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An Observational Crossover Study of People Using Real-Time Continuous Glucose Monitors Versus Self-Monitoring of Blood Glucose: Real-World Evidence Using EMR Data From More Than 12,000 People With Type 1 Diabetes

Noor, Nudrat; Norman, Gregory; Sonabend, Rona; Chao, Lily; Kamboj, Manmohan; Golden, Lauren; Bekx, M Tracy; Hseih, Susan; Levy, Carol; Sanchez, Janine; Rapaport, Robert; Ebekozien, Osagie
BACKGROUND/UNASSIGNED:We used real-world electronic health record (EHR) data to examine HbA1c levels among children and adults with type 1 diabetes (T1D) who are classified as continuous glucose monitor (CGM) users after T1D diagnosis and switch to self-monitoring of blood glucose (SMBG) during follow-up, versus people who opt for SMBG after T1D diagnosis and switch to CGM during follow-up visits. METHODS/UNASSIGNED:We conducted an observational, case-crossover study using electronic medical record (EMR) data from the T1D Exchange Quality Improvement Collaborative. The primary outcome in this study was HbA1c. Baseline HbA1c levels were taken at the index date, corresponding to initial device classification, and compared with HbA1c value recorded at the clinic visit following device switch. RESULTS/UNASSIGNED:< .001). CONCLUSION/UNASSIGNED:We found that people who switched to CGM use had significantly improved HbA1c levels compared to those who switched to glucose monitoring with SMBG.
PMID: 37264642
ISSN: 1932-2968
CID: 5543452

PATIENT-REPORTED SEVERE HYPOGLYCEMIA AMONG HYBRID CLOSED LOOP SYSTEM (HCLS) USERS: REAL-WORLD EVIDENCE FROM A MULTICENTER STUDY FOR PEOPLE WITH TYPE 1 DIABETES [Meeting Abstract]

Ebekozien, O; Noor, N; Lee, J; Izquierdo, R; Golden, L; Miyazaki, B; Wilkes, M; Scott, M; Mekhoubad, A; Sanchez, J
Background and Aims: Background: There is growing evidence that Hybrid Closed Loop Systems (HCLS) are associated with a lower risk of severe hypoglycemia (SH) in people with type 1 diabetes. In this study, we use real-world data from the T1D Exchange (T1DX-QI) EMR database to investigate the association between HCLS use and patient-reported SH events using propensity score matching.
Method(s): In this analysis, we examined SH events across propensity score-matched HCLS user and HCLS non-user groups. All available data for the pediatric (6 years and older) and adult population with T1D from March 2018-March 2022 were included in this analysis. Patient-reported SH events are defined as SH events reported by the patient at their most recent clinic visit and were classified as a binary variable (Yes/No), with those reporting one or more SH events being classified under 'Yes' Similarly, HCLS device use was defined as the use of HCLS reported by the patient at their most recent clinic encounter.
Result(s): Propensity scores were estimated using a logit model, including age, gender, race/ethnicity, and insurance status as covariates. Matching was done using 1:1 matching with the nearest neighbor approach and a caliper of 0.1. There were 1537 matched people with T1D in the HCLS user and non-users group. Analysis showed that HCLS users were less likely than HCLS non-users to report >1 SH event (OR [95% CI]: 0.2 [0.1, 0.4] when controlling for covariates.
Conclusion(s): In this population-level real-world data analysis, we found HCLS use among people with T1D associated with lower patient-reported SH events
EMBASE:640507056
ISSN: 1557-8593
CID: 5512032

Differences in COVID-19 Outcomes among Patients with Type 1 Diabetes: First vs Later Surges

