Hybrid care model: Combining telemedicine and office visits for diabetes management in older adults with type 1 diabetes.

Aims: To evaluate the use of hybrid (telehealth and in-person) care on visitation and glycaemia in older adults with type 1 diabetes (T1D).

Methods: In this retrospective study, we examined clinical characteristics, number of visits (telehealth and in-person) and continuous glucose monitoring (CGM) metrics for older adults (≥65 years) with T1D from electronic health records during the pre-COVID-19 pandemic (March 1, 2019-March 1, 2020; in-person) and pandemic (September 1, 2020-August 31, 2021; hybrid) periods. Main outcomes were the number of visits and changes in glycaemic control (HbA1c), and in a sub-group of older adults using CGM, changes in CGM metrics between in-person and hybrid care.

How predictive of future healthcare utilisation and mortality is data-driven population segmentation based on healthcare utilisation and chronic condition comorbidity?

Background: In recent years data-driven population segmentation using cluster analyses of mainly health care utilisation data has been used as a proxy of future health care need. Chronic conditions patterns tended to be examined after segmentation but may be useful as a segmentation variable which, in combination with utilisation could indicate severity. These could further be of practical use to target specific clinical groups including for prevention.

Self-care barriers and facilitators in older adults with T1D during a time of sudden isolation.

Older adults with type 1 diabetes (T1D) have unique challenges and needs. In this mixed-methods study, we explored the impact of isolation during a pandemic on diabetes management and overall quality of life in this population. Older adults (age ≥ 65 years) with T1D receiving care at a tertiary care diabetes center participated in semi-structured interviews during COVID-19 pandemic isolation between June and August 2020.

Use of Telemedicine in Adults with Type 1 Diabetes: Do Age and Use of Diabetes-Related Technology Matter?

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Use of Telecommunication and Diabetes-Related Technologies in Older Adults With Type 1 Diabetes During a Time of Sudden Isolation: Mixed Methods Study.

Background: The COVID-19 lockdown imposed a sudden change in lifestyle with self-isolation and a rapid shift to the use of technology to maintain clinical care and social connections.

Objective: In this mixed methods study, we explored the impact of isolation during the lockdown on the use of technology in older adults with type 1 diabetes (T1D).

Methods: Older adults (aged ≥65 years) with T1D using continuous glucose monitoring (CGM) participated in semistructured interviews during the COVID-19 lockdown.

Impact of Diabetes Duration on Functional and Clinical Status in Older Adults With Type 1 Diabetes.

Objective: Adults with type 1 diabetes (T1D) are aging successfully. The impact of diabetes duration on clinical and functional status as people age with T1D is not well known.

Research Design And Methods: We performed a cross-sectional study of older adults (age ≥65 years) with T1D.

Usefulness of CGM-Derived Metric, the Glucose Management Indicator, to Assess Glycemic Control in Non-White Individuals With Diabetes.

Objective: To assess the relationship between the glucose management indicator (GMI) and HbA in non-White individuals with diabetes.

Research Design And Methods: We performed a retrospective analysis of continuous glucose monitoring metrics in individuals with diabetes divided by race into non-White and White cohorts.

Results: We evaluated 316 individuals (non-White = 68; White = 248).

Closed-Loop Insulin Therapy in Older Adults with Type 1 Diabetes: Real-World Data.

To assess the impact of initiation of closed-loop control (CLC) on glycemic metrics in older adults with type 1 diabetes (T1D) in the real world. Retrospective analysis of electronic health records from a single tertiary diabetes center of older adults prescribed CLC between January and December 2020. Forty-eight patients (mean age 70 ± 4 years, T1D duration 42 ± 14 years) were prescribed CLC and 39/48 started on the CLC.

Use of Technology in Older Adults with Type 1 Diabetes: Clinical Characteristics and Glycemic Metrics.

The use of diabetes-related technology, both for insulin administration and glucose monitoring, has shown benefits in older adults with type 1 diabetes (T1D). However, the characteristics of older adults with T1D and their use of technology in real-world situations are not well documented. Older adults (age ≥65 years) with T1D, using insulin pump or multiple daily injections (MDI) for insulin administration, and continuous glucose monitoring (CGM) or glucometer (blood glucose monitoring [BGM]) for glucose monitoring were evaluated.

The Relationship Between CGM-Derived Metrics, A1C, and Risk of Hypoglycemia in Older Adults With Type 1 Diabetes.

Objective: Continuous glucose monitoring (CGM) is now commonly used in the management of type 1 diabetes (T1D). The CGM-derived coefficient of variation (CV) measures glucose variability, and the glucose management indicator (GMI) measures mean glycemia (previously called estimated A1C). However, their relationship with laboratory-measured A1C and the risk of hypoglycemia in older adults with T1D is not well studied.

Evaluation of a national lung cancer symptom awareness campaign in Wales.

Background: Lung cancer is the leading cause of cancer mortality in Wales. We conducted a before- and after- study to evaluate the impact of a four-week mass-media campaign on awareness, presentation behaviour and lung cancer outcomes.

Methods: Population-representative samples were surveyed for cough symptom recall/recognition and worry about wasting doctors' time pre-campaign (June 2016; n = 1001) and post-campaign (September 2016; n = 1013).

Examining the Relationship Between Pre- and Postprandial Glucose Levels and Insulin Bolus Timing Using Bluetooth-Enabled Insulin Pen Cap Technology and Continuous Glucose Monitoring.

Timing of insulin administration in persons using multiple daily injections (MDI) is self-reported. New technology enabling tracking and logging of insulin doses, combined with continuous glucose monitoring (CGM), may provide insight into the relationship between insulin administration and glucose levels. We performed a prospective observational study using Bluetooth-enabled pen caps, along with CGM, in participants with type 1 diabetes (T1D) on MDI to objectively assess the relationship between the timing of insulin administration and its impact on pre- and postprandial glucose levels for a 2-week period.

Nonadherence to Insulin Therapy Detected by Bluetooth-Enabled Pen Cap Is Associated With Poor Glycemic Control.

Objective: To objectively evaluate adherence to timing and dosing of insulin by using Bluetooth pen caps and examine factors related to adherence.

Research Design And Methods: Bluetooth-enabled insulin pen caps were used in younger (ages 18-35 years) and older (ages ≥65 years) adults on two or more insulin injections per day.

Results: We evaluated 75 participants with diabetes, 42 younger (29 ± 4 years) and 33 older (73 ± 7 years).

Liberating A1C goals in older adults may not protect against the risk of hypoglycemia.

Aims: Hemoglobin A1C is universally used as a marker for glycemic control and to establish glycemic goals in patients with diabetes. In the older population, experts recommend liberating A1C goals to decrease the risk of hypoglycemia. However, it's not clear which A1C level is optimal for this purpose.

Shortfalls of the use of HbA1C-derived eAG in older adults with diabetes.

Aims: The hemoglobin HbA1C (HbA1C) value, translated into estimated average glucose concentration (eAG), is commonly used to assess glycaemic control and manage treatment regimens in people with diabetes. However, the relationships among HbA1C-derived eAG, and mean glucose concentration derived from continuous glucose monitoring (CGM) in different populations have not been well studied. We examined this relationship in older people with diabetes and compared the results to those currently used in clinical practice.