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References

integrated-diabetes-care

Integrated Diabetes Care

Time-In-Range (TIR): How to interpret it and how it is associated with outcomes

Watch the Interview with Dr. Richard Bergenstal, International Diabetes Center, Minneapolis, USA following the ATTD 2021 Congress. Dr. Richard Bergenstal explains on how to interpret TIR and how it is associated with outcomes.

INTEGRATED-DIABETES-CARE

DIABETES

What Is Time-in-Range?

While HbA1c is the gold standard for measuring glycemic control, it has some limitations that need to be addressed, therefore; there is a need for metrics beyond glycated hemoglobin (HbA1c) to provide a more comprehensive picture of a patient's glycemic status. Time-in-range (TIR) is an intuitive way of presenting glycemic data, and it simply refers to the time a patient's glucose level remains in a target range (70–180 mg/dL).
TIR is unified and recognized by the ATTD CGM consensus, referenced in the ADA, and included in AACE guidelines. Watch the video to learn about insights from Prof. Tadej Battelino on the value of time-in-range as a glycemic biomarker.

Insulin advancement in Type 2 diabetes: Unmet needs with commonly-used options

Educational video on "Insulin advancement in Type 2 diabetes: Unmet needs with commonly-used options" outlining key data from indirect comparisons of iGlarLixi versus IDegAsp.

Type 2 Diabetes Cost Effective Management

Prof. Colin Dayan discussing how to best manage your Diabetic Patients with a cost effective approach.

World Diabetes Day

Dr. Hussein Elbadawi talks about Hypoglycemia and how is it classified.

Safe & Smart - Dr. Salah

Dr. Salah gives us the updated guidelines on Sulphonylureas and Cardiovascular safety

<h2>U.S-FDA approved inpatient and outpatient technology-based solutions for effective insulin dose management for people with diabetes</h2>
This review focuses on U.S. Food and Drug Administration (FDA) approved products designed to aid insulin dosing (inpatient/outpatient settings).

<h2>Key Takeaway</h2>
Diabetes care is well suited for virtual/remote care:
<ul>
 <li>Insulin dosing technology integrated with electronic medical record (EMR) supports clinicians in glucose management in the hospital setting, and app-based systems assist insulin dose adjustments at home.</li>
 <li>Inpatient and outpatient digital solutions can serve as educational tools in the academic settings, particularly for insulin initiation and titration.</li>
 <li>Appropriate usage of inpatient/outpatient insulin management technologies aids effective self-management of diabetes by the patients, reduces the economic burden, and assists health care providers (HCPs) in communicating with the patients efficiently.</li>
 <li>New technologies with computer algorithms improve health outcomes by overcoming barriers associated with insulin initiation/titration/adherence.</li>
 <li>With the availability of mobile apps for insulin management and other digital solutions that remotely transmit glucose monitoring results, diabetes care is well adapted for the novel coronavirus pandemic situation.</li>
</ul>

<h2>Why This Matters</h2>
<ul>
 <li>Diabetes and associated complications increase the economic burden on the U.S. health care system, emphasizing the need for effective diabetes management.</li>
 <li>Despite significant advances in drug development, people with diabetes and their HCPs find it difficult to achieve guidelinerecommended A1C goals, making improvisation/digitalization of insulin-management essential.</li>
</ul>

