The Diabeo Software Enabling Individualized Insulin Dose Adjustments Combined With Telemedicine Support Improves HbA1c in Poorly Controlled Type 1 Diabetic Patients

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Abstract

OBJECTIVE

To demonstrate that Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support significantly improves HbA _1c in poorly controlled type 1 diabetic patients.

RESEARCH DESIGN AND METHODS

In a six-month open-label parallel-group, multicenter study, adult patients ( n = 180) with type 1 diabetes (>1 year), on a basal-bolus insulin regimen (>6 months), with HbA _1c ≥8%, were randomized to usual quarterly follow-up (G1), home use of a smartphone recommending insulin doses with quarterly visits (G2), or use of the smartphone with short teleconsultations every 2 weeks but no visit until point end (G3).

RESULTS

Six-month mean HbA _1c in G3 (8.41 ± 1.04%) was lower than in G1 (9.10 ± 1.16%; P = 0.0019). G2 displayed intermediate results (8.63 ± 1.07%). The Diabeo system gave a 0.91% (0.60; 1.21) improvement in HbA _1c over controls and a 0.67% (0.35; 0.99) reduction when used without teleconsultation. There was no difference in the frequency of hypoglycemic episodes or in medical time spent for hospital or telephone consultations. However, patients in G1 and G2 spent nearly 5 h more than G3 patients attending hospital visits.

CONCLUSIONS

The Diabeo system gives a substantial improvement to metabolic control in chronic, poorly controlled type 1 diabetic patients without requiring more medical time and at a lower overall cost for the patient than usual care.

Related collections

Most cited references 15

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Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial.

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To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes. Randomised design with participants either attending training immediately (immediate DAFNE) or acting as waiting list controls and attending "delayed DAFNE" training 6 months later. Secondary care diabetes clinics in three English health districts. 169 adults with type 1 diabetes and moderate or poor glycaemic control. Glycated haemoglobin (HbA(1c)), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL). At 6 months, HbA(1c) was significantly better in immediate DAFNE patients (mean 8.4%) than in delayed DAFNE patients (9.4%) (t=6.1, P<0.0001). The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients (t=-5.4, P<0.0001), as was the impact of diabetes on overall quality of life (t=2.9, P<0.01). General wellbeing and treatment satisfaction were also significantly improved, but severe hypoglycaemia, weight, and lipids remained unchanged. Improvements in "present quality of life" did not reach significance at 6 months but were significant by 1 year. Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk. This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation.

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The purpose of this report is to summarize and integrate the findings of the Diabetes Control and Complications Trial (DCCT), a randomized controlled clinical trial, and the succeeding observational follow-up of the DCCT cohort in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, regarding the effects of intensive treatment on the microvascular complications of type 1 diabetes mellitus. The DCCT proved that intensive treatment reduced the risks of retinopathy, nephropathy, and neuropathy by 35% to 90% compared with conventional treatment. The absolute risks of retinopathy and nephropathy were proportional to the mean glycosylated hemoglobin (HbA(1c)) level over the follow-up period preceding each event. Intensive treatment was most effective when begun early, before complications were detectable. These risk reductions, achieved at a median HbA(1c) level difference of 9.1% for conventional treatment vs 7.3% for intensive treatment have been maintained through 7 years of EDIC, even though the difference in mean HbA(1c) levels of the 2 former randomized treatment groups was only 0.4% at 1 year (P<.001) (8.3% in the former conventional treatment group vs 7.9% in the former intensive treatment group), continued to narrow, and became statistically nonsignificant by 5 years (8.1% vs 8.2%, P =.09). The further rate of progression of complications from their levels at the end of the DCCT remains less in the former intensive treatment group. Thus, the benefits of 6.5 years of intensive treatment extend well beyond the period of its most intensive implementation. Intensive treatment should be started as soon as is safely possible after the onset of type 1 diabetes mellitus and maintained thereafter, aiming for a practicable target HbA(1c) level of 7.0% or less.

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Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring.

Dorothee Deiss, Jan Bolinder, Jean-Pierre Riveline … (2006)

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Author and article information

Journal

Journal ID (nlm-ta): Diabetes Care

Journal ID (hwp): diacare

Journal ID (pmc): dcare

Journal ID (publisher-id): Diabetes Care

Title: Diabetes Care

Publisher: American Diabetes Association

ISSN (Print): 0149-5992

ISSN (Electronic): 1935-5548

Publication date (Print): March 2011

Publication date (Electronic): 17 February 2011

Volume: 34

Issue: 3

Pages: 533-539

Affiliations

[1] ¹Department of Diabetes and the Centre d’Études et de Recherche pour l’Intensification du Traitement du Diabète, Sud-Francilien Hospital, Corbeil-Essonnes, France

[2] ²Department of Endocrinology, University Hospital, Grenoble, France

[3] ³Department of Endocrinology, University Hospital, Besançon, France

[4] ⁴University Hospital Sainte Marguerite, Marseille, France

[5] ⁵Department of Endocrinology, CHU Bordeaux, Pessac, France

[6] ⁶Department of Diabetology, Toulouse Rangueil University Hospital, Toulouse, France

[7] ⁷Clinique d’Endocrinologie, Maladies Métaboliques et Nutrition, Institut du Thorax, Hôpital Laennec, Nantes, France

[8] ⁸Endocrinology Department, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, Montpellier, France

[9] ⁹CIC-INSERM, Grenoble University Hospital, Grenoble, France

Author notes

Corresponding author: Guillaume Charpentier, kerbonac@ 123456free.fr .

J.-L.B. and A.P. contributed equally to this work.

Article

Publisher ID: 1259

DOI: 10.2337/dc10-1259

PMC ID: 3041176

PubMed ID: 21266648

SO-VID: 137c4a4a-ddaa-45f3-9dc1-1c34add528a3

License:

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