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Article ; Online: Emerging technologies for the management of type 2 diabetes mellitus.

Shah, Nirali A / Levy, Carol J

2021 Volume 13, Issue 9, Page(s) 713–724

Abstract: Diabetes mellitus is a global health problem affecting 422 million people worldwide, of which 34.2 million live in the United States alone. Complications due to diabetes can lead to considerable morbidity and mortality related to both microvascular and ... ...

Abstract	Diabetes mellitus is a global health problem affecting 422 million people worldwide, of which 34.2 million live in the United States alone. Complications due to diabetes can lead to considerable morbidity and mortality related to both microvascular and macrovascular disease. While glycosylated hemoglobin testing is the standard test utilized to evaluate glycemic control, emerging targets like "time in range" and "glycemic variability" often provide more accurate assessments of glycemic fluctuations and have implications for diabetes complications and quality of life. Patients with diabetes face considerable burdens of self-care including frequent glucose monitoring, multiple insulin injections, dietary management, and the need to track daily activities, all of which lead to reduced adherence and psychological burnout. From the provider perspective, limited patient data and access to self-management tools lead to treatment inertia and a reduced ability to help patients achieve and maintain their glycemic goals. In the past few decades, there have been considerable advances in treatment-based technology and technological applications designed to help reduce patient burden and provide tools for better self-management. These advances make real-time clinical data available for clinicians to make necessary changes in treatment regimens. In this review, we discuss the latest emerging technologies available for the management of people with type 2 diabetes mellitus.
MeSH term(s)	Blood Glucose/metabolism ; Cost-Benefit Analysis ; Delivery of Health Care/economics ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/physiopathology ; Diabetes Mellitus, Type 2/therapy ; Diet ; Humans ; Hypoglycemic Agents/therapeutic use ; Insulin/administration & dosage ; Insulin/therapeutic use ; Life Style ; Mobile Applications ; Patient Compliance ; Quality of Life
Chemical Substances	Blood Glucose ; Hypoglycemic Agents ; Insulin
Language	English
Publishing date	2021-05-11
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	2503337-2
ISSN	1753-0407 ; 1753-0393
ISSN (online)	1753-0407
ISSN	1753-0393
DOI	10.1111/1753-0407.13188
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Zs.A 6791: Show issues

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Article ; Online: Expert Guidance on Off-Label Use of Hybrid Closed-Loop Therapy in Pregnancies Complicated by Diabetes.

Szmuilowicz, Emily D / Levy, Carol J / Buschur, Elizabeth O / Polsky, Sarit

Diabetes technology & therapeutics

2023 Volume 25, Issue 5, Page(s) 363–373

Abstract: Automated insulin delivery (AID) systems have established benefits in terms of glycemic control, health outcomes, and quality of life and are strongly recommended for people with type 1 diabetes outside of pregnancy. While evidence for use of ... ...

Abstract	Automated insulin delivery (AID) systems have established benefits in terms of glycemic control, health outcomes, and quality of life and are strongly recommended for people with type 1 diabetes outside of pregnancy. While evidence for use of investigational AID systems during pregnancy is promising, data and guidance are still needed regarding use of commercially available systems during pregnancy. Unfortunately, none of the hybrid closed-loop (HCL) systems that are currently available in the United States have glucose targets that are as aggressive as pregnancy glycemic targets, none have a pregnancy-specific algorithm, and none are approved for use during pregnancy. As such, any use of these systems during pregnancy is considered off-label in the United States and would be "assisted" by provider/user techniques. Despite these limitations, many women conceive while using clinically available HCL systems and may be hesitant to cease use during pregnancy. Achievement of strict pregnancy glycemic targets can be difficult, and it is conceivable that selective off-label use of clinically available HCL systems in some women could lead to improved glycemia. We herein offer expert guidance based on clinical experience and available case reports on how to identify appropriate candidates for HCL therapy in pregnancy, how to counsel pregnant women with diabetes on the potential risks and benefits of HCL therapy during pregnancy, and how to manage commercially available systems off-label throughout gestation in an assisted HCL approach.
MeSH term(s)	Female ; Humans ; Pregnancy ; Hypoglycemic Agents/therapeutic use ; Off-Label Use ; Insulin/therapeutic use ; Quality of Life ; Blood Glucose ; Insulin Infusion Systems ; Diabetes Mellitus, Type 1/drug therapy ; Blood Glucose Self-Monitoring
Chemical Substances	Hypoglycemic Agents ; Insulin ; Blood Glucose
Language	English
Publishing date	2023-03-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1452816-2
ISSN	1557-8593 ; 1520-9156
ISSN (online)	1557-8593
ISSN	1520-9156
DOI	10.1089/dia.2022.0540
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Zs.A 5269: Show issues

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Article: The Current and Future Role of Insulin Therapy in the Management of Type 2 Diabetes: A Narrative Review.

