Long-Term Glucose-Lowering Effect of Intermittently Scanned Continuous Glucose Monitoring for Type 1 Diabetes Patients in Poor Glycaemic Control from Region North Denmark:An Observational Real-World Cohort Study

BACKGROUND: Lowering glucose levels is a complex task for patients with type 1 diabetes, and they often lack contact with health care professionals. Intermittently scanned continuous glucose monitoring (isCGM) has the potential to aid them with blood glucose management at home. The aim of this study was to investigate the long-term effect of isCGM on HbA(1c) in type 1 diabetes patients with poor glycaemic control in a region-wide real-world setting. METHODS: All patients with type 1 diabetes receiving an isCGM due to poor glycaemic control (≥70 mmol/mol [≥8.6%]) in the period of 2020–21 in Region North Denmark (“T1D-CGM”) were compared with all type 1 diabetes patients without isCGM (“T1D-NOCGM”) in the same period. A multiple linear regression model adjusted for age, sex, diabetes duration and use of continuous subcutaneous insulin infusion was constructed to estimate the difference in change from baseline HbA(1c) between the two groups and within subgroups of T1D-CGM. RESULTS: A total of 2,527 patients (T1D-CGM: 897; T1D-NOCGM: 1,630) were included in the study. The estimated adjusted difference in change from baseline HbA(1c) between T1D-CGM vs T1D-NOCGM was -5.68 mmol/mol (95% CI: (-6.69 to -4.67 mmol/mol; p<0.0001)). Older patients using isCGM dropped less in HbA(1c). CONCLUSIONS: Our results indicate that patients with type 1 diabetes in poor glycaemic control from Region North Denmark in general benefit from using isCGM with a sustained 24-month improvement in HbA(1c), but the effect on HbA(1c) may be less pronounced for older patients

"Stay on top of your diabetes": A better way to control your diabetes?

Background and aims: The Region of North Denmark (RND) has been facing difficulties with high levels of long-term blood sugar levels (HbA1c) for several years. In 2019 a new quality strategy was developed by Steno Diabetes Center North Denmark (SDCN) and implemented in 2020 at Department of Endocrinology, Aalborg University Hospital. The new strategy contains a fast-track program "Stay on Top of Your Diabetes" which aims to help patients with poor glycemic control (≥70 mmol/mol). The program offers a personalized 12-month fast-track program where the patients are undergoing a tighter follow-up by a doctor and nurse.Materials and methods: Patients with type 1 diabetes (T1D) or type 2 diabetes (T2D) with poor glycemic control were included in the program during a two-year period from January 2021 to March 2023 if they fulfill following criteria: poor glycemic control for more than the last three visits at the hospital, not being on a waiting list for receiving any kind of diabetes technology and referral to this program from an endocrinologist based on a clinical assessment. The patients were seen every three months during the program period at the Department of Endocrinology and a HbA1c was collected at every visit. A paired t-test was performed to analyze the differences in HbA1c from baseline to program outcome. To assess the program from the patient’s perspective a satisfaction questionnaire was distributed after the 12-month follow-up.Results: 138 patients were enrolled in "Stay on Top of Your Diabetes" (93 with T1D and 42 with T2D). The calculated difference in change for HbA1c from baseline to program outcome for T1D was -6.82 mmol/mol (95% CI: -1.67 to -11.98 mmol/mol; p=0,0105) and for T2D -14.43 mmol/mol (95% CI: -7.99 to 20.87mmol/mol; p&lt;0,0001). A questionnaire was distributed to 81 out of 138 patients who had a Danish digital mailbox (e-Boks) where 53 out of 81 patients (65,4%) responded to the questionnaire.Conclusion: This study indicates that patients have strong significant benefits from participating in the program based on the decreased HbA1c and that it supports patients to achieve better glycemic control. The satisfaction questionnaire reveals that the patients are extremely satisfied with the program and score highly on all questions. However, it is important to address that this study was performed in a daily clinical setting and was not randomized or further adjusted which means that the interpretation of the results should be done carefully. The results could be further investigated by adding a control group or adjusting variables for sex, age, and diabetes duration.<br/

DiaProfil (PRO) identificerer systematisk værdibaserede interventionsbehov for voksne med diabetes

IntroduktionI RKKPs strategi for 2019-2022 var en af deres målsætninger at kunne bidrage til en bedre indsamling og anvendelse af patientrapporterede oplysninger (PRO-data) for at belyse patientinvolveringen. PRO-data afspejler patientens selvrapporterede helbredstilstand og kan derfor bruges i en vurdering af behandlingseffekten. DiaProfil.dk er et digitalt dialogværktøj, videnskabeligt udviklet i samarbejde mellem personer med diabetes og fagpersoner inden for diabetes tilknyttet Steno Diabetes Center Nordjylland. Dialogværktøjet indeholder ni domæner, som giver et indblik i hverdagen for personer med diabetes og danner grundlag for dialog, behandling og fælles handlingsplan.FormålI Region Nordjylland foreligger de første resultater fra DiaProfil, hvor vi nu har et datasæt med 2.545 besvarelser fra diabetesambulatorierne i Aalborg, Farsø og Hjørring. 674 personer har besvaret spørgeskemaet flere gange over tid og derfor er der sammenlagt 1.871 unikke personer. Formålet er at beskrive effekten af DiaProfil og de handlinger, der er afledt af det, især i forhold til selvvurderet helbred, generel trivsel baseret på WHO-5, bekymring for senfølgekomplikationer og tryghed ved diabetes. Vi ønsker også at belyse forbindelser mellem PRO-data og kliniske endepunkter, såsom HbA1c.MetodeBesvarelser er indsamlet for perioden 01.01.2022 til 01.03.2023. For at belyse mulige signifikante kausale sammenhænge, vil der blive lavet deskriptiv statistik og trend- og årsagsanalyser.ResultaterIndtil nu har 1.371 personer med diabetes modtaget et DiaProfil-spørgeskema i Aalborg, hvortil 1.002 personer har besvaret det (73 %). I denne undersøgelse fokuseres der på udvalgte aspekter af de ni domæner. Blandt resultaterne ses, at 19,9 % vurderer deres helbred som dårligt, 27,1 % har risiko for stress eller depression, 21 % bekymrer sig om senfølger, 8,1 % har oplevet alvorlig hypoglykæmi i det seneste år, og ikke mindst føler 29,7 % sig utrygge i relation til deres diabetes. En fuld analyse af 1.371 besvarelser, inklusive trend- og årsagsanalyser, vil blive præsenteret.KonklusionPreliminære data viser, at DiaProfil er et klinisk anvendeligt dialogværktøj, som identificerer individuelle interventionsbehov og sikrer en individualiseret diabetessamtale mellem personen med diabetes og diabetesbehandleren.<br/