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1.
Am J Health Syst Pharm ; 79(6): 452-458, 2022 03 07.
Article in English | MEDLINE | ID: covidwho-1545903

ABSTRACT

PURPOSE: Inpatient diabetes management involves frequent assessment of glucose levels for treatment decisions. Here we describe a program for inpatient real-time continuous glucose monitoring (rtCGM) at a community hospital and the accuracy of rtCGM-based glucose estimates. METHODS: Adult inpatients with preexisting diabetes managed with intensive insulin therapy and a diagnosis of coronavirus disease 2019 (COVID-19) were monitored via rtCGM for safety. An rtCGM system transmitted glucose concentration and trending information at 5-minute intervals to nearby smartphones, which relayed the data to a centralized monitoring station. Hypoglycemia alerts were triggered by rtCGM values of ≤85 mg/dL, but rtCGM data were otherwise not used in management decisions; insulin dosing adjustments were based on blood glucose values measured via fingerstick blood sampling. Accuracy was evaluated retrospectively by comparing rtCGM values to contemporaneous point-of-care (POC) blood glucose values. RESULTS: A total of 238 pairs of rtCGM and POC data points from 10 patients showed an overall mean absolute relative difference (MARD) of 10.3%. Clarke error grid analysis showed 99.2% of points in the clinically acceptable range, and surveillance error grid analysis showed 89.1% of points in the lowest risk category. It was determined that for 25% of the rtCGM values, discordances in rtCGM and POC values would likely have resulted in different insulin doses. Insulin dose recommendations based on rtCGM values differed by 1 to 3 units from POC-based recommendations. CONCLUSION: rtCGM for inpatient diabetes monitoring is feasible. Evaluation of individual rtCGM-POC paired values suggested that using rtCGM data for management decisions poses minimal risks to patients. Further studies to establish the safety and cost implications of using rtCGM data for inpatient diabetes management decisions are warranted.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Adult , Blood Glucose/analysis , Blood Glucose Self-Monitoring/methods , COVID-19/drug therapy , Diabetes Mellitus, Type 1/drug therapy , Humans , Hypoglycemic Agents , Insulin/adverse effects , Retrospective Studies , SARS-CoV-2
2.
Br J Community Nurs ; 26(11): 544-552, 2021 Nov 02.
Article in English | MEDLINE | ID: covidwho-1506202

ABSTRACT

Type 1 diabetes is a lifelong condition which affects all age ranges, for reasons unknown, and the UK has one of the highest incidences of this complex condition in the world. Type 1 diabetes is caused by autoimmune damage to the insulin-producing ß-cells found in the pancreatic islet cells, leading to severe insulin deficiency. People with diabetes need to achieve a target glyosylated haemoglobin level to avoid macro- and microvascular complications, but there is the associated risk of hypoglycaemic events. These can vary in severity and consequences but will likely always cause worry for the person living with diabetes. There are many risk factors and reasons to be explored when looking at hypoglycaemia. This case study explores the nursing interventions that can be safely worked through and prioritised, within the community setting, to allow people with diabetes to be safe from severe hypoglycaemia, thus improving their quality of life and safety, as well as reducing costs for the NHS.


Subject(s)
Blood Glucose Self-Monitoring/methods , Diabetes Mellitus, Type 1/nursing , Glycated Hemoglobin A/analysis , Hypoglycemia/prevention & control , Hypoglycemic Agents/administration & dosage , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/drug therapy , Humans , Hypoglycemia/etiology , Hypoglycemia/nursing , Hypoglycemic Agents/therapeutic use , Quality of Life
3.
Diabetes Technol Ther ; 24(1): 67-74, 2022 01.
Article in English | MEDLINE | ID: covidwho-1411425

