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Publications (245)
OBJECTIVE
This study aimed to explore the relationship between time below range (TBR), impaired awareness of hypoglycemia (IAH), and severe hypoglycemia (SH).
RESEARCH DESIGN AND METHODS
This cross-sectional study analyzed data from individuals with diabetes using continuous glucose monitors (CGMs) in the Association of British Clinical Diabetolog...
Background: Intermittent scanning continuous glucose monitoring (is-CGM) technology has gained widespread adoption and is known to improve glycemic control and quality of life for persons with diabetes. The elderly may lag behind in their adoption of the technology, which could be a potential avenue for improving quality of care. In this study, we...
This article summarises the Joint British Diabetes Societies for Inpatient Care (JBDS‐IP) Group guidelines on the use of technology to support diabetes care in hospital. The guideline incorporates two main areas: (i) use of wearable technology devices to improve diabetes management in hospital (including continuous glucose monitoring and insulin pu...
OBJECTIVE
Use of continuous glucose monitoring (CGM) has led to greater detection of hypoglycemia; the clinical significance of this is not fully understood. The Hypoglycaemia–Measurement, Thresholds and Impacts (Hypo-METRICS) study was designed to investigate the rates and duration of sensor-detected hypoglycemia (SDH) and their relationship with...
Aims/hypothesis
The aim of this work was to examine the impact of hypoglycaemia on daily functioning among adults with type 1 diabetes or insulin-treated type 2 diabetes, using the novel Hypo-METRICS app.
Methods
For 70 consecutive days, 594 adults (type 1 diabetes, n=274; type 2 diabetes, n=320) completed brief morning and evening Hypo-METRICS ‘c...
Aim
To assess the differential association of risk factors with severe and non‐severe hypoglycaemia.
Materials and Methods
The Hypoglycaemia Assessment Tool study evaluated the risk of hypoglycaemia over a 4‐week period in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) on insulin in 24 countries. Negative binomial regressions were a...
Background: Connected insulin pens capture data on insulin dosing/timing and can integrate with continuous glucose monitoring (CGM) devices with essential insulin and glucose metrics combined into a single platform. Standardization of connected insulin pen reports is desirable to enhance clinical utility with a single report. Methods: An internatio...
Introduction: This study examined associations between hypoglycemia awareness status and hypoglycemia symptoms reported in real-time using the novel Hypoglycaemia-MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone application (app) among adults with insulin-treated type 1 (T1D) or type 2 diabetes (T2D). Methods: Adults who experienced at...
Continuous glucose monitoring (CGM) usage has been shown to improve disease outcomes in people living with diabetes by facilitating better glycemic management. However, previous research has suggested that access to these devices can be influenced by nonmedical factors such as socioeconomic status and ethnicity. It is critical that equitable access...
Introduction: The present report celebrates the benchmarking of 100,000 MiniMed™ 780G system users in Europe, Middle East, and Africa (EMEA) and summarizes the major insights into the usability and outcomes of this system. Methods: Carelink Personal data (August 2020-August 2023) of users living in EMEA were analyzed. Continuous glucose monitoring-...
Aims
To assess the cost‐effectiveness of HARPdoc (Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised care), focussed upon cognitions and motivation, versus BGAT (Blood Glucose Awareness Training), focussed on behaviours and education, as adjunctive treatments for treatment‐r...
Introduction: Nocturnal hypoglycemia is generally calculated between 00:00 and 06:00. However, those hours may not accurately reflect sleeping patterns and it is unknown whether this leads to bias. We therefore compared hypoglycemia rates while asleep with those of clock-based nocturnal hypoglycemia in adults with type 1 diabetes (T1D) or insulin-t...
People living with diabetes have many medical devices available to assist with disease management. A critical aspect that must be considered is how systems for continuous glucose monitoring and insulin pumps communicate with each other and how the data generated by these devices can be downloaded, integrated, presented and used. Not only is interop...
Background
The Hypoglycaemia – MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone app was developed to investigate the impact of hypoglycemia on daily functioning in adults with type 1 diabetes mellitus or insulin-treated type 2 diabetes mellitus. The app uses ecological momentary assessments, thereby minimizing recall bias and maximizin...
