Effect of Carelink, an Internet-Based Insulin Pump Monitoring System, on Glycemic Control in Children with Type 1 Diabetes Mellitus

Objective : To determine whether use of the internet-based Carelink system improved glycemic control in children on insulin pump therapy. Research Design and Methods - We reviewed records of 146 children treated with insulin pump therapy between the years 2004-2007, and compared glycemic control and diabetes self-care measures associated with Carelink use. Forty percent of the patients resided one hour or more from our clinic. Results: Patients who used the Carelink software and website showed significant improvement in HbA1c levels following use (8.0 ± 0.1 (SE) vs 7.7 ± 0.1 (SE), p=0.002). They uploaded data from their pump and glucometer 2.2 ± 1.8 times per month over 0.8 ± 0.4 (SD) years. Patients who had no access to Carelink software and were followed in a conventional manner showed no change in HbA1c ( 8.0 ± 0.1 (SE) vs 8.1 ± 0.1 (SE), p=0.27) during the study period. These patients did not differ significantly from Carelink users in diabetes self care behaviors. Patients who had Carelink access but did not use it had a higher HbA1c level at the onset and did not change over the study period (HbA1c 8.9 ± 0.2 (SE) vs 8.9 ± 0.3 (SE), p=0.76). These patients differed significantly from Carelink users in self-care behaviors, but not in the frequency of blood glucose monitoring. Patients in a rural location benefited equally as compared to patients who lived within one hour of our clinic. Conclusions: The Carelink software program is a powerful tool that can be used by diabetes care providers and parents to manage insulin pump therapy in children and to improve glycemic control, especially in states with a large rural population

Effectiveness of Continuous Subcutaneous Insulin Infusion Therapy Education in a Clinic Setting

Diabetes affects an estimated 29.1 million Americans, with approximately another 1/3 of Americans not yet diagnosed. Complications associated with diabetes include heart disease, stroke, hypertension, blindness, kidney disease, neuropathy and death. All of these complications can be prevented with optimal control of blood glucose levels. Advances in technology provide people living with diabetes (PLWD) a multitude of treatment options such as continuous subcutaneous insulin infusion (CSII) therapy. Unfortunately, sustained improvement in glycated hemoglobin A1c (HgA1c) is not always achieved even with this advanced therapy. The purpose of this doctoral project was to educate nurses on CSII therapy and promote improved patient compliance, knowledge and ultimately improve HgA1c control. This doctoral project is an evaluation of an Evidence-Based Quality Improvement Project (EB-QIP) that evaluated nurse-led educational sessions for PLWD using CSII therapy. The integrated theory of health behavior change was used to guide the project. The CDC process evaluation model was used to evaluate the outcomes of the education sessions. Results showed that patients who were instructed by the nurses who took part in the EB-QIP had a reduction in the overall HgA1c by an average of 1.1 points 3-months post-education. The project promotes positive social change through establishing the effectiveness of an EB-QIP that focused on the use of education on CSII therapy in improving outcomes for patients living with diabetes

The benefi ts of using bolus calculator Bolus Wizard® in patients treated with insulin pumps Medtronic Paradigm®