ABSTRACT

Background: Clinic-to-clinic telemedicine can increase visit frequency in pediatric patients with type 1 diabetes (T1D) living far from a diabetes specialty clinic, but the impact on adoption of diabetes technology is unclear. Materials and Methods: Pediatric patients with T1D in Colorado and surrounding states who received diabetes care using clinic-to-clinic telemedicine were enrolled. Medical records and surveys were reviewed to ascertain technology use, and data were compared to patients from the main clinic population. Results: Patients (N = 128, baseline mean age 12.4 ± 4.2 years, median T1D duration 3.3 years [IQR 1.4-7.7], mean A1c 8.9% ± 1.8%, 60% male, 75% non-Hispanic white, 77% private insurance) who utilized telemedicine were included. Technology use among telemedicine patients was not associated with gender, T1D duration, insurance, distance from the main clinic or rural designation but was associated with ethnicity and A1c. Compared to the main clinic cohort (N = 3636), continuous glucose monitor (CGM) use and pump/CGM combination use was lower among patients participating in clinic-to-clinic telemedicine (CGM: 29.7% vs. 56.0%, P < 0.001; CGM/pump combination: 27.3% vs. 40.3%, P = 0.004). Technology use was associated with lower A1c regardless of cohort. Conclusions: Compared to patients attending in-person clinic, pediatric T1D patients who use clinic-to-clinic telemedicine due to their distance from the main clinic, have lower CGM and combination CGM/pump use. For both telemedicine and main clinic patients, CGM and CGM/pump combination was associated with lower A1c. Additional research is needed to explore reasons for this discrepancy and find methods to improve CGM use in this population.


Subject(s)
Diabetes Mellitus, Type 1 , Telemedicine , Adolescent , Blood Glucose , Blood Glucose Self-Monitoring/methods , Child , Diabetes Mellitus, Type 1/therapy , Female , Glycated Hemoglobin A/analysis , Humans , Hypoglycemic Agents , Male , Technology
4.
Front Endocrinol (Lausanne) ; 12: 703905, 2021.
Article in English | MEDLINE | ID: covidwho-1376692

ABSTRACT

Importance: There is no consensus on the impact of the 2020 COVID-19 pandemic lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) in the US. Aim: To determine the impact of the pandemic lockdown of March 15th through July 6th, 2020 on glycemic control after controlling for confounders. Subjects and Methods: An observational study of 110 subjects of mean age 14.8 ± 4.9 years(y), [male 15.4 ± 4.0y, (n=57); female 14.1 ± 3.8y, (n=53), p=0.07] with T1D of 6.31 ± 4.3y (95% CI 1.0-19.7y). Data were collected at 1-4 months before the lockdown and 1-4 months following the lifting of the lockdown at their first post-lockdown clinic visit. Results: There was no significant change in A1c between the pre- and post-pandemic lockdown periods, 0.18 ± 1.2%, (95% CI -0.05 to 0.41), p=0.13. There were equally no significant differences in A1c between the male and female subjects, -0.16 ± 1.2 vs -0.19 ± 1.2%, p=0.8; insulin pump users and non-pump users, -0.25 ± 1.0 vs -0.12 ± 1.4%, p=0.5; and pubertal vs prepubertal subjects, 0.18 ± 1.3 vs -0.11 ± 0.3%, p=0.6. The significant predictors of decrease in A1c were pre-lockdown A1c (p<0.0001) and the use of CGM (p=0.019). The CGM users had significant reductions in point-of-care A1c (0.4 ± 0.6%, p=0.0012), the CGM-estimated A1c (p=0.0076), mean glucose concentration (p=0.022), a significant increase in sensor usage (p=0.012), with no change in total daily dose of insulin (TDDI). The non-CGM users had significantly increased TDDI (p<0.0001) but no change in HbA1c, 0.06 ± 1.8%, p=0.86. Conclusions: There was no change in glycemic control during the pandemic lockdown of 2020 in US children.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/blood , Glycemic Control , Quarantine , Adolescent , Age Factors , Blood Glucose/metabolism , Blood Glucose Self-Monitoring/instrumentation , Blood Glucose Self-Monitoring/methods , COVID-19/prevention & control , Child , Communicable Disease Control/organization & administration , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Female , Glycated Hemoglobin A/metabolism , Glycemic Control/instrumentation , Glycemic Control/methods , History, 21st Century , Humans , Insulin/administration & dosage , Insulin Infusion Systems , Male , Pandemics , Quarantine/organization & administration , Retrospective Studies , United States/epidemiology
5.
Endocrinol Metab (Seoul) ; 36(2): 240-255, 2021 04.
Article in English | MEDLINE | ID: covidwho-1359307

