Diabetes Technology & Therapeutics 

About: Diabetes Technology & Therapeutics is an academic journal published by Mary Ann Liebert, Inc.. The journal publishes majorly in the area(s): Diabetes mellitus & Type 1 diabetes. It has an ISSN identifier of 1520-9156. Over the lifetime, 3054 publications have been published receiving 88460 citations. The journal is also known as: Diabetes technology and therapeutics.

State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018

Abstract: Objective To provide a snapshot of the profile of adults and youth with type 1 diabetes (T1D) in the United States and assessment of longitudinal changes in T1D management and clinical outcomes in the T1D Exchange registry. Research design and methods Data on diabetes management and outcomes from 22,697 registry participants (age 1-93 years) were collected between 2016 and 2018 and compared with data collected in 2010-2012 for 25,529 registry participants. Results Mean HbA1c in 2016-2018 increased from 65 mmol/mol at the age of 5 years to 78 mmol/mol between ages 15 and 18, with a decrease to 64 mmol/mol by age 28 and 58-63 mmol/mol beyond age 30. The American Diabetes Association (ADA) HbA1c goal of 10-fold in children Conclusions Data from the T1D Exchange registry demonstrate that only a minority of adults and youth with T1D in the United States achieve ADA goals for HbA1c.

The Performance and Usability of a Factory-Calibrated Flash Glucose Monitoring System.

Abstract: Introduction: The purpose of the study was to evaluate the performance and usability of the FreeStyle® Libre™ Flash glucose monitoring system (Abbott Diabetes Care, Alameda, CA) for interstitial glucose results compared with capillary blood glucose results. Materials and Methods: Seventy-two study participants with type 1 or type 2 diabetes were enrolled by four U.S. clinical sites. A sensor was inserted on the back of each upper arm for up to 14 days. Three factory-only calibrated sensor lots were used in the study. Sensor glucose measurements were compared with capillary blood glucose (BG) results (approximately eight per day) obtained using the BG meter built into the reader (BG reference) and with the YSI analyzer (Yellow Springs Instrument, Yellow Springs, OH) reference tests at three clinic visits (32 samples per visit). Sensor readings were masked to the participants. Results: The accuracy of the results was demonstrated against capillary BG reference values, with 86.7% of sensor results w...

Continuous Glucose Monitoring: A Review of Successes, Challenges, and Opportunities

Abstract: Continuous glucose monitoring (CGM) provides information unattainable by intermittent capillary blood glucose, including instantaneous real-time display of glucose level and rate of change of glucose, alerts and alarms for actual or impending hypo- and hyperglycemia, “24/7” coverage, and the ability to characterize glycemic variability. Progressively more accurate and precise, reasonably unobtrusive, small, comfortable, user-friendly devices connect to the Internet to share information and are sine qua non for a closed-loop artificial pancreas. CGM can inform, educate, motivate, and alert people with diabetes. CGM is medically indicated for patients with frequent, severe, or nocturnal hypoglycemia, especially in the presence of hypoglycemia unawareness. Surprisingly, despite tremendous advances, utilization of CGM has remained fairly limited to date. Barriers to use have included the following: (1) lack of Food and Drug Administration approval, to date, for insulin dosing (“nonadjuvant use”) in t...

Glucose Outcomes with the In-Home Use of a Hybrid Closed-Loop Insulin Delivery System in Adolescents and Adults with Type 1 Diabetes.

Abstract: Background: The safety and effectiveness of the in-home use of a hybrid closed-loop (HCL) system that automatically increases, decreases, and suspends insulin delivery in response to continuous glucose monitoring were investigated. Methods: Adolescents (n = 30, ages 14–21 years) and adults (n = 94, ages 22–75 years) with type 1 diabetes participated in a multicenter (nine sites in the United States, one site in Israel) pivotal trial. The Medtronic MiniMed® 670G system was used during a 2-week run-in phase without HCL control, or Auto Mode, enabled (Manual Mode) and, thereafter, with Auto Mode enabled during a 3-month study phase. A supervised hotel stay (6 days/5 nights) that included a 24-h frequent blood sample testing with a reference measurement (i-STAT) occurred during the study phase. Results: Adolescents (mean ± standard deviation [SD] 16.5 ± 2.29 years of age and 7.7 ± 4.15 years of diabetes) used the system for a median 75.8% (interquartile range [IQR] 68.0%–88.4%) of the time (2977 pati...

The MiniMed Continuous Glucose Monitoring System

Abstract: S-13 DIABETES is a major source of morbidity, mortality, and economic expense. All patients with type 1 diabetes and an estimated 3–4 million patients in the United States with type 2 diabetes must take insulin to control their glucose levels. The majority of these patients selfmonitor their blood glucose one or more times each day, using fingerstick blood sampling and analysis with a portable glucose meter device. Approximately 200,000 type 1 diabetes patients in the United States practice intensive insulin therapy, requiring four or more blood glucose measurements each day coupled with either multiple daily injections of insulin or an insulin pump. The Diabetes Control and Complications Trial (DCCT) clearly demonstrated the importance of frequent self-monitoring of blood glucose (SMBG) in attaining tight glycemic control.1 Patients undergoing intensive therapy had a 39–76% reduced occurrence of long-term complications as compared to patients treated with conventional therapy. The primary drawback of intensive therapy was a threefold increase in the occurrence of severe hypoglycemia, despite performing four or more SMBG tests per day. Consequently, methods to improve the ability to achieve intensive control without hypoglycemia are being explored. There is a tremendous need to develop and commercialize a truly simple, accurate method of measuring glucose that can provide a basis for more accurate and directed disease selfmanagement. Generally, it is not practical to perform SMBG frequently enough throughout the day to accurately identify every blood glucose excursion. MiniMed® has taken a first step in advancing the practice of glucose self-monitoring by developing a short-term, continuous glucose sensor. The sensor is inserted subcutaneously and is capable of reliable operation for up to 3 days, followed by replacement with a new sensor at a different location, if necessary. The assay method is based on electrochemical detection of glucose through its reaction with glucose oxidase. Data are collected once every 5 min by a pager-sized monitor device and can be periodically downloaded into a computer for analysis and interpretation. In future product iterations, the sensor will function as a hypoglycemia and hyperglycemia alarm, by notifying the user when blood glucose levels reach preselected thresholds (such as 60 mg/dL and 200 mg/dL), and will provide real-time glucose readouts. The alarm feature will be especially important in patients with hypoglycemic unawareness, which is believed to occur in anywhere from 25% to 50% of patients with type 1 diabetes,2 especially those who have neuropathy or those without complications who are following intensive glycemic control regimens.3 Fanelli et al.4 have shown that meticulous control to prevent low glucose excursions can result in a significant recovery of hypoglycemic awareness.