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Successful Initiation of Hybrid Closed-Loop System Using Virtual Pump Training Program in a Teenager With Type 1 Diabetes Previously Treated with Multiple Daily Injections.

ABSTRACT: Due to the coronavirus disease 2019 restrictions in providing diabetes services, we have developed an innovative pump training program, which consisted of technical session, pump training, one in-person practical session, and four consecutive online sessions (Skype Meet Now).A 13-year-old female patient with a 4-year history of type 1 diabetes (T1D) on multiple daily injections (MDI) with glycated hemoglobin 8.9%; 74 mmol/mol) initiated Minimed 670G system using the program. Time in range (70-180 mg/dL) of 39% and sensor glucose (SG) of 214±91 mg/dL (MDI with continuous glucose monitoring) increased to 69% in the first 2 weeks and reached 86% and SG of 140±40 mg/dL in the first month of auto mode initiation, without severe hypoglycemia or hyperglycemia. Virtual pump training program can be an effective tool to initiate a hybrid closed-loop system and to improve glycemic control in people with T1D on MDI.

SUBMITTER: Petrovski G

PROVIDER: S-EPMC8564223 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveTo investigate the long term effects of continuous subcutaneous insulin infusion (insulin pump therapy) on cardiovascular diseases and mortality in people with type 1 diabetes.DesignObservational study.SettingSwedish National Diabetes Register, Sweden 2005-12.Participants18,168 people with type 1 diabetes, 2441 using insulin pump therapy and 15,727 using multiple daily insulin injections.Main outcome measuresCox regression analysis was used to estimate hazard ratios for the outcomes, with stratification of propensity scores including clinical characteristics, risk factors for cardiovascular disease, treatments, and previous diseases.ResultsFollow-up was for a mean of 6.8 years until December 2012, with 114,135 person years. With multiple daily injections as reference, the adjusted hazard ratios for insulin pump treatment were significantly lower: 0.55 (95% confidence interval 0.36 to 0.83) for fatal coronary heart disease, 0.58 (0.40 to 0.85) for fatal cardiovascular disease (coronary heart disease or stroke), and 0.73 (0.58 to 0.92) for all cause mortality. Hazard ratios were lower, but not significantly so, for fatal or non-fatal coronary heart disease and fatal or non-fatal cardiovascular disease. Unadjusted absolute differences were 3.0 events of fatal coronary heart disease per 1000 person years; corresponding figures were 3.3 for fatal cardiovascular disease and 5.7 for all cause mortality. When lower body mass index and previous cardiovascular diseases were excluded, results of subgroup analyses were similar to the results from complete data. A sensitivity analysis of unmeasured confounders in all individuals showed that an unmeasured confounders with hazard ratio of 1.3 would have to be present in >80% of the individuals treated with multiple daily injections versus not presence in those treated with pump therapy to invalidate the significantly lower hazard ratios for fatal cardiovascular disease. Data on patient education and frequency of blood glucose monitoring were missing, which might have influenced the observed association.ConclusionAmong people with type 1 diabetes use of insulin pump therapy is associated with lower cardiovascular mortality than treatment with multiple daily insulin injections.

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Successful Initiation of Hybrid Closed-Loop System Using Virtual Pump Training Program in a Teenager With Type 1 Diabetes Previously Treated with Multiple Daily Injections.

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