W ostatnich latach istotnie wzrosła liczba chorych nacukrzycę leczonych metodą intensywnej czynnościowejinsulinoterapii przy użyciu osobistej pompy insulinowej.Terapia ta przynosi wiele korzyści. Jednak u częścipacjentów stosujących ciągły podskórny wlew insulinyobserwuje się mniejsze od spodziewanych efekty terapii,a czasem nawet pogorszenie parametrów wyrównaniametabolicznego cukrzycy. Zjawisko to wynikazazwyczaj z niezrozumienia zasad działania urządzeniaoraz nieprzestrzegania zasad intensywnej czynnościowejinsulinoterapii. Do najczęściej popełnianych przezpacjentów błędów należy omijanie lub nieprawidłowewyliczanie dawki insuliny podawanej przed posiłkiemi/lub w celu korektę hiperglikemii. Najnowsze pompyinsulinowe zostały wyposażone w funkcję kalkulatorabolusa, która pomaga precyzyjnie określić dawkę insuliny.Na podstawie wyliczonej przez urządzenie ilościaktywnej insuliny oraz uwzględniając dane przekazanedo pompy przez jej użytkownika (przelicznik insulina/wymiennik węglowodanowy, współczynnik korekty,liczba spożywanych wymienników węglowodanowych,aktualna glikemia), kalkulator bolusa precyzyjnie obliczawielkość bolusa posiłkowego i/lub korekcyjnego.W pracy przedstawiono zasady korzystania z kalkulatorabolusa typu Bolus Wizard® u pacjentów leczonychza pomocą osobistych pomp insulinowych MedtronicParadigm®.In the recent years, the number of patients treatedwith intensive functional insulin therapy with the useof insulin pumps is constantly increasing. This type oftherapy might be very benefi cial. However, in somepatients, who use continuous subcutaneous insulininfusions, we observe that the metabolic control ofdiabetes deteriorates. This phenomenon most probablyresults from lack of understanding and improper useof this equipment and non-compliance with insulintherapy. The most common mistakes include omissionor inapropriate calculation of insulin dose for theplanned meal and for correction of hyperglycaemia.The latest insulin pumps are equipped with Bolus Wizard® function, which helps to precisely determine the doseof insulin bolus. Based on estimated amount of activeinsulin and taking into account data entered by patient(insulin/carbohydrate ratio, insulin sensitivity, number ofcarbohydrate units and actual glycaemia), the Bolus Wizard® exactly suggests the dose of prandial or correctioninsulin bolus. In this article the principles of using BolusWizard® function in patients treated with personal insulinpumps Medtronik Paradigm® are presented

Assessing the effectiveness of 3 months day and night home closed-loop insulin delivery in adults with suboptimally controlled type 1 diabetes: a randomised crossover study protocol.

INTRODUCTION: Despite therapeutic advances, many people with type 1 diabetes are still unable to achieve optimal glycaemic control, limited by the occurrence of hypoglycaemia. The objective of the present study is to determine the effectiveness of day and night home closed-loop over the medium term compared with sensor-augmented pump therapy in adults with type 1 diabetes and suboptimal glycaemic control. METHODS AND ANALYSIS: The study will adopt an open label, three-centre, multinational, randomised, two-period crossover study design comparing automated closed-loop glucose control with sensor augmented insulin pump therapy. The study will aim for 30 completed participants. Eligible participants will be adults (≥18 years) with type 1 diabetes treated with insulin pump therapy and suboptimal glycaemic control (glycated haemoglobin (HbA1c)≥7.5% (58 mmol/mmol) and ≤10% (86 mmol/mmol)). Following a 4-week optimisation period, participants will undergo a 3-month use of automated closed-loop insulin delivery and sensor-augmented pump therapy, with a 4-6 week washout period in between. The order of the interventions will be random. All analysis will be conducted on an intention to treat basis. The primary outcome is the time spent in the target glucose range from 3.9 to 10.0 mmol/L based on continuous glucose monitoring levels during the 3 months free living phase. Secondary outcomes include HbA1c changes; mean glucose and time spent above and below target glucose levels. Further, participants will be invited at baseline, midpoint and study end to participate in semistructured interviews and complete questionnaires to explore usability and acceptance of the technology, impact on quality of life and fear of hypoglycaemia. ETHICS AND DISSEMINATION: Ethical approval has been obtained at all sites. Before screening, all participants will be provided with oral and written information about the trial. The study will be disseminated by peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT01961622 (ClinicalTrials.gov)

Effective Use of Functionalities of Selected Insulin Pumps

Import 23/08/2017Moderní inzulinové pumpy jsou v dnešní době vybaveny stále více funkcemi, které mají za cíl usnadnit a zefektivnit léčbu. Tato bakalářská práce se zabývá onemocněním diabetes mellitus 1. typu a zejména jeho léčbě pomocí inzulinových pump Paradigm Veo a MiniMed 640G od firmy Medtronic. Teoretická část poukazuje na problematiku onemocnění, historii a způsoby léčby včetně jednotlivých funkcí inzulinových pump. Praktická část je zaměřena na nastavení těchto funkcí a jejich efektivnost v porovnání s léčbou bez jejich využití. Bylo provedeno experimentální měření, které se zaměřuje na hodnoty glykémie měřené 4krát denně a změnu HbA1c během testování. Cílem práce bylo zjistit, zda využívání těchto funkcí má vliv na úspěšnost léčby diabetu a zhodnotit tak jejich přínosnost.Modern insulin pumps are nowadays equipped with more functions, which are able to make treatment easier and more effective. This bachelor thesis deals with type 1 diabetes and especially its treatment with Paradigm Veo and MiniMed 640G insulin pumps from Medtronic. The theoretical part shows the problems of the disease, the history and methods of treatment, including the individual functions of insulin pumps. The practical part is focused on settings of these functions and their effectiveness compared to treatment without their use. Experimental measurement was performed to focus on blood glucose values measured 4 times a day and change of HbA1c during testing. The aim of the work was to find out if success of the diabetes treatment is affected by using of these functions and evaluate their benefits.450 - Katedra kybernetiky a biomedicínského inženýrstvívýborn