Aims
To determine the frequency, severity, burden, and utility of hypoglycaemia symptoms among adults with type 1 diabetes (T1D) and impaired awareness of hypoglycaemia (IAH) at baseline and week 24 following the HypoCOMPaSS awareness restoration intervention.
Methods
Adults (N=96) with T1D (duration: 29±12 years; 64% women) and IAH completed the...
Aim
Frequent hypoglycaemia results in disruption to usual hypoglycaemic autonomic responses leading to impaired awareness of hypoglycaemia, which is associated with an increased risk of severe hypoglycaemia requiring third‐party assistance (SH). The UK Driving and Vehicle Licensing Agency (DVLA) does not permit car driving if they have either a com...
Background:
Donor hyperglycaemia following brain death has been attributed to reversible insulin resistance. However, our islet and pancreas transplant data suggest that other mechanisms may be predominant. We aimed to determine the relationships between donor insulin use and markers of beta-cell death and beta-cell function in pancreas donors aft...
Objective:
We explored longitudinal changes associated with switching to hybrid closed loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy.
Research design and methods:
We undertook a pragmatic, prepla...
Aims:
To reassess the 6-month efficacy and to assess the 12-month sustained efficacy of the MiniMed™ 780G advanced hybrid closed-loop automated insulin delivery (AID) system compared to multiple daily injections plus intermittently scanned glucose monitoring (MDI+isCGM) in people with type 1 diabetes not meeting glucose targets.
Methods:
The ADA...
Background: Hyperglycemia is common among hospitalized patients and is associated with suboptimal outcomes. We investigated the impact of hyperglycemia in persons admitted with severe infection (diagnosis of infection according to the treating physician combined with either ≥2 qSOFA-criteria or ≥2 SIRS-criteria) with and without diabetes.
Methods:...
We aimed to compare weekly rates of sensor detected hypoglycemia (SDH), person reported hypoglycemia (PRH) and psychological outcomes in people with type 1 (T1D) and insulin treated type 2 diabetes (T2D) using routine continuous glucose monitoring (CGM) or capillary blood glucose monitoring (BGM) in the prospective observational Hypo-METRICS study....
Objectives:
To suggest how continuous glucose monitoring (CGM) may be used intermittently in individuals with type 2 diabetes (T2D).
Materials and methods:
The use of CGM is largely in those with type 1 diabetes (T1D), in whom it makes sense to use CGM continuously as CGM provides a valuable tool to not only adjust their insulin doses but also t...
Background:
When launched, FreeStyle Libre (FSL; a flash glucose monitor) onboarding was mainly conducted face-to-face. The COVID-19 pandemic accelerated a change to online starts with patients directed to online videos such as Diabetes Technology Network UK for education. We conducted an audit to evaluate glycemic outcomes in people who were onbo...
Background:
There has been a significant increase in the use of wearable diabetes technologies in the outpatient setting over recent years, but this has not consistently translated into inpatient use.
Methods:
An online survey was undertaken to understand the current use of technology to support inpatient diabetes care in the United Kingdom.
Re...
This best practice guide is written with the aim of providing an overview of current hybrid closed-loop (HCL) systems in use within the United Kingdom's (UK) National Health Service (NHS) and to provide education and advice for their management on both an individual and clinical service level. The environment of diabetes technology, and particularl...
Introduction
The aim of this study was to determine the acceptability and psychometric properties of the Hypo-METRICS (Hypoglycemia MEasurement, ThResholds and ImpaCtS) application (app): a novel tool designed to assess the direct impact of symptomatic and asymptomatic hypoglycemia on daily functioning in people with insulin-treated diabetes.
Mate...
People with diabetes admitted to hospital are at risk of diabetes related complications including hypoglycaemia and diabetic ketoacidosis. Point-of-care (POC) tests undertaken at the patient bedside, for glucose, ketones, and other analytes, are a key component of monitoring people with diabetes, to ensure safety. POC tests implemented with a quali...
Aims/hypothesis
The aims of this study were to assess cognitions relating to hypoglycaemia in adults with type 1 diabetes and impaired awareness of hypoglycaemia before and after the multimodal HypoCOMPaSS intervention, and to determine cognitive predictors of incomplete response (one or more severe hypoglycaemic episodes over 24 months).
