Clinical Practice Experiences Using a Professional Diabetes Management Ecosystem During COVID.

BACKGROUND: Challenges of patient care in diabetes were exacerbated by COVID, undermining the ability of patients to engage in-person with health care professionals (HCPs). To combat this, there has been accelerated adoption of telemedicine to support patient and provider connectivity. METHODS: We collated survey information regarding telemedicine from 21 European clinical institutions. Health care professionals joined virtual meetings focusing on the OneTouch Reveal (OTR) ecosystem and its utility for conducting telemedicine. Selected HCPs provided clinical case studies to explain how the OTR ecosystem supported patient care. RESULTS: Remote consultations increased by nearly 50% in 21 European clinics during the pandemic (Belgium [24%], Iberia [65%], Germany [34%], Italy [54%]). In all, 52% of people with diabetes using OTR app to connect remotely with HCPs had type 1 diabetes and 48% had type 2 diabetes. Remote connection methods included telephone (60%), email (19%), video chat (10%), text only (3%), or a mix of these methods (8%). Health care professionals usually reviewed patient data during consultations (45%) rather than before consultations (25%). Fifty-five percent of HCPs indicated digital ecosystems like OTR ecosystem would become their standard of care for diabetes management. In-depth conversations with HCPs provided a deeper understanding of how a digital ecosystem integrated into clinical practice and population management. In addition, five patient case studies using OTR ecosystem were provided by a selection of our HCPs. CONCLUSION: Diabetes management solutions, such as OTR ecosystem, supported telemedicine during the pandemic and will continue to play a valuable role in patient care beyond the pandemic.

[Glycemic changes during menstrual cycles in women with type 1 diabetes]. / Cambios glucémicos durante el ciclo menstrual en mujeres con diabetes mellitus tipo 1.

BACKGROUND AND OBJECTIVE: To determine frequency of women with type 1 diabetes showing menstrual cyclic changes in glycemia, analyze their clinical characteristics, and assess the pattern of glycemic changes. PATIENTS AND METHODS: We analyzed glucose meter readings along 168 menstrual cycles of 26 women with type 1 diabetes. We evaluated mean glucose, mean glucose standard deviation, mean fasting glucose, percentage of glucose readings>7.8 mmol/L and<3.1 mmol/L, and mean insulin dose in 4 periods for each cycle. A woman was identified as having cyclic changes when mean glucose rose from early follicular to late luteal in two-thirds of her menstrual cycles. RESULTS: A percentage of 65.4 of the women had cyclic changes. Characteristics of women with and without cyclic changes, including self-perception of glycemic changes, were similar with exception of age at diabetes diagnosis (22.5 [7.5] vs. 14.4 [9.5] years; P=.039). In women with cyclic changes mean percentage of glucose readings>7.8 mmol/L rose from early follicular (52.2 [16.3] %) to early and late luteal (58.4 [16.0] %, P=.0269; 61.0 [16.9] %, P=.000). CONCLUSION: Almost two-thirds of women with type 1 diabetes experience a menstrual cycle phenomenon, attributable to an increase in hyperglycemic excursions during the luteal phase. Enabling women to evaluate their weekly mean glucose from their meter and exploring the causes of hyperglycemic excursions during luteal phase should ensure more accuracy when giving instructions for diabetes management in women with premenstrual hyperglycemia.

Results and analysis of the 2008-2009 Insulin Injection Technique Questionnaire survey.

BACKGROUND: The efficacy of injection therapy in diabetes depends on correct injection technique and, to provide patients with guidance in this area, we must understand how they currently inject. METHODS: From September 2008 to June 2009, 4352 insulin-injecting Type 1 and Type 2 diabetic patients from 171 centers in 16 countries were surveyed regarding their injection practices. RESULTS: Overall, 3.6% of patients use the 12.7-mm needle, 1.8% use the 12-mm needle, 1.6% use the 10-mm needle, 48.6% use the 8-mm needle, 15.8% use the 6-mm needle, and 21.6% use the 5-mm needle; 7% of patients do not know what length of needle they use. Twenty-one percent of patients admitted injecting into the same site for an entire day, or even a few days, a practice associated with lipohypertrophy. Approximately 50% of patients have or have had symptoms suggestive of lipohypertrophy. Abdominal lipohypertrophy seems to be more frequent in those using the two smaller injection size areas, and less frequent in those using larger areas. Nearly 3% of patients reported always injecting into lipohypertrophic lesions and 26% inject into them sometimes. Of the 65% of patients using cloudy insulins (e.g. NPH), 35% do not remix it before use. CONCLUSIONS: It is clear from the latest survey that we have improved in certain areas, but that, in others, we have either not moved at all or our efforts have not yielded the results we expected. The results of the present survey are available online on a country-by-country and question-by-question basis at http://www.titan-workshop.org.