<h2>Key Results</h2>
Inpatient electronic glucose management systems to manage insulin doses: These programs support clinical reasoning but do not substitute for it
<ul>
 <li>Glucommander (Glytec): Uses evidence-based multivariate algorithms: (1) offers surveillance/report capabilities (2) is adaptable for EMR systems (3) approved for intravenous (IV) insulin infusion, IV–subcutaneous (SQ) transition, SQ insulin, hospital-to-home transitions, and outpatient SQ insulin management (4) increased nurses’ satisfaction (5) cost saving</li>
 <li>EndoTool system (Monarch Medical Technologies): Provides clinical decision support for IV insulin, IV-to-SQ transition, and SQ insulin for pediatric and adult patients; is suitable for EMR systems; supports parenteral carbohydrate calculation; its usage decreases hospital-acquired conditions</li>
 <li>GlucoStabilizer (Medical Decision Network): Network-based software solution that enables automatic IV insulin drip rate calculation; it is also approved for IV–SQ transitions</li>
 <li>Core Diabetes App (Transformative Med): Helps the HCPs to calculate insulin dose, but the app does not make automatic changes to the dose; it can be integrated into EMR systems; it provides help with IV insulin rates, IV-to-SQ transitions, and SQ insulin initial doses</li>
</ul>
Technologies to assist in outpatient insulin dosing: These systems are not intended to be used as a substitute for professional medical advice
<ul>
 <li>Basal insulin titration systems: 
 <ul>
 <li>Insulia (Voluntis): Shares reports with HCPs; patients receive educational coaching messages and safety rules for hypoglycemia management (type 2 diabetes [T2D]/long-acting insulin dosing/manual entry/mobile app + web-based portal)</li>
 <li>iSage Rx (Amalgam): HCPs can choose which algorithm to use for titration and can access reports (T2D/long-acting insulin dosing/manual entry/mobile app + web-based portal)</li>
 <li>Mobile Insulin Dosing System (MIDS, Glooko): Patient can self-adjust basal insulin after the HCPs install the treatment plan using MIDS (T2D/long-acting insulin dosing/automatic/mobile app + web-based platform)</li>
 <li>My Dose Coach&nbsp;(Sanofi, Approved by authorities and available in KSA &amp; KWT) The HCPs can create an individualized dose plan on a Web-based portal. Patients need to manually input their fasting blood glucose levels and insulin dosing once daily, along with any incidences of hypoglycemia in the mobile app. Based on these inputs, the app tells users whether and by how much to adjust their dose (shares reports with HCPs/T2D/long-acting insulin dosing/manual entry/mobile app + web-based portal) 
 &nbsp;</li>
 </ul></li>
 <li>Mealtime insulin calculators:
 <ul>
 <li>InPen (Companion Medical): Shares reports with HCPs, sends reminders, and monitors insulin temperature (insulin on board [IOB]) (type 1 diabetes [T1D] and T2D/rapid-acting insulin dosing/manual entry/pen connected with app by Bluetooth)</li>
 <li>Accu-Chek Bolus Advisor (Roche): Shares reports with HCPs and calculates IOB (T1D and T2D/rapid-acting insulin dosing/manual entry/mobile app + web-based portal)</li>
 </ul></li>
</ul>

Insulin titration and technology-based solutions

<h2>Hypoglycemia1</h2>
<h3>Symptoms of Low Blood Glucose</h3>
An individual may not always recognize symptoms of low blood glucose.
These common symptoms, and others, may indicate low blood glucose.
Hypoglycemia (low blood glucose) happens when blood glucose drops below optimal levels.
A blood glucose of 70 mg/dl or less is considered hypoglycemia usually occurs in people who take insulin or certain diabetes pills; although, it can happen to anyone with diabetes.

<h2>Hypoglycemia may result from one or more of the following:</h2>
<ul>
 <li>Taking too much diabetes medication</li>
 <li>Delaying or skipping a meal</li>
 <li>Not eating enough carbohydrate at your meal</li>
 <li>Exercising harder or more than usual</li>
</ul>

<h2>Follow the Rule of 15 - to treat hypoglycemia</h2>
<h3>Step 1</h3>
Check your blood glucose. If it is below 70 mg/dl, eat or drink 15 grams of carbohydrate. Examples include:
<ul>
 <li>3-4 glucose tablets</li>
 <li>15-gram tube of glucose gel or liquid</li>
 <li>1/2 cup fruit juice</li>
 <li>1/2 cup regular soda</li>
</ul>
If you cannot check your blood glucose right away, eat or drink 15 grams of carbohydrate just to be safe.
<h3>Step 2</h3>
Wait&nbsp;15 minutes&nbsp;- this is important! It takes 15 minutes to feel better, no matter how much carbohydrate you use to treat the low blood glucose.
<h3>Step 3</h3>
Check your blood glucose again. If your blood glucose level is still low (&lt;70 mg/dl), or if you still have symptoms, repeat steps 1 through 3.
If you still have a low blood glucose after the three checks, call 997.
<h3>Step 4</h3>
Check your blood glucose one hour after treatment, as additional carbohydrate may be needed if you don't have a meal or snack planned. (Blood glucose levels tend to drop about one hour after treatment.).py: Up-titration to 150 mg Q2W occurred at week 12 in 17% of patients who did not achieve their predefined target LDL-C at week 8. Overall, 84% had clinical ASCVD.1

Reference

Hypoglycemia

<h2>What is Diabetes?</h2>
Diabetes is a chronic (long-lasting) disease that affects how your body turns food into energy.
Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. Your pancreas makes a hormone called insulin, which acts like a key to let the blood sugar into your body's cells for use as energy.
If you have diabetes, your body either doesn't make enough insulin or can't use the insulin it makes as well as it should. When there isn't enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream, which over time can cause serious health problems, such as heart disease, vision loss, and kidney disease.
There isn't a cure yet in diabetes, but healthy lifestyle habits, taking medicine as needed, getting diabetes self-management education, and keeping appointments with your health care team can greatly reduce its impact on your life.