Methods...
This article is the second of a two-part series providing a scoping review and summary of the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) guidelines on the use of diabetes technology in people with diabetes admitted to hospital. The first part reviewed the use of continuous glucose monitoring (CGM) in hospital. In this article, we...
Randomised controlled trials and other prospective clinical studies for novel medical interventions in people with diabetes have traditionally reported HbA1c as the measure of average blood glucose levels for the 3 months preceding the HbA1c test date. The use of this measure highlights the long-established correlation between HbA1c and relative ri...
Objectives:
Diabetes management presents a substantial burden to individuals living with the condition and their families, healthcare professionals, and healthcare systems. Although an increasing number of digital tools are available to assist with tasks such as blood glucose monitoring and insulin dose calculation, multiple persistent barriers co...
The National Institute for Clinical Excellence updated guidance for continuous glucose monitoring (CGM) in 2022, recommending that CGM be available to all people living with type 1 diabetes. Manufacturers can trade in the United Kingdom (UK) with Conformité Européenne (CE) marking without an initial national assessment. The regulatory process for C...
Increasing numbers of people, particularly with type 1 diabetes (T1D), are using wearable technologies. That is, continuous subcutaneous insulin infusion (CSII) pumps, continuous glucose monitoring (CGM) systems, and hybrid closed-loop systems, which combine both these elements. Given over a quarter of all people admitted to hospital have diabetes,...
The past 10 years have seen a revolution in technology improving the lives of people with diabetes. This has implications for diabetes care in hospitalized inpatients. These technological developments have the potential to significantly improve the care of people with diabetes in hospital. Combining point of care glucose monitoring, electronic pres...
Aims:
InRange is the first randomized controlled trial to use continuous glucose monitoring (CGM)-based time-in-range (TIR) as a primary efficacy endpoint to compare second-generation basal insulin (BI) analogs insulin glargine 300 U/mL (Gla-300) and insulin degludec 100 U/mL (IDeg-100) in adults with type 1 diabetes (T1D).
Materials and methods:...
The significant and growing global prevalence of diabetes continues to challenge people with diabetes (PwD), healthcare providers and payers. While maintaining near-normal glucose levels has been shown to prevent or delay the progression of the long-term complications of diabetes, a significant proportion of PwD are not attaining their glycemic goa...
Background
Adults with type 1 diabetes who are treated with multiple daily injections of insulin plus intermittently scanned continuous glucose monitoring (isCGM) can have suboptimal glucose control. We aimed to assess the efficacy of an advanced hybrid closed loop (AHCL) system compared with such therapy in this population.
Methods
The Advanced H...
Introduction:
With increasing access to continuous glucose monitoring (CGM), particularly intermittently scanned CGM (isCGM) (FreeStyle Libre), it is essential to understand the relationship between Time in Range (TIR) achieved using the isCGM with changes in glycaemic control, diabetes-related distress (DRD), and resource utilisation in people li...
BACKGROUND
The Hypoglycaemia – MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone app was developed to investigate the impact of hypoglycemia on daily functioning in adults with type 1 diabetes mellitus or insulin-treated type 2 diabetes mellitus. The app uses ecological momentary assessments, thereby minimizing recall bias and maximizin...
Aims:
To explore the association between use of glycaemic technologies and person-reported outcomes (PROs) in adults with type 1 diabetes (T1D).
Methods:
We included T1D and technology publications reporting on PROs since 2014. Only randomised controlled trials and cohort studies that used validated PRO measures (PROMs) were considered.
Results...
Aims/hypothesis:
Problematic hypoglycaemia still complicates insulin therapy for some with type 1 diabetes. This study describes baseline emotional, cognitive and behavioural characteristics in participants in the HARPdoc trial, which evaluates a novel intervention for treatment-resistant problematic hypoglycaemia.
Methods:
We documented a cross...
Impaired awareness of hypoglycemia (IAH) is attributed to hypoglycemia exposure. Continuous glucose monitoring (CGM) detects more hypoglycemia particularly during sleep. We compared rates and duration of sensor detected hypoglycemia (SDH) and patient reported hypoglycemia (PRH) in people with type 1 diabetes (T1D) using CGM or flash monitoring.We r...
