Skip to main content

Advertisement

SpringerLink
Log in

Technology to Optimize Pediatric Diabetes Management and Outcomes

  • Psychosocial Aspects (KK Hood, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. The DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  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 

  3. Dailey G. Assessing glycemic control with self-monitoring of blood glucose and hemoglobin A(1c) measurements. Mayo Clin Proc. 2007;82:229–35.

    PubMed  CAS  Google Scholar 

  4. Ziegler R, Heidtmann B, Hilgard D, Hofer S, Rosenbauer J, Holl R, et al. Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2011;12:11–7.

    Article  PubMed  Google Scholar 

  5. Wood JR, Laffel LMB. Technology and intensive management in youth with type 1 diabetes: state of the art. Curr Diab Rep. 2007;7:104–13.

    Article  PubMed  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.

    Article  PubMed  Google Scholar 

  7. Pfutzner A, Mitri M, Musholt PB, Sachsenheimer D, Borchert M, Yap A, et al. Clinical assessment of the accuracy of blood glucose measurement devices. Curr Med Res Opin. 2012;28:525–31.

    Article  PubMed  Google Scholar 

  8. Recupero A, Mahnke B, Pinsker JE. Emerging technology in diabetes care: the real-time diabetes monitoring system. Mil Med. 2013;178:218–21.

    PubMed  Google 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.

    Article  Google Scholar 

  10. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. The effect of continuous glucose monitoring in well-controlled type 1 diabetes. Diabetes Care. 2009;32:1378–83. PMCID:PMC2713649.

    Article  Google 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 

  12. Bergenstal RM, Tamborlane WV, Ahmann A, Buse JB, Dailey G, Davis SN, et al. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med. 2010;363:311–20.

    Article  PubMed  CAS  Google Scholar 

  13. Raccah D, Sulmont V, Reznik Y, Guerci B, Renard E, Hanaire H, et al. Incremental value of continuous glucose monitoring when starting pump therapy in patients with poorly controlled type 1 diabetes: the RealTrend study. Diabetes Care. 2009;32:2245–50.

    Article  PubMed  CAS  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.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  CAS  Google Scholar 

  16. Tsalikian E, Fox L, Weinzimer S, Buckingham B, White NH, Beck R, et al. Feasibility of prolonged continuous glucose monitoring in toddlers with type 1 diabetes. Pediatr Diabetes. 2012;13:301–7.

    Article  PubMed  CAS  Google Scholar 

  17. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Validation of measures of satisfaction with and impact of continuous and conventional glucose monitoring. Diabetes Technol Ther. 2010;12:679–84.

    Article  Google Scholar 

  18. Tansey M, Laffel L, Cheng J, Beck R, Coffey J, Huang E, et al. Satisfaction with continuous glucose monitoring in adults and youths with Type 1 diabetes. Diabet Med. 2011;28:1118–22.

    Article  PubMed  CAS  Google Scholar 

  19. Markowitz JT, Pratt K, Aggarwal J, Volkening LK, Laffel LM. Psychosocial correlates of continuous glucose monitoring use in youth and adults with type 1 diabetes and parents of youth. Diabetes Technol Ther. 2012;14:523–6. PMCID:PMC3359621.

    Article  PubMed  Google 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 

  21. Elleri D, Allen JM, Biagioni M, Kumareswaran K, Leelarathna L, Caldwell K, et al. Evaluation of a portable ambulatory prototype for automated overnight closed-loop insulin delivery in young people with type 1 diabetes. Pediatr Diabetes. 2012;13:449–53.

    Article  PubMed  CAS  Google Scholar 

  22. Nimri R, Atlas E, Ajzensztejn M, Miller S, Oron T, Phillip M. Feasibility study of automated overnight closed-loop glucose control under MD-logic artificial pancreas in patients with type 1 diabetes: the DREAM Project. Diabetes Technol Ther. 2012;14:728–35.

    Article  PubMed  CAS  Google Scholar 

  23. Breton M, Farret A, Bruttomesso D, Anderson S, Magni L, Patek S, et al. Fully integrated artificial pancreas in type 1 diabetes: modular closed-loop glucose control maintains near normoglycemia. Diabetes. 2012;61:2230–7. PMCID:PMC3425406.

    Article  PubMed  CAS  Google Scholar 

  24. Dauber A, Corcia L, Safer J, Agus MS, Einis S, Steil GM. Closed-loop insulin therapy improves glycemic control in children aged <7 years: a randomized controlled trial. Diabetes Care. 2013;36:222–7. PMCID:PMC3554296.

    Article  PubMed  CAS  Google Scholar 

  25. Hovorka R, Allen JM, Elleri D, Chassin LJ, Harris J, Xing D, et al. Manual closed-loop insulin delivery in children and adolescents with type 1 diabetes: a phase 2 randomized crossover trial. Lancet. 2010;375:743–51.

    Article  PubMed  CAS  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.

    Article  PubMed  CAS  Google Scholar 

  27. Elleri D, Acerini CL, Allen JM, Hayes J, Pesterfield C, Wilinska ME, et al. Parental attitudes towards overnight closed-loop glucose control in children with type 1 diabetes. Diabetes Technol Ther. 2010;12:35–9.

    Article  PubMed  Google Scholar 

  28. van Bon AC, Brouwer TB, von Basum G, Hoekstra JB, DeVries JH. Future acceptance of an artificial pancreas in adults with type 1 diabetes. Diabetes Technol Ther. 2011;13:731–6.

    Article  PubMed  Google 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.

