Data showed that patients using diabetes technology incorporated different strategies to prevent nocturnal hypoglycemia vs patients who did not use such technology.
New research is providing insight into the strategies patients with type 1 diabetes (T1D) use to prevent hypoglycemic episodes overnight and how the technology they use has an impact on their approach.
The findings, coming from over 800 patients, showed that patients using diabetes technology, such as continuous subcutaneous insulin infusion (CSII), an intermittently scanned continuous glucose monitor (isCGM), a real-time CGM (rtCGM), and automated insulin delivery (AID), used different strategies to prevent nocturnal hypoglycemia (NH) compared with patients who did not use such technology.
Findings appeared in Diabetes Research and Clinical Practice.
Overall, the strategies used by patients—including glucose monitoring before bed, having a snack in the evening or before bed, and overnight basal insulin reduction—were in line with current recommendations. For example, most patients monitored their glucose at bedtime. However, the researchers also found that the treatment they use and the level of fear of hypoglycemia (FOH) may sway their behavior.
“Current NH prevention strategies can be classified into lifestyle, pharmacological, or technological strategies,” described the researchers. “The most consistently recommended lifestyle-related prevention strategy is the consumption of a bedtime snack containing carbohydrates and protein. The clinical recommendation for a bedtime snack is mostly supported for use when bedtime glycemia is < 7.0 mmol/L or in high-risk situations (ie, after alcohol consumption or physical activity in the evening). However, evidence supporting these recommendations is scarce, and their use by people with T1D [PWT1D] has not been assessed.”
Compared with patients using multiple daily injections (MDI) plus capillary blood glucose (CBG), those using CSII plus an isCGM, CSII plus rtCGM, AID, or MDI plus rtCGM were less likely to have a nighttime snack to prevent NH (odds ratio [OR], 0.55, 0.40, 0.34, and 0.44, respectively).
Use of CSII was significantly associated with reducing basal insulin throughout the night when combined with other modalities. When used with CBG (OR, 3.15), isCGM (OR, 4.00), and rtCGM (OR, 2.78), CSII increased the likelihood of reducing basal insulin compared with MDI plus CBG. Monitoring glucose at bedtime was less likely among patients using CSII plus rtCGM vs patients using MDI plus CBG.
There were no differences in reducing alcohol consumption or reducing physical activity at the end of the day across the treatments.
“Beyond treatment modality, the factor that was significantly associated with most of the strategies used was an elevated FOH,” detailed the researchers. “Participants with elevated fear were more likely to consume an evening/bedtime snack, avoid bolus insulin in the evening, reduce/avoid alcohol consumption, and reduce/avoid physical activity. FOH is a significant barrier to optimal T1D management, as many PWT1D tend to maintain higher glucose levels to avoid experiencing the negative effects of hypoglycemia. This can negatively influence diabetes management, as FOH was found to be associated with higher caloric intake and greater glycemic variability and has been identified as a significant barrier to participating in physical activities.”
The researchers noted that patient choice of strategy could be a result of their latest NH episode, although the current study was unable to characterize this. They group also underscored that the role of diabetes technology in driving certain behaviors in T1D is undefined. As a result, they recommend future research assess different motivators for choosing a strategy for preventing hypoglycemia episodes and how technology influences their behaviors.
Reference
Talbo M, Rabasa-Lhoret R, Yale J, Peters T, Brazeau A. Are nocturnal hypoglycemia prevention strategies influenced by diabetes technology usage? a BETTER registry analysis. Diabetes Res Clin Pract. Published online September 12, 2022. doi:10.1016/j.diabres.2022.110080
Real-World Data Show Sotorasib Effective for NSCLC With KRAS Mutation
May 18th 2024Data from real-world and clinical-trial settings on frontline monotherapy treatment with the KRAS inhibitor sotorasib both show similar progression-free survivals and a high likelihood that the treatment’s efficacy is not affected with dose reduction.
Read More
Health Equity and Access Weekly Roundup: May 18, 2024
May 18th 2024The US Senate hosted a panel addressing physician and health care shortages and efforts to increase minority representation in the medical field. An expert discussed initiatives to prevent senior homelessness. Advocates called for the repeal of the Comstock Act. Regulatory reforms are called for to improve rural cancer patients' access to pharmacies. Research reveals the impact of denials on patient access to immunology treatments.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Study Highlights Significant Increases in Utilization, Spending on DMD Drugs in Medicaid
May 17th 2024The findings add to recent research on the growing utilization, expenditure, and prices of Duchenne muscular dystrophy (DMD) therapies in the current landscape, an area health care policy could potentially address.
Read More