ABSTRACT

Continuous glucose monitors (CGMs) have suddenly become part of routine care in many hospitals. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. The use of CGMs to automatically and remotely supplement or replace assisted monitoring of blood glucose by bedside nurses can decrease: the amount of necessary nursing exposure to COVID-19 patients with diabetes; the amount of time required for obtaining blood glucose measurements, and the amount of personal protective equipment necessary for interacting with patients during the blood glucose testing. The United States Food and Drug Administration (FDA) is now exercising enforcement discretion and not objecting to certain factory-calibrated CGMs being used in a hospital setting, both to facilitate patient care and to obtain performance data that can be used for future regulatory submissions. CGMs can be used in the hospital to decrease the frequency of fingerstick point of care capillary blood glucose testing, decrease hyperglycemic episodes, and decrease hypoglycemic episodes. Most of the research on CGMs in the hospital has focused on their accuracy and only recently outcomes data has been reported. A hospital CGM program requires cooperation of physicians, bedside nurses, diabetes educators, and hospital administrators to appropriately select and manage patients. Processes for collecting, reviewing, storing, and responding to CGM data must be established for such a program to be successful. CGM technology is advancing and we expect that CGMs will be increasingly used in the hospital for patients with diabetes.


Subject(s)
Blood Glucose Self-Monitoring/trends , Blood Glucose/metabolism , COVID-19/epidemiology , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Hospitals/trends , Blood Glucose Self-Monitoring/methods , COVID-19/prevention & control , Humans , Hypoglycemia/blood , Hypoglycemia/epidemiology , Hypoglycemia/prevention & control , Monitoring, Ambulatory/methods , Monitoring, Ambulatory/trends
8.
Diabetes Metab Syndr ; 15(4): 102188, 2021.
Article in English | MEDLINE | ID: covidwho-1293736

ABSTRACT

AIM: The pandemic has generated the need for COVID-19 patients to be treated as best as possible; however, the effect of these treatments on glycemic control has not yet been taken into account. This article aims to determine whether the daily variation of glucose is influenced by the use of corticosteroids in COVID-19 patients treated in Lima-Peru. METHODOLOGY: A prospective cohort study was undertook, in which glucose was measured four times a day in 53 patients hospitalized due to COVID-19. These values were associated with the use of corticosteroids and adjusted for other socio-educational variables, all by means of PA-GEE models. RESULTS: Nested multivariate analysis of daily glucose variation found that those using corticosteroids increased the daily average glucose as well as the first and last glucose measurements, this is, at 6am and 10pm, respectively (all p-values <0.026). An increase in glucose levels was also observed in those with diabetes (all p-values <0.001). In contrast, we found that there was a decrease in the last glucose measurement of the day in obese patients (p-value = 0.044). CONCLUSIONS: The patients who used corticosteroids for the treatment of COVID-19 increased the average glucose per day, especially in the first and last measurement.


Subject(s)
Adrenal Cortex Hormones/adverse effects , Blood Glucose/analysis , COVID-19/drug therapy , Hyperglycemia/pathology , SARS-CoV-2/isolation & purification , Aged , Blood Glucose Self-Monitoring/methods , COVID-19/epidemiology , COVID-19/virology , Female , Humans , Hyperglycemia/chemically induced , Hyperglycemia/metabolism , Male , Middle Aged , Peru/epidemiology , Prospective Studies
9.
J Clin Endocrinol Metab ; 106(10): e4007-e4016, 2021 09 27.
Article in English | MEDLINE | ID: covidwho-1261287

ABSTRACT

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic has created a need for remote blood glucose (BG) monitoring in the intensive care unit (ICU). OBJECTIVE: To evaluate feasibility and patient safety of a hybrid monitoring strategy of point-of-care (POC) BG plus continuous glucose monitor (CGM) in the ICU. DESIGN: Retrospective analysis. SETTING: ICU of an academic medical center. PATIENTS: Patients with COVID-19 on IV insulin. INTERVENTION: After meeting initial validation criteria, CGM was used for IV insulin titration and POC BG was performed every 6 hours or as needed. MAIN OUTCOME MEASURES: Outcomes included frequency of POC BG, workflow, safety, and accuracy measures. RESULTS: The study included 19 patients, 18 with CGM data, mean age 58 years, 89% on mechanical ventilation, 37% on vasopressors, and 42% on dialysis. The median time to CGM validation was 137 minutes (interquartile range [IQR] 114-206). During IV insulin, the median number of POC values was 7 (IQR 6-16) on day 1, and declined slightly thereafter (71% reduction compared with standard of 24/day). The median number of CGM values used nonadjunctively to titrate IV insulin was 11.5 (IQR 0, 15) on day 1 and increased thereafter. Time in range 70 to 180 mg/dL was 64 ± 23% on day 1 and 72 ± 16% on days 2 through 7, whereas time <70 mg/dL was 1.5 ± 4.1% on day 1 and <1% on days 2 through 7. CONCLUSIONS: This study provides data to support that CGM using a hybrid protocol is feasible, accurate, safe, and has potential to reduce nursing and staff workload.


