Technology to Optimize Pediatric Diabetes Management and Outcomes
- 936 Downloads
Technology for diabetes management is rapidly developing and changing. With each new development, there are numerous factors to consider, including medical benefits, impact on quality of life, ease of use, and barriers to use. It is also important to consider the interaction between developmental stage and technology. This review considers a number of newer diabetes-related technologies and explores issues related to their use in the pediatric diabetes population (including young adults), with a focus on psychosocial factors. Areas include trend technology in blood glucose monitoring, continuous glucose monitoring, sensor-augmented insulin pumps and low glucose suspend functions, internet applications including videoconferencing, mobile applications (apps), text messaging, and online gaming.
KeywordsPediatric diabetes Technology Psychosocial Continuous glucose monitoring Insulin pump Management Outcomes
This work was supported in part by National Institute of Diabetes and Digestive and Kidney Diseases Grant 1K23DK092335, the William Randolph Hearst Foundation, the Katherine Adler Astrove Youth Education Fund, the Maria Griffin Drury Pediatric Fund, the Eleanor Chesterman Beatson Fund, National Institute of Diabetes and Digestive and Kidney Diseases Grant 1R01DK095273 and National Institute of Diabetes and Digestive and Kidney Diseases Grant 5R01DK089349 Reference List.
Compliance with Ethics Guidelines
Conflict of Interest
Jessica T. Markowitz has received honoraria and travel/accommodations expenses covered or reimbursed from Children with Diabetes. Kara R. Harrington declares that she has no conflict of interest. Lori M.B. Laffel has been a consultant for Bristol-Myers Squibb, JDRF, Johnson & Johnson, LifeScan/Animas, Eli Lilly, Menarini, Oshadi Administrative Devices, and Sanofi. She has received grant support from NIH/Bayer. She has received honoraria from TrialNet and has received royalties from Up to Date. She has also received travel/accommodations expenses covered or reimbursed from Advance Technologies and Treatment for Diabetes (ATTD), International Diabetes Forum, French Diabetes Society, Spanish Diabetes Society, European Association for the Study of Diabetes (EASD, and International Society for Pediatric and Adolescent Diabetes (ISPAD).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Laffel L, Volkening L, Hood K, Lochrie A, Nansel T, Anderson B, et al. Optimizing glycemic control in youth with T1DM: importance of BG monitoring and supportive family communication [Abstract]. Diabetes. 2006;55 Suppl 1:A197.Google Scholar
- 6.Polonsky WH, Fisher L, Schikman CH, Hinnen DA, Parkin CG, Jelsovsky Z, et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. Diabetes Care. 2011;34:262–7. PMCID:PMC3024331.PubMedCrossRefGoogle Scholar
- 9.Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. JDRF randomized clinical trial to assess the efficacy of real-time continuous glucose monitoring in the management of type 1 diabetes: research design and methods. Diabetes Technol Ther. 2008;10:310–21.CrossRefGoogle Scholar
- 11.Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Factors predictive of use and of benefit from continuous glucose monitoring in type 1 diabetes. Diabetes Care. 2009;32:1947–53. PMCID:PMC2768196.Google Scholar
- 14.Deiss D, Hartmann R, Schmidt J, Kordonouri O. Results of a randomised controlled cross-over trial on the effect of continuous subcutaneous glucose monitoring (CGMS) on glycaemic control in children and adolescents with type 1 diabetes. Exp Clin Endocrinol Diabetes. 2006;114:63–7.PubMedCrossRefGoogle Scholar
- 15.Mauras N, Beck R, Xing D, Ruedy K, Buckingham B, Tansey M, et al. A randomized clinical trial to assess the efficacy and safety of real-time continuous glucose monitoring in the management of type 1 diabetes in young children aged 4 to <10 years. Diabetes Care. 2012;35:204–10. PMCID:PMC3263860.PubMedCrossRefGoogle Scholar
- 20.Spielberger CD, Gorsuch RL, Lushene RE, Vagg PR, Jacobs GA. Test manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1983.Google Scholar
- 26.•• Phillip M, Battelino T, Atlas E, Kordonouri O, Bratina N, Miller S, et al. Nocturnal glucose control with an artificial pancreas at a diabetes camp. N Engl J Med. 2013;368:824–33. This group brought the study of a closed-loop system out of the lab and into a free-living environment, highlighting some novel possibilities of a system such as this.PubMedCrossRefGoogle Scholar
- 29.• Bergenstal RM, Ahmann AJ, Bailey T, Beck RW, Bissen J, Buckingham B, et al. Recommendations for standardizing glucose reporting and analysis to optimize clinical decision making in diabetes: the Ambulatory Glucose Profile. J Diabetes Sci Technol. 2013;7:562–78. The amulatory glucose profile makes diabetes data easier to understand and may help improve glycemic control in youth and adults with diabetes.PubMedGoogle Scholar
- 30.Beck RW, Tamborlane WV, Bergenstal RM, Miller KM, Dubose SN, Hall CA. The T1D Exchange Clinic Registry. J Clin Endocrinol Metab. 2012;97(12):4383–89.Google Scholar
- 33.• Rubin RR, Peyrot M. Health-related quality of life and treatment satisfaction in the Sensor-Augmented Pump Therapy for A1C Reduction 3 (STAR 3) trial. Diabetes Technol Ther. 2012;14:143–51. This important study examined psychosocial issues related to the use of sensor-augmented insulin pump therapy.PubMedCrossRefGoogle Scholar
- 36.•• Ruedy KJ. The effects of inpatient hybrid closed-loop therapy initiated within 1 week of type 1 diabetes diagnosis: diabetes research in Children Network (DirecNet) and type 1 diabetes TrialNet Study Groups. Diabetes Technol Ther. 2013;15(5). This important study examined the use of closed-loop therapy in newly diagnosed patients with T1D and it was found to be safe and effective. Google Scholar
- 37.Buckingham B, Ruedy K, Chase HP, Weinzimer S, DiMeglio L, Russell W, et al. Does intensive metabolic control at the onset of diabetes followed by one year of sensor-augmented pump therapy improve c-peptide levels one year post diagnosis? ATTD. 2013;[Late Breaking Abstracts].Google Scholar
- 43.Harris MA, Freeman KA, Duke DC, Hirschfield B, Boston B. Skype-based family problem solving for youth with poorly controlled diabetes: relative effectiveness of improving adherence and metabolic control. A Journal of the American Diabetes Association. 2013;62(Suppl. 1):A198.Google Scholar
- 50.Charpentier G, Benhamou PY, Dardari D, Clergeot A, Franc S, Schaepelynck-Belicar P, et al. The Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support improves HbA1c in poorly controlled type 1 diabetic patients: a 6-month, randomized, open-label, parallel-group, multicenter trial (TeleDiab 1 Study). Diabetes Care. 2011;34:533–9. PMCID:PMC3041176.PubMedCrossRefGoogle Scholar
- 54.Klingensmith GJ, Aisenberg J, Kaufman F, Halvorson M, Cruz E, Riordan ME, Varma C, Pardo S, Viggiani MT, Wallace JF, et al. Evaluation of a combined blood glucose monitoring and gaming system (Didget®) for motivation in children, adolescents, and young adults with type 1 diabetes. Pediatr Diabetes. 2011;14(5):350–7.Google Scholar
- 55.Nagelberg N, Shemesh Iron M. Classmate — unique edutainment software for better management of diabetes in children. ATTD Presentation. 2013.Google Scholar