DYNAMIC: dynamic glucose management strategies delivered through a structured education program improves time in range in a socioeconomically deprived cohort of children and young people with type 1 diabetes with a history of hypoglycemia

John S Pemberton, Melanie Kershaw, Renuka Dias, Jan Idkowiak, Zainab Mohamed, Vrinda Saraff, Timothy G Barrett, Ruth Krone, Suma Uday

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

OBJECTIVES: Create and evaluate the effectiveness of a structured education program in children and young people (CYP) with type 1 diabetes using continuous glucose monitoring (CGM).

DESIGN AND METHODS: Step 1: CGM devices were evaluated for predetermined criteria using a composite score. Step 2: The education program was developed following review of international structured education guidance, dynamic glucose management (DynamicGM) literature, award-winning diabetes educators' websites, and CGM user feedback. Step 3: Program effectiveness was assessed at six months by change in time below range (TBR) (<3.9mmol/L), time in range (TIR) (3.9-10.0mmol/L), time above range level 2 (TAR2) (>13.9mmol/L), severe hypoglycemia and HbA1c using a paired T-test. A DynamicGM score was developed to assess proactive glucose management. Factors predicting TBR and TIR were assessed using regression analysis.

RESULTS: Dexcom G6 was chosen for integrated CGM (iCGM) status and highest composite score (29/30). Progressive DynamicGM strategies were taught through five sessions delivered over two months. Fifty CYP (23 male) with a mean (±SD) age and diabetes duration of 10.2 (±4.8) and 5.2 (±3.7) years respectively, who completed the education program were prospectively evaluated. Evaluation at six months showed a significant reduction in TBR (10.4% to 2.1%, p<.001), TAR2 (14.1% to 7.3%, p<.001), HbA1c [7.4 to 7.1% (57.7 to 53.8 mmol/mol), p<.001] and severe hypoglycemic episodes (10 to 1, p<.05); TIR increased (47.4% to 57.0%, p<.001). Number of Dexcom followers (p<.05) predicted reduction in TBR and DynamicGM score (p<.001) predicted increased TIR.

CONCLUSION: Teaching DynamicGM strategies successfully improves TIR and reduces hypoglycemia.

Original languageEnglish
Pages (from-to)249-260
Number of pages12
JournalPediatric Diabetes
Volume22
Issue number2
Early online date17 Nov 2020
DOIs
Publication statusPublished - Mar 2021

Keywords

  • continuous glucose monitoring
  • structured education
  • Hypoglycemia
  • pediatric type 1
  • cost analysis

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