Subject(s)
Blood Glucose Self-Monitoring/methods , COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Insulin/administration & dosage , SARS-CoV-2 , Adult , Aged , Blood Glucose/analysis , COVID-19/therapy , Comorbidity , Critical Illness/therapy , Diabetes Complications/epidemiology , Diabetes Complications/therapy , Diabetes Complications/virology , Female , Glycemic Control/methods , Humans , Infusions, Intravenous , Intensive Care Units , Male , Middle Aged , Point-of-Care Systems , Retrospective Studies , Treatment Outcome
10.
Expert Rev Endocrinol Metab ; 16(4): 181-189, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1233816

ABSTRACT

Introduction: The COVID-19 pandemic has affected the entire population with the most deleterious effects in elders. Elders, especially those with diabetes, are at the highest risk of COVID-19 related adverse outcomes and mortality. This is usually linked to the comorbidities that accumulate with age, diabetes-related chronic inflammation, and the pandemic's psychosocial effects.Areas covered: We present some approaches to manage these complicated elderly patients with diabetes during the COVID-19 pandemic. In the inpatient setting, we suggest similar (pre-pandemic) glycemic targets and emphasize the importance of using IV insulin and possible use of continuous glucose monitoring to reduce exposure and PPE utilization. Outside the hospital, we recommend optimal glycemic control within the limits imposed by considerations of safety. We also describe the advantages and challenges of using various technological platforms in clinical care.Expert opinion: The COVID-19 pandemic has lifted the veil off serious deficiencies in the infrastructures for care at both the individual level and the population level and also highlighted some of the strengths, all of which affect individuals with diabetes and COVID-19. We anticipate that things will not return to 'normal' after the COVID-19 pandemic has run its course, but rather they will be superseded by 'New Normal.'


Subject(s)
COVID-19/psychology , Diabetes Mellitus/drug therapy , Inflammation/complications , Personal Protective Equipment/ethics , Administration, Intravenous , Aged , Aged, 80 and over , Blood Glucose/analysis , Blood Glucose Self-Monitoring/methods , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/mortality , Chronic Disease , Comorbidity , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Disease Management , Humans , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/therapeutic use , Insulin/administration & dosage , Insulin/therapeutic use , Patient Education as Topic/methods , Personal Protective Equipment/standards , Prevalence , Risk Assessment , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Telemedicine/methods
12.
Endocrinol Metab (Seoul) ; 36(2): 240-255, 2021 04.
Article in English | MEDLINE | ID: covidwho-1167796

ABSTRACT

Continuous glucose monitors (CGMs) have suddenly become part of routine care in many hospitals. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. The use of CGMs to automatically and remotely supplement or replace assisted monitoring of blood glucose by bedside nurses can decrease: the amount of necessary nursing exposure to COVID-19 patients with diabetes; the amount of time required for obtaining blood glucose measurements, and the amount of personal protective equipment necessary for interacting with patients during the blood glucose testing. The United States Food and Drug Administration (FDA) is now exercising enforcement discretion and not objecting to certain factory-calibrated CGMs being used in a hospital setting, both to facilitate patient care and to obtain performance data that can be used for future regulatory submissions. CGMs can be used in the hospital to decrease the frequency of fingerstick point of care capillary blood glucose testing, decrease hyperglycemic episodes, and decrease hypoglycemic episodes. Most of the research on CGMs in the hospital has focused on their accuracy and only recently outcomes data has been reported. A hospital CGM program requires cooperation of physicians, bedside nurses, diabetes educators, and hospital administrators to appropriately select and manage patients. Processes for collecting, reviewing, storing, and responding to CGM data must be established for such a program to be successful. CGM technology is advancing and we expect that CGMs will be increasingly used in the hospital for patients with diabetes.