McGill, Janet B / Hirsch, Irl B / Parkin, Christopher G / Aleppo, Grazia / Levy, Carol J / Gavin, James R

Diabetes therapy : research, treatment and education of diabetes and related disorders

2024 Volume 15, Issue 5, Page(s) 1085–1098

Abstract: Early initiation of intensive insulin therapy has been demonstrated to be effective in controlling glycemia and possibly preserving beta-cell function. Innovations in insulin formulations and delivery systems continue. However, we have seen an ... ...

Abstract	Early initiation of intensive insulin therapy has been demonstrated to be effective in controlling glycemia and possibly preserving beta-cell function. Innovations in insulin formulations and delivery systems continue. However, we have seen an acceleration in the development of new classes of diabetes medications for individuals with type 2 diabetes and obesity, such as, for example, glucagon-like peptide-1 receptor agonists (GLP-1 RAs). These formulations have been shown to confer significant benefits in achieving good glycemic control with reduced hypoglycemia risk, weight loss, and cardiorenal protection. Therefore, it is reasonable to question whether there is still a role for insulin therapy in the management of type 2 diabetes. However, there are clear limitations inherent to GLP-1 RA therapy, including high rates of suboptimal adherence and treatment discontinuation due to high cost and side effects, which diminish long-term efficacy, and supply issues. In addition, newer formulations have shown improvements in convenience and tolerability, and have been shown to be even more effective when used in conjunction with basal insulin. In this narrative review, we discuss current evidence that supports GLP-1 RA use in combination with insulin therapy and the potential pitfalls of reliance on GLP-1 RAs as a substitute for insulin therapy.
Language	English
Publishing date	2024-04-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2566702-6
ISSN	1869-6961 ; 1869-6953
ISSN (online)	1869-6961
ISSN	1869-6953
DOI	10.1007/s13300-024-01569-8
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Article: Automated Insulin Delivery Systems as a Treatment for Type 2 Diabetes Mellitus: A Review.

Karol, Alexander B / O'Malley, Grenye / Fallurin, Reshmitha / Levy, Carol J

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

2022 Volume 29, Issue 3, Page(s) 214–220

Abstract: Objective: Approximately 6.3% of the worldwide population has type 2 diabetes mellitus (T2DM), and the number of people requiring insulin is increasing. Automated insulin delivery (AID) systems integrate continuous subcutaneous insulin infusion and ... ...

Abstract	Objective: Approximately 6.3% of the worldwide population has type 2 diabetes mellitus (T2DM), and the number of people requiring insulin is increasing. Automated insulin delivery (AID) systems integrate continuous subcutaneous insulin infusion and continuous glucose monitoring with a predictive control algorithm to provide more physiologic glycemic control. Personalized glycemic targets are recommended in T2DM owing to the heterogeneity of the disease. Based on the success of hybrid closed-loop systems in improving glycemic control and safety in type 1 diabetes mellitus, there has been further interest in the use of these systems in people with T2DM. Methods: We performed a review of AID systems with a focus on the T2DM population. Results: In 5 randomized controlled trials, AID systems improve time in range and reduce glycemic variability, without increasing insulin requirements or the risk of hypoglycemia. Conclusion: AID systems in T2DM are safe and effective in hospitalized and closely monitored settings. Home studies of longer duration are required to assess for long-term benefit and identify target populations of benefit.
MeSH term(s)	Humans ; Diabetes Mellitus, Type 2/drug therapy ; Hypoglycemic Agents/therapeutic use ; Blood Glucose Self-Monitoring ; Blood Glucose ; Insulin Infusion Systems ; Insulin
Chemical Substances	Hypoglycemic Agents ; Blood Glucose ; Insulin
Language	English
Publishing date	2022-10-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1473503-9
ISSN	1530-891X
ISSN	1530-891X
DOI	10.1016/j.eprac.2022.10.001
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Article ; Online: All Children Deserve to Be Safe, Mothers Too: Evidence and Rationale Supporting CGM Use in Gestational Diabetes Within the Medicaid Population.