Introduction: With increasing access to intermittently scanned continuous glucose monitoring (isCGM) , with the FSL, it is essential to understand the effect of TIR and TBR on HbA1c, DRD, and resource utilisation in people living with diabetes
Methods: Clinicians from 1NHS UK hospitals submitted FSL user data for16,034 participants, (96% type 1 dia...
Background: InRange has previously demonstrated that insulin glargine 300 U/mL (Gla-300) is non-inferior to insulin degludec 100 U/mL (IDeg-100) in terms of time in glucose range 70--180 mg/dL (primary endpoint) and total glucose coefficient of variation (CV) as measured by CGM in people with T1D.
Methods: InRange (NCT04075513) was a multicenter, r...
Background: Hypoglycemia and its impact on people with diabetes is typically reported retrospectively and is subject to recall bias. Ecological momentary assessment (EMA) uses repeated sampling to collect real time, granular data about patient experiences, typically over 3-5 days. We developed the Hypo-METRICS app to determine the physical, psychol...
Background: Restoration of symptoms in response to hypogycemia has been seen in people with type 1 diabetes (T1D) and impaired awareness of hypoglycaemia (IAH) using an education and diabetes technology approach (HypoAware Study) and a psycho-educational approach addressing cognitions (HARPdoc Trial) . We investigated regional brain responses to hy...
Objective: To assess the effect of the MiniMed™ 780G Advanced Hybrid Closed Loop (AHCL) system compared to MDI with isCGM (MDI+isCGM) therapy on treatment satisfaction (TS) and fear of hypoglycemia (FoH) , in adults with type 1 diabetes (T1D) with above-target baseline glycemic control participating in the ADAPT study.
Methods: Participants with T1...
Acute hypoglycemia impacts negatively on cognitive function. However, it remains unclear which specific domains of cognitive function are affected, and the extent to which level of hypoglycemia modifies this relationship. We conducted a systematic review and meta-analysis to investigate the impact of controlled hyperinsulinaemic hypoglycemia on cog...
Continuous glucose monitoring (CGM) allows greater detection of hypoglycemia. We compared rates and duration of sensor detected hypoglycemia (SDH) and patient reported hypoglycemia (PRH) in people with type 1 diabetes (T1D) and normal awareness of hypoglycemia (NAH) (Gold score >4) using either flash or capillary blood glucose (CGB) monitoring. We...
Aim: To examine how hypoglycemia while asleep impacts self-reported daily functioning among adults with type 1 diabetes (T1D) .
Methods: On 70 consecutive mornings, 250 people with T1D wearing a continuous glucose monitor reported sleep quality, mood, and alertness via the Hypo-METRICS smartphone app. Each night was categorized based on presence (+...
Introduction:
Hypoglycaemia is a significant burden to people living with diabetes and an impediment to achieving optimal glycaemic outcomes. The use of continuous glucose monitoring CGM has improved capacity to assess duration and level of hypoglycaemia. The personal impact of sensor-detected hypoglycaemia SDH is unclear. Hypo-METRICS is an obser...
Background and objective
In type 1 diabetes (T1D) research, in-silico clinical trials (ISCTs) notably facilitate the design/testing of new therapies. Published simulation tools embed mathematical models of blood glucose (BG) and insulin dynamics, continuous glucose monitoring (CGM) sensors, and insulin treatments, but lack a realistic description o...
Background and aims:
We report normative glucose metrics for time in ranges ( % TIR 3.9-10 mmol/L, %TBR <3.9 mmol/L and %TAR >10 mmol/L) for UK adult FreeStyle Libre (FSL) users within 4 defined age-groups and observed changes during the COVID-19 pandemic on these over time.
Methods:
Data was extracted from 8,914 LibreView de-identified user acc...
Impaired awareness of hypoglycaemia (IAH) is a major risk for severe hypoglycaemia in insulin treatment of type 1 diabetes (T1D). To explore the hypothesis that unhelpful health beliefs create barriers to regaining awareness, we conducted a multi-centre, randomised, parallel, two-arm trial (ClinicalTrials.gov NCT02940873) in adults with T1D and tre...
