In Chile, 1 in 8 pregnant women of middle socioeconomic level has gestational diabetes mellitus (GDM), and in general, 5-10% of women with GDM develop type 2 diabetes after giving birth. Recently, ...various technological tools have emerged to assist patients with GDM to meet glycemic goals and facilitate constant glucose monitoring, making these tasks more straightforward and comfortable.
To evaluate the impact of remote monitoring technologies in assisting patients with GDM to achieve glycemic goals, and know the respective advantages and disadvantages when it comes to reducing risk during pregnancy, both for the mother and her child.
A total of 188 articles were obtained with the keywords "gestational diabetes mellitus," "GDM," "gestational diabetes," added to the evaluation levels associated with "glucose level," "glycemia," "glycemic index," "blood sugar," and the technological proposal to evaluate with "glucometerm" "mobile application," "mobile applications," "technological tools," "telemedicine," "technovigilance," "wearable" published during the period 2016-2021, excluding postpartum studies, from three scientific databases: PUBMED, Scopus and Web of Science. These were managed in the Mendeley platform and classified using the PRISMA method.
A total of 28 articles were selected after elimination according to inclusion and exclusion criteria. The main measurement was glycemia and 4 medical devices were found (glucometer: conventional, with an infrared port, with Bluetooth, Smart type and continuous glucose monitor), which together with digital technology allow specific functions through 2 identified digital platforms (mobile applications and online systems). In four articles, the postprandial glucose was lower in the Tele-GDM groups than in the control group. Benefits such as improved glycemic control, increased satisfaction and acceptability, maternal confidence, decreased gestational weight gain, knowledge of GDM, and other relevant aspects were observed. There were also positive comments regarding the optimization of the medical team's time.
The present review offers the opportunity to know about the respective advantages and disadvantages of remote monitoring technologies when it comes to reducing risk during pregnancy. GDM centered technology may help to evaluate outcomes and tailor personalized solutions to contribute to women's health. More studies are needed to know the impact on a healthcare system.
To evaluate access to screening tools for monogenic diabetes in paediatric diabetes centres across the world and its impact on diagnosis and clinical outcomes of children and youth with genetic forms ...of diabetes.
79 centres from the SWEET diabetes registry including 53,207 children with diabetes participated in a survey on accessibility and use of diabetes related antibodies, c-peptide and genetic testing.
73, 63 and 62 participating centres had access to c-peptide, antibody and genetic testing, respectively. Access to antibody testing was associated with higher proportion of patients with rare forms of diabetes identified with monogenic diabetes (54 % versus 17 %, p = 0.01), lower average whole clinic HbA1c (7.7Q1,Q2: 7.3–8.0%/6156–64mmol/mol versus 9.28.6–10.0%/7770–86mmol/mol, p < 0.001) and younger age at onset (8.3 7.3–8.8 versus 9.7 8.6–12.7 years p < 0.001). Additional access to c-peptide or genetic testing was not related to differences in age at onset or HbA1c outcome.
Clinical suspicion and antibody testing are related to identification of different types of diabetes. Implementing access to comprehensive antibody screening may provide important information for selecting individuals for further genetic evaluation. In addition, worse overall clinical outcomes in centers with limited diagnostic capabilities indicate they may also need support for individualized diabetes management.
Trial Registration: NCT04427189.
Objective: To compare the number of medical visits during the 2020 lockdown with the previous two years (2018, 2019) and with post-lockdown (2021) in Latin American children with type 1 diabetes ...(T1DM) with and without telemedicine access.
Methods: Children with T1DM in 2018 from three Latin American countries and at least one consultation in 2018 were consecutively recruited between February and November 2021. The number of medical visits and telemedicine access were extracted from their medical records.
Results: 217 children (60.4% females) aged 13.1± 3.2 years with a duration of 6.1 ± 2.7 years of T1DM were evaluated. There was a higher prevalence of children with telemedicine access than those without (139 (64.1%) vs. 78 (35.9%) ; p<0.01) . The number of medical visits was significantly higher in children with than without telemedicine access in lockdown 2020 (7.02 vs. 2.61, respectively) and post-lockdown 2021 (5.36 vs. 1.91) . The number of medical visits during post-lockdown 2021 (5.33) was not significantly different than in 2018 (5.13) in those with telemedicine access. However, the number was significantly lower in those without access (1.91 in 2021 vs. 5.99 in 2018) .
Conclusion: the number of medical visits of Latin American children during post-lockdown returned to a similar number to pre-lockdown 2018 in children with telemedicine access, but not in those without access.
Disclosure
A.M. Figueroa Sobrero: None. D.S. Gonzalez: None. E.R. Scaiola: None. P. Bocco: None. P.M. Pinto Ibarcena: None. C.M. Del Aguila: None. A.I. Mac: None. S. Lapertosa: None.
