Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monitoring (CGM). However, successful utilization ...of CGM technology in routine clinical practice remains relatively low. This may be due in part to the lack of clear and agreed-upon glycemic targets that both diabetes teams and people with diabetes can work toward. Although unified recommendations for use of key CGM metrics have been established in three separate peer-reviewed articles, formal adoption by diabetes professional organizations and guidance in the practical application of these metrics in clinical practice have been lacking. In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address this issue. This article summarizes the ATTD consensus recommendations for relevant aspects of CGM data utilization and reporting among the various diabetes populations.
A 25-year-old man with cerebral palsy, scoliosis, and ventilator dependence since SARS-CoV-2 infection 11 months earlier presented with a 2-week history of chest redness and swelling. The area of ...erythema and edema was located on the left side of the anterior chest and had grown to approximately 9 cm in diameter over the 2 weeks. It was tender to palpation. There was no history of trauma, injury, or bug bites at that site. He had not had a rash or similar lesions elsewhere on his body and had not taken any new medications. He did have increased, thick, yellow secretions from his tracheostomy, but no fevers. He was born in the Dominican Republic and moved to the United States as a child. He had not traveled anywhere outside the United States in more than a decade.
Social support plays an important role in both mental and physical well-being. This study used patient-reported outcomes to better understand the effect of social support and diabetes communities on ...the behaviors and health outcomes of those living with diabetes. People with diabetes (n=4,717) from an opted-in U.S. research panel were surveyed about their level of social support using the Interpersonal Support Evaluation List-12 (ISEL-12). Physical activity level was determined using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and health and demographic information were collected. Findings show that higher levels of support are associated with better glycemic control, healthier lifestyle choices, and lower rates of diabetes complications and comorbidities.
Notably, when controlling for overall level of social support and evaluating participants within one SD of the ISEL-12 mean, diabetes community members are more likely than those not in a community to have high diet adherence (≥80%) and high levels of physical activity. These diabetes community members are also less likely to have A1c >7, heart/circulation problems, high blood pressure, and cholesterol/triglyceride problems. These findings emphasize the importance of social support on the overall health of those with diabetes and suggest that diabetes communities are an important tool for managing diabetes.
Disclosure
S. Suhl: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. J.B. Rost: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. K.C. Stoner: Other Relationship; Self; Various companies and organizations. R. Gowen: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. C. Florissi: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. R. Wood: Consultant; Self; Abbott, ADOCIA, American Diabetes Association, Ascensia Diabetes Care, Boehringer Ingelheim Pharmaceuticals, Inc., CeQur Corporation, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation. Employee; Self; dQ&A Market Research Inc.
SGLT2 inhibitors are not approved for people with type 1 diabetes in the U.S. due to elevated risk of diabetic ketoacidosis (DKA), prompting interest in ketone testing education. This study surveyed ...4,612 people with type 1 diabetes across the U.S., EU, and Canada regarding their preferred method and duration of ketone testing education if they were to start a new therapy that increased DKA risk. Overall, a phone app was the preferred method of education, with some country-level differences apparent. In the U.S., Germany, and the Netherlands, 15-30 minutes was the most selected training time duration, while the remaining countries most commonly selected 1-2 hours. When considering the safety of SGLT2 therapy for type 1 patients, this data lends important insights into the feasibility and optimal composition of ketone test training.
Disclosure
J.B. Rost: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. S. Suhl: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. K.C. Stoner: Other Relationship; Self; Various companies and organizations. C. Florissi: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. R. Gowen: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. R. Wood: Consultant; Self; Abbott, ADOCIA, American Diabetes Association, Ascensia Diabetes Care, Boehringer Ingelheim Pharmaceuticals, Inc., CeQur Corporation, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation. Employee; Self; dQ&A Market Research Inc.
Background: Understanding qualities that make up trust in AID systems is imperative for successful development of systems built for long-term use. Previous research has demonstrated that trust is ...associated with: (a) better glycemic outcomes, (b) decreased self-management burdens, and (c) continued use of therapy.
Method: In December 2018, 5,037 individuals with diabetes responded to an online survey administered by dQ&A. We analyzed a subgroup of 386 survey participants who reported on their use of an AID system (The t:slim X2™ insulin pump with Basal-IQ® technology from Tandem Diabetes Care® = 116 ; The MiniMed 670G insulin pump system from Medtronic = 270).
Results: Hierarchical multiple regression analysis was used to ascertain the significance of ease of use (device level) and psychosocial (individual level) predictors of trust in AID systems. There were no issues with multicollinearity (all VIFs < 3). In Model 1, ease of use accounted for 45% of variance in trust, F (3,382) = 106.74, p < .001. After psychosocial predictors were added in Model 2, variance accounted for was 64%, explaining an additional 19% of unique variance in trust, F (3,379) = 65.46, p < .001.
Conclusion: These findings suggest that both ease of use and psychosocial outcomes are distinctly informative and instrumental in the development of trust in AID systems.
Disclosure
M.L. Manning: Employee; Self; Tandem Diabetes Care. M. McElwee-Malloy: Employee; Self; Tandem Diabetes Care. K.C. Stoner: Other Relationship; Self; Multiple companies and organizations in the diabetes field (greater than 10). S. Habif: Employee; Self; Tandem Diabetes Care.
