to be able to resist contaminated aerosols from entering the respiratory system. Therefore, it is vital to use respirators which have been proven to offer better protection against droplets, aerosols and fluid penetration and which form a tight seal around the mouth and nose. Various types of respirators are used in healthcare settings, such as half-mask filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). The most commonly used FFR is the N95 disposable respirator, which is tight fitting and has a 95% or above particle filtering efficiency for a median particle size of 0.3 µm. This review discusses respirators, their purpose, types, clinical efficiency and proper donning and doffing techniques.