Gallagher, Mary Pat; Rompicherla, Saketh; Ebekozien, Osagie; Wilkes, Meredith; Antal, Zoltan; Feuer, Alexis Jamie; Rioles, Nicole; Noor, Nudrat; Gabriel, Liana; O"â„¢Malley, Grenye; Golden, Lauren; Alonso, G. Todd; Ospelt, Emma; Odugbesan, Ori; Lyons, Sarah K.; Mungmode, Ann; Prahalad, Priya; Clements, Mark; Neyman, Anna; Demeterco-Berggren, Carla; Rapaport, Robert
Background: Patient outcomes of COVID-19 have improved throughout the pandemic. However, because it is not known whether outcomes of COVID-19 in the type 1 diabetes (T1D) population improved over time, we investigated differences in COVID-19 outcomes for patients with T1D in the United States. Methods: We analyzed data collected via a registry of patients with T1D and COVID-19 from 56 sites between April 2020 and January 2021. We grouped cases into first surge (April 9, 2020, to July 31, 2020, n = 188) and late surge (August 1, 2020, to January 31, 2021, n = 410), and then compared outcomes between both groups using descriptive statistics and logistic regression models. Results: Adverse outcomes were more frequent during the first surge, including diabetic ketoacidosis (32% vs 15%, P< .001), severe hypoglycemia (4% vs 1%, P= .04), and hospitalization (52% vs 22%, P< .001). Patients in the first surge were older (28 [SD,18.8] years vs 18.0 [SD, 11.1] years, P< .001), had higher median hemoglobin A1c levels (9.3 [interquartile range {IQR}, 4.0] vs 8.4 (IQR, 2.8), P< .001), and were more likely to use public insurance (107 [57%] vs 154 [38%], P< .001). The odds of hospitalization for adults in the first surge were 5 times higher compared to the late surge (odds ratio, 5.01; 95% CI, 2.11-12.63). Conclusion: Patients with T1D who presented with COVID-19 during the first surge had a higher proportion of adverse outcomes than those who presented in a later surge.
SCOPUS:85131638092
ISSN: 1079-6533
CID: 5314772

Quality Improvement in Diabetes Care: A Review of Initiatives and Outcomes in the T1D Exchange Quality Improvement Collaborative

Ginnard, Olivia Z B; Alonso, G Todd; Corathers, Sarah D; Demeterco-Berggren, Carla; Golden, Lauren H; Miyazaki, Brian T; Nelson, Grace; Ospelt, Emma; Ebekozien, Osagie; Lee, Joyce M; Obrynba, Kathryn S; DeSalvo, Daniel J
Despite immense strides in therapeutic advances, clinical outcomes continue to be less than ideal for people with type 1 diabetes. This discrepancy has prompted an outpouring of quality improvement (QI) initiatives to address the medical, psychosocial, and health equity challenges that complicate ideal type 1 diabetes care and outcomes. This article reviews a framework for QI in diabetes care that guided the development of the T1D Exchange Quality Improvement Collaborative to improve care delivery and health outcomes in type 1 diabetes. Evaluation of the methodology, outcomes, and knowledge gained from these initiatives will highlight the importance of continued QI initiatives in diabetes care.
PMCID:8329011
PMID: 34421200
ISSN: 0891-8929
CID: 5011572

Pregnancy and type 1 diabetes: updates on technology and treatment

Kennedy-Grant, Abigail; Golden, Lauren
PURPOSE OF REVIEW/OBJECTIVE:The goal of this article is to review recent research of technology use, including insulin pumps, continuous glucose monitors, and smartpens, for pregnant women with preexisting type 1 diabetes. RECENT FINDINGS/RESULTS:Recent research shows that there may be benefits from technology use in type 1 diabetes pregnancies given the changes in insulin sensitivity throughout the span of pregnancy as well as allowing for more monitoring to allow for sooner titration of insulin doses. SUMMARY/CONCLUSIONS:There may be utility in incorporation of technology during pregnancy with appropriate medical guidance. Additional research would be helpful to further assess the ability of newer automated insulin systems to aid in tight glucose management goals during pregnancy and show value in receiving FDA approval.
PMID: 33369575
ISSN: 1752-2978
CID: 4762472

COVID-19 Hospitalization in Adults with Type 1 Diabetes: Results from the T1D Exchange Multicenter Surveillance Study

O'Malley, Grenye; Ebekozien, Osagie; Desimone, Marisa; Pinnaro, Catherina T; Roberts, Alissa; Polsky, Sarit; Noor, Nudrat; Aleppo, Grazia; Basina, Marina; Tansey, Michael; Steenkamp, Devin; Vendrame, Francesco; Lorincz, Ilona; Mathias, Priyanka; Agarwal, Shivani; Golden, Lauren; Hirsch, Irl B; Levy, Carol J
CONTEXT:Diabetes mellitus is associated with increased COVID-19 morbidity and mortality, but there are few data focusing on outcomes in people with type 1 diabetes. OBJECTIVE:The objective of this study was to analyze characteristics of adults with type 1 diabetes for associations with COVID-19 hospitalization. DESIGN:An observational multisite cross-sectional study was performed. Diabetes care providers answered a 33-item questionnaire regarding demographics, symptoms, and diabetes- and COVID-19-related care and outcomes. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between glycated hemoglobin (HbA1c), age, and comorbidities and hospitalization. SETTING:Cases were submitted from 52 US sites between March and August 2020. PATIENTS OR OTHER PARTICIPANTS:Adults over the age of 19 with type 1 diabetes and confirmed COVID-19 infection were included. INTERVENTIONS:None. MAIN OUTCOME MEASURES:Hospitalization for COVID-19 infection. RESULTS:A total of 113 cases were analyzed. Fifty-eight patients were hospitalized, and 5 patients died. Patients who were hospitalized were more likely to be older, to identify as non-Hispanic Black, to use public insurance, or to have hypertension, and less likely to use continuous glucose monitoring or insulin pumps. Median HbA1c was 8.6% (70 mmol/mol) and was positively associated with hospitalization (odds ratio 1.42, 95% confidence interval 1.18-1.76), which persisted after adjustment for age, sex, race, and obesity. CONCLUSIONS:Baseline glycemic control and access to care are important modifiable risk factors which need to be addressed to optimize care of people with type 1 diabetes during the worldwide COVID-19 pandemic.
PMCID:7717244
PMID: 33165563
ISSN: 1945-7197
CID: 4798452