Subject(s)
Blood Glucose Self-Monitoring/trends , Blood Glucose/metabolism , COVID-19/epidemiology , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Hospitals/trends , Blood Glucose Self-Monitoring/methods , COVID-19/prevention & control , Humans , Hypoglycemia/blood , Hypoglycemia/epidemiology , Hypoglycemia/prevention & control , Monitoring, Ambulatory/methods , Monitoring, Ambulatory/trends
13.
Clin Biochem ; 92: 71-76, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1141672

ABSTRACT

Owing to their ease of use, glucose meters are frequently used in research and medicine. However, little is known of whether other non-glucose molecules, besides vitamin C, interfere with glucometry. Therefore, we sought to determine whether other antioxidants might behave like vitamin C in causing falsely elevated blood glucose levels, potentially exposing patients to glycemic mismanagement by being administered harmful doses of glucose-lowering drugs. To determine whether various antioxidants can be detected by seven commercial glucose meters, human blood samples were spiked with various antioxidants ex vivo and their effect on the glucose results were assessed by Parkes error grid analysis. Several of the glucose meters demonstrated a positive bias in the glucose measurement of blood samples spiked with vitamin C, N-acetylcysteine, and glutathione. With the most interference-sensitive glucose meter, non-blood solutions of 1 mmol/L N-acetylcysteine, glutathione, cysteine, vitamin C, dihydrolipoate, and dithiothreitol mimicked the results seen on that glucose meter for 0.7, 1.0, 1.2, 2.6, 3.7 and 5.5 mmol/L glucose solutions, respectively. Glucose meter users should be alerted that some of these devices might produce spurious glucose results not only in patients on vitamin C therapy but also in those being administered other antioxidants. As discussed herein, the clinical relevance of the data is immediate in view of the current use of antioxidant therapies for disorders such as the metabolic syndrome, diabetes, cardiovascular diseases, and coronavirus disease 2019.


Subject(s)
Antioxidants/chemistry , Blood Glucose Self-Monitoring/instrumentation , Blood Glucose/analysis , Acetylcysteine/blood , Acetylcysteine/chemistry , Antioxidants/analysis , Antioxidants/metabolism , Ascorbic Acid/analysis , Ascorbic Acid/blood , Blood Glucose/chemistry , Blood Glucose Self-Monitoring/methods , Glutathione/blood , Glutathione/chemistry , Humans , Point-of-Care Systems
14.
Acta Diabetol ; 58(7): 919-927, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1141430

