Research
RESEARCH ROUNDUP Here are a few of the highlights from the past 18 months of research into diabetes globally. THE IMPORTANCE OF TIME IN RANGE
A 2019 Canadian study points out that increased use of CGMs has given people with diabetes and their carers a new range of ways to measure diabetes control. One of these ways is time in range (TIR). TIR graphs on your CGM capture the proportion of time your glucose levels are within a target range. (The target range is usually 3.9 to 10.0 mmol/L). For people with diabetes who use CGMs, TIR is now a common discussion point at appointments with healthcare professionals. Evidence is emerging that TIR can predict risks of complications and that lower TIR is tied to greater risk. Standardised TIR targets are being developed. The study suggests that, for most people with type 1 or type 2 diabetes, a TIR greater than 70% is a recommended target. However, the study also makes the point that it’s still important to consider what blood glucose levels are when they are out of range. In particular, it discusses the importance of including the amount and severity of time below range (TBR) in any discussions. The study recommends a target of less than 4% of time below 3.9 mmol/L , and less than 1% of time below <3.0 mmol/L. However, there should be “less stringent targets for older or high-risk individuals and for those under 25 years of age … glycaemic targets should be individualised.” https://doi.org/10.1007/s00125-019-05027-0
RELAPSE AFTER BARIATRIC SURGERY – NO FAILURE
A 2020 study published by the American Diabetes Association followed 736 people with type 2 diabetes who underwent Roux-en-Y gastric bypass or sleeve gastrectomy. Of 736 patients, 425 (58%) experienced diabetes remission in the first year after surgery. These 425 patients were then followed for several more years to document any late relapses of diabetes. It was found that 136 (32%) patients did experience late relapse of type 2, but, despite this, they maintained significant improvements in their blood sugar control and other indicators, such as their lipid profiles. The study concluded that, while late relapse of type 2 diabetes after bariatric surgery is a real phenomenon, it should not be thought of as a failure, as the trajectory of the disease is still generally changed for the better.
•
•
•
https://care.diabetesjournals.org/ content/43/3/534.abstract
THE PSYCHOLOGY OF TECHNOLOGY
A study released by Diabetes UK in January this year reviews existing research into users’ feelings about, and behaviours with, three types of technology: insulin pumps, CGMs, and – newest of all – the automated insulin delivery systems that blend those technologies to “close the loop”. Points made by the study include: • Users of pumps and CGMs often report lower levels of diabetes distress or depression. This also holds true for automated insulin
•
delivery systems, but as they are so new that evidence is still limited. In one study of CGM users, most users reported increased feelings of safety, control, and confidence in their diabetes management, but not all. Some found CGM output intrusive, and others reported frustration because of technical failures and difficulty trusting the device. Some users, rather than finding the increased information provided by CGMs empowering, find it overwhelming. Some users of CGMs, particularly teenagers, may find the shareability of CGM data is associated with unwanted interference and attention to their diabetes. The study notes: “This reduction to being nothing more than a glycaemic control number and a signal of brokenness or disability, rather than the recognition of the person's self, can have detrimental impacts on selfidentity, personality and selfconfidence. These psychosocial hurdles are far from understood and may again exclude significant segments of people with diabetes from living the lives they want rather than the lives they are boxed into.” For some people, disliking wearing a device on their body is a barrier to use of any technologies. There are a number of reasons: it may feel restrictive, it may be associated with negative body image or there may be a sense of being stigmatised by making diabetes visible in this way. Continues on page 42
40
DIABETES WELLNESS | Summer 2020