The association between dispositional mindfulness and glycemic control in type 1 diabetes during early adulthood: Differences by age and adverse childhood experiences

Nagel, Kathryn E; Dearth-Wesley, Tracy; Herman, Allison N; Smith, Hannah G; Gandica, Rachelle G; Golden, Lauren H; Weil, Henry F C; Whitaker, Robert C
BACKGROUND:levels among young adults with type 1 diabetes (T1D) and whether this association differed by age or exposure to adverse childhood experiences (ACEs). METHODS:levels were abstracted from medical records. Respondents were categorized by age, high and low dispositional mindfulness (median split on Cognitive and Affective Mindfulness Scale-Revised), and exposure to any of 10 ACEs. RESULTS:levels. CONCLUSIONS:only among 27- to 31-year-olds. In early adulthood, the impact of mindfulness-based interventions on glycemic control may vary by age and childhood trauma history.
PMID: 32090426
ISSN: 1399-5448
CID: 4457992

Technological Advancements in the Management of Type 2 Diabetes

Grant, Abigail Kennedy; Golden, Lauren
PURPOSE OF REVIEW/OBJECTIVE:The increasing prevalence of type 2 diabetes is driving the boundaries of clinical diabetes care outside of the traditional office setting. The purpose of this paper will be to review recent technological advances in the medical management of people with type 2 diabetes, spanning the spectrum of care from access to healthcare providers/educators, to continual virtual support methods, on-line management tools, and technologically integrated medication delivery systems. RECENT FINDINGS/RESULTS:Recent findings support a potential positive impact of technology on access to care, clinical outcomes, convenience, patient well-being, and patient acceptance. This includes the use of Bluetooth-enabled glucose meters, continuous glucose monitors, mHealth apps, smartpens, and insulin pumps. However, there are impediments to the implementation of some technologies due to cost and lack of insurance coverage. There is evidence to support the use of technology to improve the management and treatment of people with type 2 diabetes. Further research is required to demonstrate the long-term clinical benefit and financial viability of technology in the management of type 2 diabetes.
PMID: 31863200
ISSN: 1539-0829
CID: 4243772

KCNJ11 Mutation in One Family is Associated with Adult-Onset Rather than Neonatal-Onset Diabetes Mellitus

Breidbart, Emily; Golden, Lauren; Gonzaga-Jauregui, Claudia; Deng, Liyong; Lanzano, Patricia; LeDuc, Charles; Guo, JianCheng; Overton, John D; Reid, Jeffrey; Shuldiner, Alan; Chung, Wendy K
ORIGINAL:0015159
ISSN: 2376-0605
CID: 4889712

Diabetic Ketoacidosis in an Adult Patient With Spinal Muscular Atrophy Type II: Further Evidence of Extraneural Pathology Due to Survival Motor Neuron 1 Mutation?

Lamarca, Nicole Holuba; Golden, Lauren; John, Rita Marie; Naini, Ali; Vivo, Darryl C De; Sproule, Douglas M
Spinal muscular atrophy is an autosomal recessive neurodegenerative disease caused by homozygous mutation to the survival motor neuron 1 (SMN1) gene. Historically, spinal muscular atrophy has been considered to almost exclusively affect the function and survival of alpha motor neurons of the spinal cord and brainstem. With the development of animal models of spinal muscular atrophy, the presence of widespread systemic abnormalities affecting the brain, heart, and pancreas has been repeatedly noted among animals with diminished survival motor neuron protein expression. While these observations suggest similar possible effects in humans, reports of primary systemic disease manifestations among humans affected by spinal muscular atrophy are strikingly lacking. Here we report a case of a 29-year-old man with genetically confirmed spinal muscular atrophy type II who presented with new onset diabetes mellitus and diabetic ketoacidosis.
PMID: 23034979
ISSN: 1708-8283
CID: 2978762