ABSTRACT

BACKGROUND: Since 2010, more than half of World population lives in Urban Environments. Urban Diabetes has arisen as a novel nosological entity in Medicine. Urbanization leads to the accrual of a number of factors increasing the vulnerability to diabetes mellitus and related diseases. Herein we report clinical-epidemiological data of the Milano Metropolitan Area in the contest of the Cities Changing Diabetes Program. Since the epidemiological picture was taken in January 2020, on the edge of COVID-19 outbreak in the Milano Metropolitan Area, a perspective addressing potential interactions between diabetes and obesity prevalence and COVID-19 outbreak, morbidity and mortality will be presented. To counteract lock-down isolation and, in general, social distancing a pilot study was conducted to assess the feasibility and efficacy of tele-monitoring via Flash Glucose control in a cohort of diabetic patients in ASST North Milano. METHODS: Data presented derive from 1. ISTAT (National Institute of Statistics of Italy), 2. Milano ATS web site (Health Agency of Metropolitan Milano Area), which entails five ASST (Health Agencies in the Territories). A pilot study was conducted in 65 screened diabetic patients (only 40 were enrolled in the study of those 36 were affected by type 2 diabetes and 4 were affected by type 1 diabetes) of ASST North Milano utilizing Flash Glucose Monitoring for 3 months (mean age 65 years, HbA1c 7,9%. Patients were subdivided in 3 groups using glycemic Variability Coefficient (VC): a. High risk, VC > 36, n. 8 patients; Intermediate risk 20 < VC < 36, n. 26 patients; Low risk VC < 20, n. 4 patients. The control group was constituted by 26 diabetic patients non utilizing Flash Glucose monitoring. RESULTS: In a total population of 3.227.264 (23% is over 65 y) there is an overall prevalence of 5.65% with a significant difference between Downtown ASST (5.31%) and peripheral ASST (ASST North Milano, 6.8%). Obesity and overweight account for a prevalence of 7.8% and 27.7%, respectively, in Milano Metropolitan Area. We found a linear relationship (R = 0.36) between prevalence of diabetes and aging index. Similarly, correlations between diabetes prevalence and both older people depending index and structural dependence index (R = 0.75 and R = 0.93, respectively), were found. A positive correlation (R = 0.46) with percent of unoccupied people and diabetes prevalence was also found. A reverse relationship between diabetes prevalence and University level instruction rate was finally identified (R = - 0.82). Our preliminary study demonstrated a reduction of Glycated Hemoglobin (p = 0.047) at 3 months follow-up during the lock-down period, indicating Flash Glucose Monitoring and remote control as a potential methodology for diabetes management during COVID-19 lock-down. HYPOTHESIS AND DISCUSSION: The increase in diabetes and obesity prevalence in Milano Metropolitan Area, which took place over 30 years, is related to several environmental factors. We hypothesize that some of those factors may have also determined the high incidence and virulence of COVID-19 in the Milano area. Health Agencies of Milano Metropolitan Area are presently taking care of diabetic patients facing the new challenge of maintaining sustainable diabetes care costs in light of an increase in urban population and of the new life-style. The COVID-19 pandemic will modify the management of diabetic and obese patients permanently, via the implementation of approaches that entail telemedicine technology. The pilot study conducted during the lock-down period indicates an improvement of glucose control utilizing a remote glucose control system in the Milano Metropolitan Area, suggesting a wider utilization of similar methodologies during the present "second wave" lock-down.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/therapy , Quarantine , Telemedicine , Adult , Aged , Aged, 80 and over , Blood Glucose Self-Monitoring/methods , Blood Glucose Self-Monitoring/standards , Blood Glucose Self-Monitoring/statistics & numerical data , Communicable Disease Control , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Female , Glycemic Control/methods , Glycemic Control/psychology , Glycemic Control/standards , Glycemic Control/statistics & numerical data , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Obesity/epidemiology , Obesity/therapy , Overweight/epidemiology , Overweight/therapy , Pandemics , Physical Distancing , Pilot Projects , Prevalence , Quarantine/psychology , Quarantine/statistics & numerical data , SARS-CoV-2/physiology , Socioeconomic Factors , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/standards , Telemedicine/statistics & numerical data , Urban Population
15.
Diabetes Res Clin Pract ; 174: 108750, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1135306

ABSTRACT

AIMS: to evaluate the effect of home confinement related to COVID-19 lockdown on metabolic control in subjects with T2DM in Italy. METHODS: we evaluated the metabolic profile of 304 individuals with T2DM (65% males; age 69 ± 9 years; diabetes duration 16 ± 10 years) attending our Diabetes Unit early at the end of lockdown period (June 8 to July 7, 2020) and compared it with the latest one recorded before lockdown. RESULTS: There was no significant difference in fasting plasma glucose (8.6 ± 2.1 vs 8.8 ± 2.5 mmol/L; P = 0.353) and HbA1c (7.1 ± 0.9 vs 7.1 ± 0.9%; P = 0.600) before and after lockdown. Worsening of glycaemic control (i.e., ΔHbA1c ≥ 0.5%) occurred more frequently in older patients (32.2% in > 80 years vs 21.3% in 61-80 years vs 9.3% in < 60 years; P = 0.05) and in insulin users (28.8 vs 16.5%; P = 0.012). On multivariable analysis, age > 80 years (OR 4.62; 95%CI: 1.22-16.07) and insulin therapy (OR 1.96; 95%CI: 1.10-3.50) remained independently associated to worsening in glycaemic control. CONCLUSIONS: Home confinement related to COVID-19 lockdown did not exert a negative effect on glycaemic control in patients with T2DM. However, age and insulin therapy can identify patients at greatest risk of deterioration of glycaemic control.


Subject(s)
Blood Glucose Self-Monitoring/methods , Blood Glucose/metabolism , COVID-19/epidemiology , Diabetes Mellitus, Type 2/blood , Aged , Female , Humans , Italy/epidemiology , Male , SARS-CoV-2/isolation & purification
16.
Diabetes Care ; 44(4): 1055-1058, 2021 04.
Article in English | MEDLINE | ID: covidwho-1076409

ABSTRACT

OBJECTIVE: The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment and reduce potential exposures during coronavirus disease 2019 (COVID-19). RESEARCH DESIGN AND METHODS: We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 intensive care unit. RESULTS: All nine patients required mechanical ventilation and corticosteroids. During the protocol, 75.7% of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients. CONCLUSIONS: A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion.