Levy, Carol J / Galindo, Rodolfo J / Parkin, Christopher G / Gillis, Jacob / Argento, Nicholas B

Journal of diabetes science and technology

2023 , Page(s) 19322968231161317

Abstract: Gestational diabetes mellitus (GDM) is a common metabolic disease of pregnancy that threatens the health of several million women and their offspring. The highest prevalence of GDM is seen in women of low socioeconomic status. Women with GDM are at ... ...

Abstract	Gestational diabetes mellitus (GDM) is a common metabolic disease of pregnancy that threatens the health of several million women and their offspring. The highest prevalence of GDM is seen in women of low socioeconomic status. Women with GDM are at increased risk of adverse maternal outcomes, including increased rates of Cesarean section delivery, preeclampsia, perineal tears, and postpartum hemorrhage. However, of even greater concern is the increased risk to the fetus and long-term health of the child due to elevated glycemia during pregnancy. Although the use of continuous glucose monitoring (CGM) has been shown to reduce the incidence of maternal and fetal complications in pregnant women with type 1 diabetes and type 2 diabetes, most state Medicaid programs do not cover CGM for women with GDM. This article reviews current statistics relevant to the incidence and costs of GDM among Medicaid beneficiaries, summarizes key findings from pregnancy studies using CGM, and presents a rationale for expanding and standardizing CGM coverage for GDM within state Medicaid populations.
Language	English
Publishing date	2023-03-15
Publishing country	United States
Document type	Journal Article
ISSN	1932-2968
ISSN (online)	1932-2968
DOI	10.1177/19322968231161317
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Article ; Online: New Paradigms in Diabetes Management From the Epicenter.

Levy, Carol J / Levister, Camilla M / Shah, Nirali A

Journal of diabetes science and technology

2020 Volume 14, Issue 4, Page(s) 750–751

MeSH term(s)	Access to Information ; Blood Glucose Self-Monitoring ; COVID-19 ; Coronavirus Infections/epidemiology ; Diabetes Mellitus/therapy ; Health Services Accessibility ; Humans ; Hyperglycemia/complications ; Inflammation ; Insulin/therapeutic use ; Ketosis/complications ; New York City/epidemiology ; Outpatients ; Pandemics ; Patient Isolation ; Personal Protective Equipment ; Pneumonia, Viral/epidemiology ; Steroids/therapeutic use ; Telemedicine/methods
Chemical Substances	Insulin ; Steroids
Language	English
Publishing date	2020-06-02
Publishing country	United States
Document type	Journal Article
ISSN	1932-2968
ISSN (online)	1932-2968
DOI	10.1177/1932296820930040
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Article ; Online: Response to Letter to the Editor from Justin M. Gregory: "Age and Hospitalization Risk in People With Type 1 Diabetes and COVID-19: Data From the T1D Exchange Surveillance Study".

Demeterco-Berggren, Carla / Ebekozien, Osagie / Levy, Carol J / Maahs, David M

The Journal of clinical endocrinology and metabolism

2021 Volume 107, Issue 4, Page(s) e1769–e1770

MeSH term(s)	COVID-19 ; Diabetes Mellitus, Type 1/epidemiology ; Diabetes Mellitus, Type 1/therapy ; Hospitalization ; Humans ; SARS-CoV-2
Language	English
Publishing date	2021-12-06
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/clinem/dgab872
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Article ; Online: Assessing Glycemic Control Using CGM for Women with Diabetes in Pregnancy.

O'Malley, Grenye / Wang, Ally / Ogyaadu, Selassie / Levy, Carol J

Current diabetes reports

2021 Volume 21, Issue 11, Page(s) 44

Abstract: Purpose of review: Diabetes during pregnancy increases the risk of maternal and fetal complications. This article reviews the types of CGM currently available, the glucose metrics which correlate with pregnancy outcomes, endocrine organization ... ...

