[Show abstract][Hide abstract] ABSTRACT: To identify psychosocial factors associated with the use of continuous glucose monitoring by adults with Type 1 diabetes.
Twenty adult patients (aged 45 +/- 15 years, diabetes duration 25 +/- 19 years, 50% female) followed at our site in the multi-centre Juvenile Diabetes Research Foundation continuous glucose monitoring trial were divided into three groups: Glycated haemoglobin (HbA(1c)) Responders who demonstrated an improvement in glycaemic control with continuous glucose monitoring (baseline HbA(1c)> or = 7.0%, HbA(1c) reduction greater than or equal to 0.5%), Hypoglycaemia Responders (baseline HbA(1c) < 7.0%) who demonstrated decreased time < 3.9 mmol/l while remaining within target HbA(1c), and HbA(1c) Non-Responders (baseline HbA(1c)> or = 7.0%, HbA(1c) reduction less than 0.5%). Subjects participated in semi-structured interviews focusing on their psychosocial experiences with continuous glucose monitoring.
Three major themes were identified that differentiated Responders (including both the HbA(1c) and Hypoglycaemia groups) from Non-Responders: (i) coping with frustrations-Responders used self-controlled rather than emotions-based coping when faced with continuous glucose monitoring frustrations; (ii) use of information-Responders used retrospective pattern analysis, not just minute-by-minute data analysis, in glycaemic management; (iii) 'significant other'/spousal involvement-Responders endorsed interest, encouragement and participation by their loved ones. Both Responders and Non-Responders expressed body image concerns when wearing continuous glucose monitoring devices.
This qualitative study points to the importance of coping skills, retrospective review of data, and 'significant other' involvement in the effective use of continuous glucose monitoring. These findings will inform clinical initiatives to improve patient selection and training in the use of this new technology and have served as the basis for development of quantitative surveys to be used in clinical practice.
Diabetic Medicine 09/2010; 27(9):1060-5. DOI:10.1111/j.1464-5491.2010.03061.x · 3.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The continuous subcutaneous insulin infusion (CSII) is an established form of insulin therapy for patients with type 1 diabetes mellitus. The vision, the development of an artificial pancreas (closed-loop) is not yet realized. One important precondition for this to achieve, the availability of continuous glucose monitoring (CGM), is given. The combination of CSII and CGM turns CSII into a new form of therapy, the sensor-augmented pump therapy (SaP). The superiority of SaP over classic CSII has been proven in randomised, controlled clinical trials. In this article, we review this new possibility of insulin therapy.
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