Subject(s)
Blood Glucose/analysis , COVID-19 , Critical Illness/therapy , Diabetes Complications , Insulin Infusion Systems , Insulin/administration & dosage , Remote Sensing Technology , Aged , Aged, 80 and over , Algorithms , Blood Glucose/metabolism , Blood Glucose Self-Monitoring/instrumentation , Blood Glucose Self-Monitoring/methods , COVID-19/blood , COVID-19/complications , COVID-19/drug therapy , Diabetes Complications/blood , Diabetes Complications/drug therapy , Equipment and Supplies , Female , Humans , Intensive Care Units , Male , Middle Aged , Point-of-Care Systems , Proof of Concept Study , Remote Sensing Technology/instrumentation , SARS-CoV-2
17.
Diabetes Res Clin Pract ; 170: 108502, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1074700

ABSTRACT

Monitoring of glucose levels is essential to effective diabetes management. Over the past 100 years, there have been numerous innovations in glucose monitoring methods. The most recent advances have centered on continuous glucose monitoring (CGM) technologies. Numerous studies have demonstrated that use of continuous glucose monitoring confers significant glycemic benefits on individuals with type 1 diabetes (T1DM) and type 2 diabetes (T2DM). Ongoing improvements in accuracy and convenience of CGM devices have prompted increasing adoption of this technology. The development of standardized metrics for assessing CGM data has greatly improved and streamlined analysis and interpretation, enabling clinicians and patients to make more informed therapy modifications. However, many clinicians many be unfamiliar with current CGM and how use of these devices may help individuals with T1DM and T2DM achieve their glycemic targets. The purpose of this review is to present an overview of current CGM systems and provide guidance to clinicians for initiating and utilizing CGM in their practice settings.


Subject(s)
Blood Glucose Self-Monitoring/methods , Blood Glucose/analysis , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 2/therapy , Technology/methods , Humans , Longitudinal Studies
18.
Diabetes Metab Syndr ; 15(1): 243-247, 2021.
Article in English | MEDLINE | ID: covidwho-1065022

ABSTRACT

BACKGROUND AND AIMS: In Colombia, the government established mandatory isolation after the first case of COVID-19 was reported. As a diabetes care center specialized in technology, we developed a virtual training program for patients with type 1 diabetes (T1D) who were upgrading to hybrid closed loop (HCL) system. The aim of this study is to describe the efficacy and safety outcomes of the virtual training program. METHOD: ology: A prospective observational cohort study was performed, including patients with diagnosis of T1D previously treated with multiple doses of insulin (MDI) or sensor augmented pump therapy (SAP) who were updating to HCL system, from March to July 2020. Virtual training and follow-up were done through the Zoom video conferencing application and Medtronic Carelink System version 3.1 software. CGM data were analyzed to compare the time in range (TIR), time below range (TBR) and glycemic variability, during the first two weeks corresponding to manual mode with the final two weeks of follow-up in automatic mode. RESULTS: 91 patients were included. Mean TIR achieved with manual mode was 77.3 ± 11.3, increasing to 81.6% ± 7.6 (p < 0.001) after two weeks of auto mode use. A significant reduction in TBR <70 mg/dL (2,7% ± 2,28 vs 1,83% ± 1,67, p < 0,001) and in glycemic variability (% coefficient of variation 32.4 vs 29.7, p < 0.001) was evident, independently of baseline therapy. CONCLUSION: HCL systems allows T1D patients to improve TIR, TBR and glycemic variability independently of previous treatment. Virtual training can be used during situations that limit the access of patients to follow-up centers.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Insulin Infusion Systems , Patient Education as Topic/methods , Telemedicine/methods , Adolescent , Adult , Aged , Blood Glucose Self-Monitoring/methods , COVID-19/prevention & control , Cohort Studies , Colombia/epidemiology , Female , Follow-Up Studies , Humans , Hypoglycemic Agents/administration & dosage , Male , Middle Aged , Prospective Studies , Young Adult
19.
Diabetes Res Clin Pract ; 173: 108682, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1062309