    PubMed  Google 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 

  31. Beck J, Lewis T, Harrison D, Sternlof S, Comp C, Copeland K. Use of the Mastery of Stress Instrument in caregivers of children newly diagnosed with type 1 diabetes: identifying a need for further intervention. Diabetes Educ. 2012;38:280–8.

    Article  PubMed  Google Scholar 

  32. Slover RH, Welsh JB, Criego A, Weinzimer SA, Willi SM, Wood MA, et al. Effectiveness of sensor-augmented pump therapy in children and adolescents with type 1 diabetes in the STAR 3 study. Pediatr Diabetes. 2012;13:6–11.

    Article  PubMed  CAS  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.

    Article  PubMed  Google Scholar 

  34. Peyrot M, Rubin RR. Treatment satisfaction in the sensor-augmented pump therapy for A1C reduction 3 (STAR 3) trial. Diabet Med. 2013;30:464–7.

    Article  PubMed  CAS  Google Scholar 

  35. Kordonouri O, Pankowska E, Rami B, Kapellen T, Coutant R, Hartmann R, et al. Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment. Diabetologia. 2010;53:2487–95.

    Article  PubMed  CAS  Google 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.

  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].

  38. Choudhary P, Shin J, Wang Y, Evans ML, Hammond PJ, Kerr D, et al. Insulin pump therapy with automated insulin suspension in response to hypoglycemia: reduction in nocturnal hypoglycemia in those at greatest risk. Diabetes Care. 2011;34:2023–5. PMCID:PMC3161284.

    Article  PubMed  CAS  Google Scholar 

  39. Danne T, Kordonouri O, Holder M, Haberland H, Golembowski S, Remus K, et al. Prevention of hypoglycemia by using low glucose suspend function in sensor-augmented pump therapy. Diabetes Technol Ther. 2011;13:1129–34.

    Article  PubMed  Google Scholar 

  40. Garg S, Brazg RL, Bailey TS, Buckingham BA, Slover RH, Klonoff DC, et al. Reduction in duration of hypoglycemia by automatic suspension of insulin delivery: the in-clinic ASPIRE study. Diabetes Technol Ther. 2012;14:205–9.

    Article  PubMed  CAS  Google Scholar 

  41. van Bastelaar KM, Pouwer F, Cuijpers P, Riper H, Snoek FJ. Web-based depression treatment for type 1 and type 2 diabetic patients: a randomized, controlled trial. Diabetes Care. 2011;34:320–5. PMCID:PMC3024341.

    Article  PubMed  Google Scholar 

  42. Stinson J, Wilson R, Gill N, Yamada J, Holt J. A systematic review of internet-based self-management interventions for youth with health conditions. J Pediatr Psychol. 2009;34:495–510.

    Article  PubMed  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 

  44. Izquierdo R, Morin PC, Bratt K, Moreau Z, Meyer S, Ploutz-Snyder R, et al. School-centered telemedicine for children with type 1 diabetes mellitus. J Pediatr. 2009;155:374–9.

    Article  PubMed  Google Scholar 

  45. Ritterband LM, Thorndike FP, Cox DJ, Kovatchev BP, Gonder-Frederick LA. A behavior change model for internet interventions. Ann Behav Med. 2009;38:18–27. PMCID:PMC2878721.

    Article  PubMed  Google Scholar 

  46. Eysenbach G. CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011;13:e126. PMCID:PMC3278112.

    Article  PubMed  Google Scholar 

  47. Hanauer DA, Wentzell K, Laffel N, Laffel LM. Computerized Automated Reminder Diabetes System (CARDS): e-mail and SMS call phone text messaging reminders to support diabetes management. Diabetes Technol Ther. 2009;11:99–106.

    Article  PubMed  Google Scholar 

  48. Franklin VL, Waller A, Pagliari C, Greene SA. A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes. Diabet Med. 2006;23:1332–8.

    Article  PubMed  CAS  Google Scholar 

  49. Liang X, Wang Q, Yang X, Cao J, Chen J, Mo X, et al. Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabet Med. 2011;28:455–63.

    Article  PubMed  CAS  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.

    Article  PubMed  Google Scholar 

  51. Garcia E, Martin C, Garcia A, Harrison R, Flood D. Systematic analysis of mobile diabetes management applications on different platforms. Lect Notes Comput Sci. 2011;7058:379–96.

    Article  Google Scholar 

  52. Demidowich AP, Lu K, Tamler R, Bloomgarden Z. An evaluation of diabetes self-management applications for Android smartphones. J Telemed Telecare. 2012;18:235–8.

    Article  PubMed  Google Scholar 

  53. Kumar VS, Wentzell KJ, Mikkelsen T, Pentland A, Laffel LM. The DAILY (Daily Automated Intensive Log for Youth) trial: a wireless, portable system to improve adherence and glycemic control in youth with diabetes. Diabetes Technol Ther. 2004;6:445–53.

    Article  PubMed  Google 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.

Download references

Acknowledgments

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

ᅟ

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.

Author information

Authors and Affiliations

  1. Joslin Diabetes Center, Pediatric, Adolescent, & Young Adult Section, Boston, MA, 02215, USA

    Jessica T. Markowitz, Kara R. Harrington & Lori M. B. Laffel

Authors
  1. Jessica T. Markowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kara R. Harrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lori M. B. Laffel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica T. Markowitz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Markowitz, J.T., Harrington, K.R. & Laffel, L.M.B. Technology to Optimize Pediatric Diabetes Management and Outcomes. Curr Diab Rep 13, 877–885 (2013). https://doi.org/10.1007/s11892-013-0419-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-013-0419-3

Keywords

Search

Navigation