Showing papers by "Kelly L. Close published in 2022"

A Glycemia Risk Index (GRI) of Hypoglycemia and Hyperglycemia for Continuous Glucose Monitoring Validated by Clinician Ratings.

Abstract: BACKGROUND A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data. METHODS We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia. We used principal component analysis and multiple regressions to develop a model to predict the clinician ranking based on seven standard metrics in an Ambulatory Glucose Profile: very low-glucose and low-glucose hypoglycemia; very high-glucose and high-glucose hyperglycemia; time in range; mean glucose; and coefficient of variation. RESULTS The analysis showed that clinician rankings depend on two components, one related to hypoglycemia that gives more weight to very low-glucose than to low-glucose and the other related to hyperglycemia that likewise gives greater weight to very high-glucose than to high-glucose. These two components should be calculated and displayed separately, but they can also be combined into a single Glycemia Risk Index (GRI) that corresponds closely to the clinician rankings of the overall quality of glycemia (r = 0.95). The GRI can be displayed graphically on a GRI Grid with the hypoglycemia component on the horizontal axis and the hyperglycemia component on the vertical axis. Diagonal lines divide the graph into five zones (quintiles) corresponding to the best (0th to 20th percentile) to worst (81st to 100th percentile) overall quality of glycemia. The GRI Grid enables users to track sequential changes within an individual over time and compare groups of individuals. CONCLUSION The GRI is a single-number summary of the quality of glycemia. Its hypoglycemia and hyperglycemia components provide actionable scores and a graphical display (the GRI Grid) that can be used by clinicians and researchers to determine the glycemic effects of prescribed and investigational treatments.

Consensus Recommendations for the Use of Automated Insulin Delivery Technologies in Clinical Practice

Abstract: Abstract The significant and growing global prevalence of diabetes continues to challenge people with diabetes (PwD), healthcare providers, and payers. While maintaining near-normal glucose levels has been shown to prevent or delay the progression of the long-term complications of diabetes, a significant proportion of PwD are not attaining their glycemic goals. During the past 6 years, we have seen tremendous advances in automated insulin delivery (AID) technologies. Numerous randomized controlled trials and real-world studies have shown that the use of AID systems is safe and effective in helping PwD achieve their long-term glycemic goals while reducing hypoglycemia risk. Thus, AID systems have recently become an integral part of diabetes management. However, recommendations for using AID systems in clinical settings have been lacking. Such guided recommendations are critical for AID success and acceptance. All clinicians working with PwD need to become familiar with the available systems in order to eliminate disparities in diabetes quality of care. This report provides much-needed guidance for clinicians who are interested in utilizing AIDs and presents a comprehensive listing of the evidence payers should consider when determining eligibility criteria for AID insurance coverage.

929-P: Person-First Language in Diabetes and Obesity Scientific Publications: Are We Making Progress?

Abstract: Several professional societies endorse the use of person-first language (PFL) in communication involving people with diabetes or obesity. The purpose of this analysis was to determine the extent to which scholarly articles focusing on diabetes or obesity use PFL. We reviewed existing guidelines and constructed separate lists of PFL and condition-first language (CFL) terms for diabetes and obesity (e.g., diabetic, obese) . Exact phrase searches were conducted using PubMed from 2011-2020 and resultant articles were categorized as PFL, CFL, or both. Journal-specific factors (e.g., scope, PFL policy) were extracted from a manual review of author guidelines. The searches yielded 56048 scholarly articles for diabetes and 45584 for obesity. Among diabetes articles, 42.8% used PFL, 40.1% used CFL, and 17.2% contained both (p<0.0PFL vs. CFL) . Among obesity articles, 0.5% used PFL, 99.3% used CFL, and 0.2% used both (p<0.0PFL vs. CFL) . Use of PFL increased by 3.1% per year for diabetes articles, compared to 117.0% for obesity articles (p=0.002) . The rate of adoption of PFL in diabetes articles was unchanged in 2018-2020 compared to years prior (p=0.970) . PFL was more likely to be used in diabetes articles published in a diabetes-focused journal (OR 1.66; p<0.001) and in journals with a PFL policy (OR 2.97; p<0.001) . Obesity articles were more likely to use PFL if published in a US journal (OR 2.34; p=0.002) and in journals after implementation of a PFL policy (OR 32.11; p<0.001) . Obesity-focused journals were not more likely to use PFL than non-specialized journals (p=0.12) . Although the use of person-first language in diabetes articles has increased over the past years, progress has slowed despite the recent publication of PFL guidelines. Fewer than 1% of obesity articles used person-first language, suggesting a widespread lack of recognition of the importance of PFL in obesity. The strongest predictor of the use of person-first language was if the article was published in a journal with a PFL policy. D.Bialonczyk: Employee; Gelesis. K.L.Close: Other Relationship; Abbott, ADOCIA, Amarin Corporation, American Association of Clinical Endocrinologists, American Diabetes Association, American Medical Association, Ascensia Diabetes Care, Astellas Pharma Inc., AstraZeneca. J.Dickinson: Consultant; DiaNavi, Vivify. J.D.Reece: None. T.K.Kyle: Advisory Panel; Nutrisystem, Inc., Consultant; Gelesis, Johnson & Johnson. J.F.Nadglowski: Employee; Obesity Action Coalition. K.Johnson: None. M.Garza: None. E.Pash: Employee; Gelesis. E.Chiquette: Employee; Gelesis.

RESCUE Collaborative Community: A New Initiative to Reduce Rates of Intended Self-Injury and Suicide Amongst People with Diabetes.

Abstract: Suicide is the leading cause of death among young people aged 20-34 and the second leading cause of death in adolescents aged 15-19. In the general population, among those attempting suicide 7% die by suicide and 23% reattempt with non-fatal consequences. Depression, closely associated with suicidal ideation, is diagnosed in 7-25% of the United States and European populations. Individuals with type 1 diabetes (T1D) have a 2-3 times higher prevalence of depression and approximately double the rate of suicide compared to the general population. Rates of self-harm and suicide amongst people with diabetes are likely to be considerably under-estimated due to poor identification. This information is critical in order to create interventions to decrease rates of suicide and self-harm. This is particularly important in the setting of advanced technologies in T1D, which offer both easier methods of self-injurious behaviours through insulin misuse and also can act as identification tools to identify risk insulin behaviours and provide opportunities to develop interventions and prevention efforts in those with depression and suicidal ideation/behavior/acts. To this end, our goal was to identify any literature on coding diabetes correctly in individuals who die by suicide or engage in intentional self-harm. Furthermore, to describe the RESCUE Collaborative Community and its goals of using multiple approaches to reduce rates of intended self-injury and suicide amongst people with diabetes. These include detection of cases, understanding support needs, identification of risk factors and early intervention for individuals at risk.