Cambios glucémicos durante el ciclo menstrual en mujeres con diabetes mellitus tipo 1 / Glycemic changes during menstrual cycles in women with type 1 diabetes

Fundamento y objetivo: Determinar la frecuencia de mujeres con diabetes tipo 1 que experimentan cambios glucémicos durante el ciclo menstrual, analizar sus características clínicas, y evaluar el patrón de los cambios glucémicos. Pacientes y métodos: Analizamos las lecturas de los glucómetros a lo largo de 168 ciclos menstruales en 26 mujeres con diabetes tipo 1. Evaluamos la glucemia media, la desviación estándar media, la glucemia media basal, el porcentaje de lecturas > 7,8 mmol/l y < 3,1 mmol/l, y la dosis de insulina media en 4 períodos de cada ciclo. Se consideró que una mujer tenía cambios cíclicos cuando la glucemia media se elevó entre la fase folicular temprana y la fase lútea tardía en dos tercios de sus ciclos menstruales. Resultados: El 65,4% de las mujeres experimentaron cambios cíclicos. Las características de las mujeres con y sin cambios cíclicos, incluyendo la autopercepción de cambios glucémicos, fueron similares, exceptuando la edad de diagnóstico de la diabetes (22,5 [7,5] frente a 14,4 [9,5] años; p = 0,039). En mujeres con cambios cíclicos el porcentaje medio de los valores de glucosa > 7,8 mmol/l se elevó entre la fase folicular temprana (52,2 [16,3] %) y la fase lútea temprana y tardía (58,4 [16,0] %, p = 0,0269; 61,0 [16,9] %, p = 0,000). Conclusión: Casi dos tercios de las mujeres con diabetes tipo 1 experimentan fenómenos del ciclo menstrual atribuibles a un incremento de las excursiones hiperglucémicas durante la fase lútea. Posibilitar que las mujeres evalúen su glucemia media semanal a partir de las lecturas de los glucómetros, y explorar las causas de las excursiones hiperglucémicas durante la fase lútea podría garantizar una mayor precisión al impartir instrucciones para la gestión de la diabetes en mujeres con hiperglucemia premenstrual (AU)

Background and objective: To determine frequency of women with type 1 diabetes showing menstrual cyclic changes in glycemia, analyze their clinical characteristics, and assess the pattern of glycemic changes. Patients and methods: We analyzed glucose meter readings along 168 menstrual cycles of 26 women with type 1 diabetes. We evaluated mean glucose, mean glucose standard deviation, mean fasting glucose, percentage of glucose readings > 7.8 mmol/L and < 3.1 mmol/L, and mean insulin dose in 4 periods for each cycle. A woman was identified as having cyclic changes when mean glucose rose from early follicular to late luteal in two-thirds of her menstrual cycles. Results: A percentage of 65.4 of the women had cyclic changes. Characteristics of women with and without cyclic changes, including self-perception of glycemic changes, were similar with exception of age at diabetes diagnosis (22.5 [7.5] vs. 14.4 [9.5] years; P = .039). In women with cyclic changes mean percentage of glucose readings > 7.8 mmol/L rose from early follicular (52.2 [16.3] %) to early and late luteal (58.4 [16.0] %, P = .0269; 61.0 [16.9] %, P = .000). Conclusion: Almost two-thirds of women with type 1 diabetes experience a menstrual cycle phenomenon, attributable to an increase in hyperglycemic excursions during the luteal phase. Enabling women to evaluate their weekly mean glucose from their meter and exploring the causes of hyperglycemic excursions during luteal phase should ensure more accuracy when giving instructions for diabetes management in women with premenstrual hyperglycemia (AU)