Abstract	Purpose of review: Diabetes during pregnancy increases the risk of maternal and fetal complications. This article reviews the types of CGM currently available, the glucose metrics which correlate with pregnancy outcomes, endocrine organization recommendations, clinical considerations for CGM implementation, and anticipated directions for future research. Recent findings: CGM use during pregnancy is increasing, and recommendations for use have been incorporated into many organizations' consensus guidelines. Increased time spent within a target range of 63-140 mg/dL and lower mean glucose are associated with lower risk of neonatal complications including large for gestational age infants. Use of CGM during pregnancy can detect postprandial and nocturnal hyperglycemia missed by self-monitoring of blood glucose (SMBG) which can be used for prognosis and to guide pharmacologic interventions. The use of continuous glucose monitoring (CGM) during pregnancies complicated by type 1, type 2, and gestational diabetes has been shown to improve outcomes.
MeSH term(s)	Blood Glucose ; Blood Glucose Self-Monitoring ; Diabetes Mellitus, Type 1 ; Diabetes, Gestational/drug therapy ; Female ; Glycemic Control ; Humans ; Infant, Newborn ; Pregnancy
Chemical Substances	Blood Glucose
Language	English
Publishing date	2021-11-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2065167-3
ISSN	1539-0829 ; 1534-4827
ISSN (online)	1539-0829
ISSN	1534-4827
DOI	10.1007/s11892-021-01415-2
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Article ; Online: Cost-effectiveness of the tubeless automated insulin delivery system vs standard of care in the management of type 1 diabetes in the United States.

Biskupiak, Joseph E / Ramos, Mafalda / Levy, Carol J / Forlenza, Greg / Hopley, Colin / Boyd, Jennifer / Swift, Dan / Lamotte, Mark / Brixner, Diana I

Journal of managed care & specialty pharmacy

2023 Volume 29, Issue 7, Page(s) 807–817

Abstract: BACKGROUND: ...

Abstract	BACKGROUND:
MeSH term(s)	Male ; Adult ; Child ; Humans ; United States ; Diabetes Mellitus, Type 1/drug therapy ; Cost-Benefit Analysis ; Standard of Care ; Insulin ; Hypoglycemia/chemically induced ; Quality-Adjusted Life Years
Chemical Substances	Insulin
Language	English
Publishing date	2023-05-03
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ISSN	2376-1032
ISSN (online)	2376-1032
DOI	10.18553/jmcp.2023.22331
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Article ; Online: Use of Continuous Glucose Monitors Upon Hospital Discharge of People With Diabetes: Promise, Barriers, and Opportunity.

Tian, Tiffany / Aaron, Rachel E / Seley, Jane Jeffrie / Longo, Rebecca / Nayberg, Irina / Umpierrez, Guillermo E / Levy, Carol J / Klonoff, David C

Journal of diabetes science and technology

2023 Volume 18, Issue 1, Page(s) 207–214

Abstract: Continuous glucose monitors (CGMs) have increasingly been used in ambulatory and inpatient or hospital settings to improve glycemic outcomes for people with diabetes. Given their capacity to aid individuals in avoiding hypo- and hyperglycemia, they may ... ...

Abstract	Continuous glucose monitors (CGMs) have increasingly been used in ambulatory and inpatient or hospital settings to improve glycemic outcomes for people with diabetes. Given their capacity to aid individuals in avoiding hypo- and hyperglycemia, they may also be useful when transitioning from hospital to home by reducing rates of hospital readmissions and emergency department visits. Several types of barriers presently exist that make the deployment of CGMs at the time of hospital discharge problematic, including (1) regulatory, (2) behavioral, (3) logistical, (4) technical, (5) staffing, and (6) systemic issues. In this commentary, we review the literature, discuss these barriers, and propose possible solutions to facilitate the use of CGMs in people with diabetes at the time of hospital discharge.
MeSH term(s)	Humans ; Patient Discharge ; Diabetes Mellitus/therapy ; Blood Glucose ; Hyperglycemia ; Hospitals ; Blood Glucose Self-Monitoring
Chemical Substances	Blood Glucose
Language	English
Publishing date	2023-10-02
Publishing country	United States
Document type	Review ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	1932-2968
ISSN (online)	1932-2968
DOI	10.1177/19322968231200847
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