Objective: This study aimed to evaluate primary care physicians’ (PCPs) perceptions of and desired improvements to diabetes continuing medical education (CME).
Methods: In March-April 2019, 306 ...U.S.-based PCPs who treat people with diabetes and earn diabetes CME credits completed an online survey.
Results: On average, respondents regularly see 391 people with diabetes (38% on insulin) for checkups and allot 16% of annual CME credit hours to diabetes. More than 75% of PCPs believe that improved PCP education could enhance care for people with diabetes and 82% believe that new diabetes technologies and therapies will change their practice significantly over the next five years. Respondents commonly reported that CME does not adequately cover diabetes drugs/devices, cost/insurance, or behavioral health. More than 80% of surveyed PCPs currently initiate and manage diabetes medications, though >55% would prefer to outsource to a diabetes specialist. The trend is reversed for diabetes devices: 34% of PCPs in this study currently initiate and manage CGM, whereas 54% would like to, and 24% currently initiate and manage insulin pumps, whereas 53% would like to. Respondents most commonly used journal articles and online courses—used by 79% and 65%, respectively—to obtain diabetes CME credits, though academic/medical conferences were regarded as the most useful. Nearly all PCPs also believe improved patient education would improve diabetes care.
Discussion: PCPs in this study believe both online and live CME, alongside improved patient education, can help them adapt to the rapidly evolving diabetes management landscape. More PCPs would prefer to outsource diabetes medication management than do currently, suggesting discomfort with managing these medications. Conversely, PCPs would like to take a more active role in diabetes device management. CME could help close both gaps in order to enhance PCPs’ comfort and efficacy in managing diabetes. CGM should be emphasized given its dual applications in diagnostics and therapy.
Disclosure
B.J. Levine: Employee; Self; Onduo. J.M. McDermott: Other Relationship; Self; Various. J.B. Lackner: None. E. Shoger: None. K.C. Stoner: Other Relationship; Self; Various companies and organizations. R.S. Beaser: None. K.L. Close: Other Relationship; Self; Abbott, Air Liquide, American Diabetes Association, AstraZeneca, Dexcom, Inc., Janssen Pharmaceuticals, Inc., JDRF, Leona M. and Harry B. Helmsley Charitable Trust, Lilly Diabetes, Merck & Co., Inc.
Funding
The Leona M. and Harry B. Helmsley Charitable Trust
Cardiovascular disease (CVD) is a leading cause of death in people with type 2 diabetes (T2D). Recent cardiovascular (CV) outcomes trials have shown CV benefits for several GLP-1 receptor agonists ...and SGLT2 inhibitors. We aimed to evaluate T2D patients’ awareness, perceptions, and behaviors regarding CVD and cardioprotective T2D drugs.
An online survey was completed by 927 T2D patients of diverse socioeconomic backgrounds from an opted-in patient research panel in the U.S. Median respondent age was 64 and median duration of diabetes was 15 years. Half were taking a GLP-1 or SGLT2, a statistically robust sample of patients on these therapies. Questions covered perceptions of CVD disease; awareness of and interest in diabetes drugs that reduce CVD risk; knowledge of their own health metrics; physicians seen and frequency of discussions about CVD; self-assigned ‘grades’ on lifestyle behaviors known to reduce CVD risk.
Most patients recognized the link between T2D and CVD: 61% strongly agreed that T2D increases CVD risk. Yet, only 29% think often about their risk of CVD. Awareness of CV benefits from some T2D therapies was also low (34% overall; 42% for those on SGLT2 or GLP-1). Interest in taking an additional cardioprotective diabetes agent aligned with awareness (37% overall; 42% for those on SGLT2 or GLP-1). While almost all knew their HbA1c and blood pressure, over 25% did not know their LDL cholesterol or other lipid levels. In the prior year, 31% of patients had seen a cardiologist and 17% had discussed CVD risk with an endocrinologist. Respondents generally ranked themselves ‘average’ to ‘below average’ on heart-healthy behaviors like exercise, weight, sleep, diet, and stress management.
Although a majority of T2D patients are aware of the link between T2D and CVD, most are not actively managing their CV health, and few know that some T2D therapies are cardioprotective. These data suggest a need to better inform T2D patients about their risk for CVD, and steps they can take to reduce that risk.
Disclosure
K.C. Stoner: Other Relationship; Self; Multiple companies and organizations in the diabetes field (greater than 10). E.N. Fitts: Other Relationship; Self; Various diabetes companies. D. Gopisetty: Other Relationship; Self; Various diabetes companies. A. Carracher: Other Relationship; Self; Other. C.S. Florissi: Other Relationship; Self; dQ&A has several clients (>10) in the diabetes field. M.J. Kurian: Other Relationship; Self; Other Company. J. Kwon: Other Relationship; Self; Various diabetes companies. P. Marathe: Consultant; Self; Close Concerns. P. Rentzepis: Other Relationship; Self; Various Diabetes Companies. J.B. Rost: Other Relationship; Self; dQ&A has several clients (>10) in the diabetes field. K.L. Close: Other Relationship; Self; Various diabetes companies. I.B. Hirsch: Consultant; Self; Abbott, Becton, Dickinson and Company, Big Foot, Roche Diabetes Care. Research Support; Self; Medtronic. M.N. Kosiborod: Consultant; Self; Amgen Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eisai Co., Ltd., GlaxoSmithKline plc., Glytec, LLC, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novartis AG, Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. R. Wood: Other Relationship; Self; Multiple companies in the diabetes field (>10 companies).