Programa educativo en el manejo de la bomba de insulina

En los últimos años, uno de los grandes avances en la terapéutica de la diabetes es el desarrollo de la bomba de infusión de insulina. Actualmente se utilizan dispositivos de circuito abierto aunque se están investigando sistemas de circuito cerrado y la llegada del "páncreas artificial " cada vez está más cerca. En España la bomba más empleada es la Minimed Paradigm Veo de Medtronic. Anima 2020 (sistema que puede sumergirse a 3 metros de profundidad) y Onmipod (bomba sin tubos muy utilizada en países latinos) son otros tipos de ISCI comercializados en el resto del mundo. Se ha demostrado una reducción del valor de la HbA1C y un mejor control de la enfermedad y la calidad de vida de los pacientes tratados con bomba de insulina. Sin embargo, no todos los pacientes son buenos candidatos para tratarse con este sistema. La persona debe : estar dispuesta a realizarse mediciones de la glucosa de 4 a 6 veces al día, conocer la acción de la insulina que se administra, saber cuantificar los hidratos de carbono durante las comidas o saber tomar decisiones para solventar imprevistos. Un personal sanitario altamente cualificado y experto en educación diabetológica y bombas de insulina deberá enseñar al paciente. Éste último aprenderá : qué es y para qué sirve un dispositivo ISCI, sus ventajas e inconvenientes, las indicaciones, el manejo en la vida diaria o cómo adaptar la bomba a diferentes situaciones especiales entre otras cosas.OtroGrado en Enfermerí

Factors associated with optimal glycemic control in patients with insulin pump therapy and continuous glucose monitoring in real time

Objetivo Cuando se utiliza monitorización continua de glucosa (MCG) y algoritmos de estimación de bolos, muchos pacientes en terapia con bomba de insulina alcanzan euglucemia. Evaluamos patrones de uso en integración de tecnología de bomba/MCG asociados con niveles de HbA1c<7%. Métodos Analizamos datos de 217 pacientes (edad>11 años; 53,5% hombres; 91,7% con diabetes tipo 1; >3 meses de experiencia en bomba) en manejo en un hospital universitario de Bogotá, Colombia, incluyendo aplicación de insulina, HbA1c, eventos hipoglucémicos severos, uso de MCG, culminación de cursos educativos en diabetes y frecuencia de glucometrías. Todos los pacientes recibieron entrenamiento para uso de bomba y la mayoría (73,7%) entrenamiento adicional en conteo de hidratos de carbono, ajustes de tasa basal y uso de datos de MCG. Resultados El inicio de terapia con bomba se asoció a disminución de HbA1c, uso de insulina y eventos hipoglucémicos severos (p80% de los bolos y uso de sensor MCG>80% del tiempo (p18 años, uso de bomba Paradigm 722 con MCG integrado, uso de alarmas por MCG, HbA1c>7% antes de terapia y controles de glucemia capilar más frecuentes (p<0,05). Muchos pacientes (45,6%) alcanzaron HbA1c≤7% con bomba. Conclusiones La educación, combinada con uso consistente de sensores-MCG y algoritmos de bolos confiere reducciones de HbA1c mayores a las alcanzadas con la terapia solamente con bomba.Q4Artículo original74-80Objective When used with continuous glucose monitoring (CGM) and bolus estimation algorithms, many patients on insulin pump therapy achieve near-euglycemia. We evaluated the usage patterns of integrated pump/CGM technology that are associated with A1C levels <7%. Methods Data from 217 patients (age>11 years, 53.5% male, 91.7% with type 1 diabetes, all with >3 months pump experience) receiving care at a teaching hospital in Bogotá, Colombia, were analyzed. Data included insulin delivery, A1C levels, severe hypoglycemic events, use of CGM, completion of diabetes education courses, and the frequency of blood glucose checks. All patients received training on the use of the pump, and most (73.7%) received additional training on carbohydrate counting, basal rate adjustments, and use of CGM data. Results Initiation of pump therapy was associated with decreases in A1C, insulin use, and severe hypoglycemic events (all P80% of bolus doses and use of CGM sensors >80% of the time (both P18, use of the Paradigm 722 pump with an integrated CGM device, use of CGM-based alarms, A1c >7% before pump therapy, and more frequent blood glucose checks (all P<.05). Many (45.6%) patients reached A1c≤7% with pump therapy. Conclusions Patient education, with an A1c below 7% before sensor-augmented pump therapy, when combined with consistent use of CGM sensors and bolus estimation algorithms, leads to favorable reductions in A1C beyond those achieved with pump therapy alon