Just a few years ago FreeStyle Libre (FSL) was a rarely encountered device, used only by a select few people with type 1 diabetes who could afford to self-fund it. This small disc has a small cannula under the skin which allows for interstitial glucose measurements and remains in situ for 14 days. Over the last 4 years the number of people with acc...
Background:
A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data.
Methods:
We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who...
Behavioural responses to hypoglycaemia require coordinated recruitment of broadly distributed networks of interacting brain regions. We investigated hypoglycaemia-related changes in brain connectivity in people without diabetes (ND) and with type 1 diabetes with normal (NAH) or impaired (IAH) hypoglycaemia awareness. Two-step hyperinsulinaemic hypo...
Introduction:
Hypoglycaemia is a frequent adverse event and major barrier for achieving optimal blood glucose levels in people with type 1 or type 2 diabetes using insulin. The Hypo-RESOLVE (Hypoglycaemia-Redefining SOLutions for better liVEs) consortium aims to further our understanding of the day-to-day impact of hypoglycaemia. The Hypo-METRICS...
Aims
This review considers the impact of the SARS-CoV-2 pandemic on access to interventions for those living with type 1 diabetes and discusses the solutions which have been considered and actioned to ensure ongoing access care.
Methods
We performed a focussed review of the published literature, and the guidelines for changes that have been effect...
Introduction:
Automated insulin delivery (AID) systems can enable improved glycaemic outcomes with reduced mental burden. Open-source AID (OS-AID) systems overcome some of the developmental and access barriers enabling a wider use of these systems. Limited data are available on healthcare professional (HCP) opinions and current practice regarding...
Objective:
The Hypoglycemia Fear Survey-II (HFS-II) is a well-validated measure of fear of hypoglycemia in people with type 1 diabetes. The aim of this study was to explore the relationships between hypoglycemia worries, behaviors, and cognitive barriers to hypoglycemia avoidance and hypoglycemia awareness status, severe hypoglycemia, and HbA1c....
Laboratory measured glycosylated hemoglobin (HbA1c) is the gold standard for assessing glycemic control in people with diabetes and correlates with their risk of long-term complications. The emergence of continuous glucose monitoring (CGM) has highlighted limitations of HbA1c testing. HbA1c can only be reviewed infrequently and can mask the risk of...
Aims:
Reliable estimation of the time spent in different glycemic ranges (time-in-ranges, TIRs) requires sufficiently long continuous glucose monitoring (CGM). In a 2019 paper (Battelino et al., Diabetes Care, 2019), an international panel of experts suggested using a correlation-based approach to obtain the minimum number of days for reliable TIR...
Background:
The COVID-19 pandemic has led to the rapid implementation of remote care delivery in type 1 diabetes. We studied current modes of care delivery, healthcare professional experiences and impact on insulin pump training in type 1 diabetes care in the United Kingdom (UK).
Methods:
The UK Diabetes Technology Network designed a 48-question...
Background and aim
The prevalence of diabetes is on its rise and South Asia bears a huge burden. Several factors such as heterogeneity in genetics, socio-economic factors, diet, and sedentary behavior contribute to the heightened risk of developing diabetes, its rapid progression, and the development of complications in this region. Even though the...
In diabetes management, the fraction of time spent with glucose concentration within the physiological range of [70−180] mg/dL, namely time in range (TIR) is often computed by clinicians to assess glycemic control using a continuous glucose monitoring sensor. However, a sufficiently long monitoring period is required to reliably estimate this index...
This chapter provides a comprehensive overview of diabetes care and management. It starts with a classification and diagnosis of diabetes, followed by sections on expert management of both Type 1 and Type 2 diabetes. Living with diabetes is then explored, from sports and exercise, travel, alcohol and recreational drug use, and special consideration...
Background: Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1c...
Objective
Severe hypoglycemia complicates insulin therapy for type 1 diabetes, with impaired awareness of hypoglycemia (IAH) being a major risk factor. We explored associations between the personality traits, alexithymia and perfectionism, and cognitive barriers to hypoglycemia avoidance described in IAH, and evaluated their prevalence in people wi...
Telemedicine in diabetes care has been evolving over several years, particularly since the advent of cloud-connected technologies for diabetes management, such as glucose monitoring devices, including continuous glucose monitoring (CGM) systems, that facilitate sharing of glucose data between people with diabetes and their healthcare professionals...