<h2>Types of Diabetes1</h2>
There are three main types of diabetes: type 1, type 2, and gestational diabetes (diabetes while pregnant).

<h2>Type 1 Diabetes</h2>
is caused by an autoimmune reaction (the body attacks itself by mistake) that stops your body from making insulin. About 5% of the people who have diabetes have type 1. Symptoms of type 1 diabetes often develop quickly. It's usually diagnosed in children, teens, and young adults. If you have type 1 diabetes, you'll need to take insulin every day to survive. Currently, no one knows how to prevent type 1 diabetes.

<h2>Type 2 Diabetes</h2>
your body doesn't use insulin well and is unable to keep blood sugar at normal levels. Most people with diabetes -9 and 10- have type 2 diabetes. It develops over many years and is usually diagnosed in adults (though increasingly in children, teens, and young adults). You may not notice any symptoms, so it's important to get your blood sugar tested if you're at risk. Type 2 diabetes can be prevented or delayed with healthy lifestyle changes, such as losing weight if you're overweight, healthy eating, and getting regular physical activity.

<h2>Gestational Diabetes</h2>
develops in pregnant women who have never had diabetes. If you have gestational diabetes, your baby could be at higher risk for health complications. Gestational diabetes usually goes away after your baby is born but increases your risk for type 2 diabetes later in life. Your baby is more likely to become obese as a child or teen, and more likely to develop type 2 diabetes later in life too.

<h2>Symptoms of Diabetes?2</h2>
People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms:
<ul>
 <li>Frequent urination</li>
 <li>Excessive thirst</li>
 <li>Unexplained weight loss</li>
 <li>Extreme hunger</li>
 <li>Sudden vision changes</li>
 <li>Tingling or numbness in hands or feet</li>
 <li>Feeling very tired much of the time</li>
 <li>Very dry skin</li>
 <li>Sores that are slow to heal</li>
 <li>More infections than usual</li>
</ul>
Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes now called Type 1 diabetes.

<h2>Who's at Risk?3</h2>
You're at risk for developing type 2 diabetes if you:
<ul>
 <li>Have prediabetes</li>
 <li>Are overweight</li>
 <li>Are 45 years or older</li>
 <li>Have a parent, brother, or sister with type 2 diabetes</li>
 <li>Are physically active less than 3 times a week</li>
 <li>Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than 9 pounds</li>
 <li>Are African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islander and Asian Americans are also at higher risk)</li>
</ul>
You can prevent or delay type 2 diabetes with simple, proven lifestyle changes such as losing weight if you're overweight, eating healthier, and getting regular physical activity.

<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td style="width: 20%; background-color: rgb(172, 180, 22);">
 Result</td>
 <td style="width: 20%; background-color: rgb(172, 180, 22);">
 A1C Test</td>
 <td style="width: 20%; background-color: rgb(172, 180, 22);">
 Fasting Blood Sugar Test</td>
 <td style="width: 20%; background-color: rgb(172, 180, 22);">
 Glucose Tolerance Test</td>
 <td style="width: 20%; background-color: rgb(172, 180, 22);">
 Random Blood Sugar Test</td>
 </tr>
 <tr>
 <td>
 Normal</td>
 <td>
 Below 5.7%</td>
 <td>
 99&nbsp;mg/dL or below</td>
 <td>
 140 mg/dL or below</td>
 <td>
 &nbsp;</td>
 </tr>
 <tr>
 <td>
 Prediabetes</td>
 <td>
 5.7 - 6.4%</td>
 <td>
 100 - 125 mg/dL</td>
 <td>
 140 - 190 mg/dL</td>
 <td>
 &nbsp;</td>
 </tr>
 <tr>
 <td>
 Diabetes</td>
 <td>
 6.5% or above</td>
 <td>
 126 mg/dL or above</td>
 <td>
 200 mg/dL or above</td>
 <td>
 200 mg/dL or above</td>
 </tr>
 </tbody>
</table>

Integrated Diabetes Care

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