Home use of closed loop insulin delivery improves overnight glucose control in adults with type 1 diabetes: A four-week multicentre randomised crossover study

This is the author accepted manuscript and will be embargoed until 16/12/14. The final published version can be found here: http://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70114-7/fulltext#article_upsell.Background: We assessed whether overnight home use of automated closed loop insulin delivery (artificial pancreas) improves glucose control. Methods: We studied 24 adults with type 1 diabetes in a multicentre crossover study design comparing four weeks of overnight closed loop using a model predictive control algorithm to direct insulin delivery, with four weeks of insulin pump therapy in which participants used real-time display of continuous glucose monitoring independent of their pumps as control. Primary outcome was time when glucose was in the target range of 3•9 and 8•0mmol/l between midnight to 07:00. Analyses were by intention to treat. Trial registration ClinicalTrials.gov NCT01440140. Findings: Closed loop was utilised over median 8•3 (interquartile range 6•0, 9•6)hours on 555nights (86%). Proportion of time when overnight glucose was in target range was significantly higher during closed loop compared to control by 13•5% (95% CI, 7•3-19•7; p<0•001). Mean overnight glucose (8•2±0•9 vs. 9•0±1•3mmol/l; p=0•005) and time spent above target (44•3%±11•9 vs. 57•1%±15•6; p=0•001) were significantly lower during closed loop. Time spent below target was low and comparable [1•8%( 0•6, 3•6) vs. 2•1%(0•7, 3•9);p=0•28]. Lower mean overnight glucose was brought about by increased overnight insulin delivery [6•4 (4•5, 8•1) vs. 4•9 (3•7, 6•3)units;p<0•001) without changing the total daily insulin amount [34•5 (29•3, 48•4) vs. 35•4 (29•7, 45•2)units;p=0•32]. No severe hypoglycaemia episodes occurred during control period and two during closed loop not related to algorithm instructions. Interpretation: Unsupervised overnight closed loop at home is feasible and may improve glucose control in adults with type 1 diabetes

Effects of performing morning versus afternoon exercise on glycemic control and hypoglycemia frequency in type 1 diabetes patients on sensor-augmented insulin pump therapy

Q1Artículo original619-624Background: Although physical exercise (PE) is recommended for individuals with type 1 diabetes (DM1), participation in exercise is challenging because it increases the risk of severe hypoglycemia and the available therapeutic options to prevent it frequently result in hyperglycemia. There is no clear recommendation about the best timing for exercise. The aim of this study was to compare the risk of hypoglycemia after morning or afternoon exercise sessions up to 36 hours postworkout. Methods: This randomized crossover study enrolled subjects with DM1, older than 18 years of age, on sensor-augmented insulin pump (SAP) therapy. Participants underwent 2 moderate-intensity exercise sessions; 1 in the morning and 1 in the afternoon, separated by a 7 to 14 day wash-out period. Continuous glucose monitoring (CGM) data were collected 24 hours before, during and 36 hours after each session. Results: Thirty-five subjects (mean age 30.31 ± 12.66 years) participated in the study. The rate of hypoglycemia was significantly lower following morning versus afternoon exercise sessions (5.6 vs 10.7 events per patient, incidence rate ratio, 0.52; 95% CI, 0.43-0.63; P < .0001). Most hypoglycemic events occurred 15-24 hours after the session. On days following morning exercise sessions, there were 20% more CGM readings in near-euglycemic range (70-200 mg/dL) than on days prior to morning exercise (P = .003). Conclusions: Morning exercise confers a lower risk of late-onset hypoglycemia than afternoon exercise and improves metabolic control on the subsequent day