ABSTRACT

BACKGROUND: To minimize the spread of Coronavirus Disease-2019, Saudi Arabia imposed a nationwide lockdown for over 6 weeks. We examined the impact of lockdown on glycemic control in individuals with type 1 diabetes (T1D) using continuous glucose monitoring (CGM); and assessed whether changes in glycemic control differ between those who attended a telemedicine visit during lockdown versus those who did not. MATERIALS AND METHODS: Flash CGM data from 101 individuals with T1D were retrospectively evaluated. Participants were categorized into two groups: Attended a telemedicine visit during lockdown (n = 61) or did not attend (n = 40). Changes in CGM metrics from the last 2 weeks pre-lockdown period (Feb 25 - March 9, 2020) to the last 2 weeks of complete lockdown period (April 7-20, 2020) were examined in the two groups. RESULTS: Those who attended a telemedicine visit during the lockdown period had a significant improvement in the following CGM metrics by the end of lockdown: Average glucose (from 180 to 159 mg/dl, p < 0.01), glycemic management indicator (from 7.7 to 7.2%, p = 0.03), time in range (from 46 to 55%, p < 0.01), and time above range (from 48 to 35%, p < 0.01) without significant changes in time below range, number of daily scans or hypoglycemic events, and other indices. In contrast, there were no significant changes in any of the CGM metrics during lockdown in those who did not attend telemedicine. CONCLUSIONS: A six-week lockdown did not worsen, nor improve, glycemic control in individuals with T1D who did not attend a telemedicine visit. Whereas those who attended a telemedicine visit had a significant improvement in glycemic metrics; supporting the clinical effectiveness of telemedicine in diabetes care.


Subject(s)
Blood Glucose/metabolism , COVID-19/epidemiology , Communicable Disease Control , Diabetes Mellitus, Type 1/blood , Glycemic Control , Telemedicine , Adolescent , Adult , Blood Glucose Self-Monitoring/methods , Communicable Disease Control/methods , Communicable Disease Control/statistics & numerical data , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/epidemiology , Disease Outbreaks , Female , Glycemic Control/methods , Glycemic Control/standards , Humans , Hypoglycemic Agents/therapeutic use , Male , Program Evaluation , Quarantine/methods , Quarantine/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Saudi Arabia/epidemiology , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Young Adult
20.
Acta Diabetol ; 58(6): 697-705, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1052986

ABSTRACT

AIMS: Children with chronic diseases were unable to receive their usual care during COVID-19 lockdown. We assessed the feasibility and impact of telehealth visits on the time-in-range (TIR) of paediatric individuals with type 1 diabetes (T1D). METHODS: An observational multicentre real-life study. Patients scheduled for an in-clinic visit during the lockdown were offered to participate in a telehealth visit. Sociodemographic, clinical, continuous glucose monitor and pump data were recorded 2 weeks prior and 2 weeks after telehealth visit. The primary endpoint was change in relative-TIR, i.e. change in TIR divided by the percent of possible change (∆TIR/(100-TIRbefore)*100). RESULTS: The study group comprised 195 individuals with T1D (47.7% males), mean±SD age 14.6 ± 5.3 years, and diabetes duration 6.0 ± 4.6 years. Telehealth was accomplished with 121 patients and their parents (62.0%); 74 (38.0%) did not transfer complete data. Mean TIR was significantly higher for the two-week period after the telehealth visit than for the two-week period prior the visit (62.9 ± 16.0, p < 0.001 vs. 59.0 ± 17.2); the improvement in relative-TIR was 5.7±26.1%. Initial higher mean glucose level, lower TIR, less time spent at <54 mg/dl range, longer time spent at 180-250 mg/dl range, higher daily insulin dose, and single-parent household were associated with improved relative-TIR. Multiple regression logistic analysis demonstrated only initial lower TIR and single-parent household were significant, odds ratio: -0.506, (95%CI -0.99,-0.023), p=0.04 and 13.82, (95%CI 0.621, 27.016), p=0.04, respectively. CONCLUSIONS: Paediatric and young adult patients with T1D benefited from a telehealth visit during COVID-19. However, this modality is not yet suitable for a considerable proportion of patients.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/trends , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Glycemic Control/trends , Telemedicine/trends , Adolescent , Blood Glucose/metabolism , Blood Glucose Self-Monitoring/methods , Blood Glucose Self-Monitoring/trends , COVID-19/prevention & control , Child , Child, Preschool , Cohort Studies , Communicable Disease Control/methods , Diabetes Mellitus, Type 1/blood , Female , Glycemic Control/methods , Humans , Israel/epidemiology , Male , Telemedicine/methods , Young Adult
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