Funding
AstraZeneca
Background
Red blood cell (RBC) units accumulate morphologic and metabolic lesions during storage before transfusion. Pyruvate–inosine–phosphate–adenine (PIPA) solutions (Rejuvesol, Biomet, Warsaw, ...IN) can be incubated with RBC units to mitigate storage lesions. This study proposes a PIPA treatment process, termed cold ‘rejuvenation’, using Rejuvesol as an adjunct additive solution, to prevent biomechanical storage lesions while avoiding the 1 h PIPA incubation required with standard PIPA treatment. We compared the efficacy of cold to standard ‘rejuvenation’ in improving metabolic lesions that occur during cold storage of RBCs, without altering function.
Methods
Twelve leucoreduced, A‐positive RBC units were obtained. Each unit was aliquoted into either control (standard storage), washed (W), standard rejuvenation (SR) or cold rejuvenation (CR) groups, the latter two requiring washing. A volume‐adjusted dose of Rejuvesol was instilled into the CR group upon receipt (Day 3). After 15 days of storage, p50, RBC deformability, in‐bag haemolysis and mechanical fragility were analysed. ‘Any treatment’ is defined as W, SR and CR, with comparisons in reference to control.
Results
Higher p50s were seen in rejuvenated groups (>30 mmHg vs. <19 mmHg; P < 0·0001). Any treatment significantly increased elongation index (P = 0·034) but did not significantly increase in‐bag haemolysis (P = 0·062). Mechanical fragility was not significantly different between groups (P = 0·055) at baseline, but the control (CTL) group was more fragile after 2 h in a cardiac bypass simulation than any treatment (P < 0·0001).
Conclusions
This study demonstrates that rejuvenation (standard or cold) prevents the leftward p50 shift of storage lesions without detrimental effect on RBC deformity, in‐bag haemolysis or mechanical fragility.
Background: Blood glucose (BG) meter apps facilitate the recording and review of BG data with the goal of improving diabetes self-management. Yet, while these apps require user engagement to be ...effective, there have been few studies exploring how people with diabetes use their apps over time. In the REALL study, we followed a group of new BG meter app users to determine how long they used their app, and how frequently they used their app to record a BG reading.
Methods: From March-July 2020, adults with diabetes who had recently paired their CONTOUR®NEXT ONE (CNO) meter with the CONTOUR®DIABETES app were enrolled in the study. All participants completed 2-3 online surveys, recorded ≥1 BG reading in their app, and shared their app data for ≥16 weeks. For each participant, ‘period of app use’ was defined as the time between one’s pair date and the date of their final recorded BG reading. Within one’s period of use, ‘frequency of BG recordings’ was defined as the percent of days with ≥1 BG reading.
Results: Participants (n=488) were 51.4 ± 11.9 years old, 52% were male, and 95% had type 2 diabetes. Based on their period of use, 78% of participants were classified as long-term app users (>4 weeks), 11% as medium-term users (>1 week, ≤4 weeks), and 11% as short-term users (≤1 week). Long-term app users were further characterized by their frequency of BG recordings, with 57% classified as high frequency users (BG on ≥70% of days), 23% as medium frequency users (BG on 40-69.9% of days), and 21% as low frequency users (BG on <40% of days). Most participants expressed high satisfaction (9 or 10 rating on 10-point scale) with the CNO meter (83%) and app (68%).
Conclusions: Over the course of four months, participants demonstrated sustained and consistent use of the CONTOUR®DIABETES app to record BG readings. These findings provide evidence of high levels of app engagement in a real-world setting, and further testify to the potential for BG meter apps to support diabetes self-management.
Disclosure
R. Wood: Research Support; Self; Abbott Diabetes, American Diabetes Association, Ascensia Diabetes Care, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk Inc., Sanofi. C. Florissi: Other Relationship; Self; Abbott Diabetes, Ascensia Diabetes Care, Dexcom, Inc., Insulet Corporation, LifeScan, Lilly Diabetes, Medtronic, Roche Diabetes Care, Senseonics, Tandem Diabetes Care. M. Younge: None. K. C. Stoner: Other Relationship; Self; Several companies in the diabetes field. L. Fisher: Consultant; Self; Ascensia Diabetes Care, Lilly Diabetes, Speaker’s Bureau; Self; Dexcom, Inc. J. Knaebel: Employee; Self; Ascensia Diabetes Care. C. T. Lu: Employee; Self; Ascensia Diabetes Care, Employee; Spouse/Partner; Engineering Resource Group. A. Stuhr: Employee; Self; Ascensia Diabetes Care.
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