Continuous glucose monitoring (CGM) devices have demonstrated efficacy in adults and more recently in youths and older adults with type 1 diabetes. In adults with type 1 diabetes, the use of ...real-time CGM compared with intermittently scanned CGM was associated with improved glycemic control, but there are limited data available for youths.
To assess real-world data on achievement of time in range clinical targets associated with different treatment modalities in youths with type 1 diabetes.
This multinational cohort study included children, adolescents, and young adults younger than 21 years (hereinafter referred to collectively as youths) with type 1 diabetes for a duration of at least 6 months who provided CGM data between January 1, 2016, and December 31, 2021. Participants were enrolled from the international Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. Data from 21 countries were included. Participants were divided into 4 treatment modalities: intermittently scanned CGM with or without insulin pump use and real-time CGM with or without insulin pump use.
Type 1 diabetes and the use of CGM with or without an insulin pump.
Proportion of individuals in each treatment modality group achieving recommended CGM clinical targets.
Among the 5219 participants (2714 52.0% male; median age, 14.4 IQR, 11.2-17.1 years), median duration of diabetes was 5.2 (IQR, 2.7-8.7) years and median hemoglobin A1c level was 7.4% (IQR, 6.8%-8.0%). Treatment modality was associated with the proportion of individuals achieving recommended clinical targets. Adjusted for sex, age, diabetes duration, and body mass index standard deviation score, the proportion achieving the recommended greater than 70% time in range target was highest with real-time CGM plus insulin pump use (36.2% 95% CI, 33.9%-38.4%), followed by real-time CGM plus injection use (20.9% 95% CI, 18.0%-24.1%), intermittently scanned CGM plus injection use (12.5% 95% CI, 10.7%-14.4%), and intermittently scanned CGM plus insulin pump use (11.3% 95% CI, 9.2%-13.8%) (P < .001). Similar trends were observed for less than 25% time above (real-time CGM plus insulin pump, 32.5% 95% CI, 30.4%-34.7%; intermittently scanned CGM plus insulin pump, 12.8% 95% CI, 10.6%-15.4%; P < .001) and less than 4% time below range target (real-time CGM plus insulin pump, 73.1% 95% CI, 71.1%-75.0%; intermittently scanned CGM plus insulin pump, 47.6% 95% CI, 44.1%-51.1%; P < .001). Adjusted time in range was highest among real-time CGM plus insulin pump users (64.7% 95% CI, 62.6%-66.7%). Treatment modality was associated with the proportion of participants experiencing severe hypoglycemia and diabetic ketoacidosis events.
In this multinational cohort study of youths with type 1 diabetes, concurrent use of real-time CGM and an insulin pump was associated with increased probability of achieving recommended clinical targets and time in range target as well as lower probability of severe adverse events compared with other treatment modalities.
To measure the changes in the number of medical visits and the number of hemoglobin A1c (HbA1c) determinations according to telemedicine access in children with type 1 diabetes (T1DM) during the ...pandemic 2020 compared with 2019 and 2018.
This is a multinational study of children with T1DM from four Latin American countries. The number of medical visits, the number of HbA1c determinations, and access to telemedicine during 2020 were extracted from their records.
Two hundred twenty-seven children (59% females) aged 12.7 ± 3.2 years with a duration of 5.4 ± 2.7 years of T1DM in 2018 were evaluated. There was a higher prevalence of children with telemedicine access in the pandemic 2020 versus those without 145 (63.9%) vs. 82 (36.1%);
< 0.01. There was a higher number of medical visits during 2020 in children with telemedicine access versus those without (6.9 vs. 2.6;
< 0.01). Children with telemedicine access had a higher number of visits in 2020 versus 2018 (6.87 vs. 5.04,
< 0.01), but similar to 2019. Children without access had a lower number of visits in 2020 versus 2019 (2.6 vs. 5.5;
< 0.01) and versus 2018 (2.6 vs. 5.1;
< 0.01). In 2020, the number of HbA1c determinations in children with telemedicine access was higher versus those without (1.8 vs. 0.9;
< 0.01). Children with telemedicine access had a lower number of HbA1c determinations in 2020 versus 2019 (1.8 vs. 2.4;
< 0.01), but similar to 2018. Furthermore, children without access had a lower number of HbA1c determinations in 2020 versus 2019 (0.9 vs. 1.9;
< 0.01) and versus 2018 (0.9 vs. 2.0;
< 0.01).
We found that children with T1DM with telemedicine access had a significantly higher number of medical visits and HbA1c determinations during lockdown than those without access in different Latin American centers.
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