ABSTRACT
Type 2 diabetes mellitus represents a multi-dimensional challenge for European and global societies alike. Building on an iterative six-step disease management process that leverages feedback loops and utilizes commodity digital tools, the PDM-ProValue study program demonstrated that integrated personalized diabetes management, or iPDM, can improve the standard of care for persons living with diabetes in a sustainable way. The novel "iPDM Goes Europe" consortium strives to advance iPDM adoption by (1) implementing the concept in a value-based healthcare setting for the treatment of persons living with type 2 diabetes, (2) providing tools to assess the patient's physical and mental health status, and (3) exploring new avenues to take advantage of emerging big data resources.
Subject(s)
Diabetes Mellitus, Type 2 , Blood Glucose Self-Monitoring , Delivery of Health Care , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/therapy , Disease Management , Europe , HumansABSTRACT
BACKGROUND: The ongoing improvement of continuous glucose monitoring (CGM) sensors and of insulin pumps are paving the way for a fast implementation of artificial pancreas (AP) for type 1 diabetes (T1D) patients. The case for type 2 diabetes (T2D) patients is less obvious since usually some residual beta cell function allows for simpler therapy approaches, and even multiple daily injections (MDI) therapy is not very widespread. However, the number of insulin dependent T2D patients is vastly increasing and therefore a need for understanding chances and challenges of an automated insulin therapy arises. Based on this background, this article analyzes conditions under which the use of more advanced therapeutic approaches, particularly AP, could bring a substantial improvement and should be considered as a viable therapy option. METHOD: Data of 14 insulin-treated T2D patients on MDI wearing a CGM device and deviation analysis methods were used to estimate the expected improvements in the clinical outcome by using self-monitoring of blood glucose (SMBG) with advanced carbohydrate counting, a full AP or intermediate approaches, either CGM measurements with MDI therapy or SMBG with insulin pump. HbA1C and time in range (70-140 mg/dl, 70-180 mg/dl, respectively) were used as a performance measure. Outcome measures beyond glycemic control (eg, compliance, patient acceptance) have not been analyzed in this study. RESULTS: AP has the potential to improve the condition of many poorly controlled insulin-treated T2D patients. However, as the interpatient variability is much higher than in T1D, a prescreening is recommended to select suitable patients. CONCLUSIONS: Clinical criteria need to be developed for inclusion/exclusion of T2D patients for AP related therapies.
