Figure 3 is an interesting comparison on how technology use (pump & CGM) affects A1C differentially across age. But looking at this and other figures I realize that many of us are completely off the charts presented in this paper. Might there be some survey we could conduct through this site that would show how well controlled T1D can be and provide some insight into how best to do this? Best practices for tight and safe blood glucose control from FUD? Even without a publication these data might be useful to others on this site.
I’ve published scientific papers (although not in this area) and would be willing to help out with such an effort. Does anyone else have any interest in this, ideas, or suggestions?
I’m no web designer, but would it be possible to add optional fields to our user profile that could be compiled and posted as deidentified summary data?
These are two interesting papers! Thanks for sharing them!
If I may suggest further:
Thread title and text are very useful both to search and to identify interest in the topic. As the papers are presented now in this thread, the reader has to open them to get enough info about them to figure what they are. Few people do that.
To disseminate these papers better, a more informative way to present them might be:
Link to one paper per thread
For each thread, give a representative title
Summarize the subject of the paper in the first paragraph, along with what you find interesting. Then put the link.
Quote a couple of short sections of the paper that are the most informative/ interesting ones.
This way, the core info is in the post, anyone can click the link if they are really interested, and the quotes validate the key points.
Thanks for the guidance- I’ll try to put more in the posts and split them up in the future. I was just in a bit of a hurry and had both papers and a larger question off the second one to get out there.
I was thinking some clearly separate extra-credit section, but I know that you only have so much freedom in what you can do on these forum sites. Perhaps it would be better to create a post with a link to surveymonkey or something similar. I’ve never used one of those sites myself but I know lots of people who have.
Very interesting publications, both, thanks for posting! The “State of Type 1 Diabetes Management” is overall depressing. We are not even moving in the right direction, mean HbA1c was higher in 2016–2018 compared with 2010–2012?!
Tight and safe control can be achieved in so many different ways, so I do not think there is a single “best” approach. Reducing carbs, or sugar-surfing manually, or using a good closed-loop system, or adding inhalable insulin to the mix, or some combination of the above, or whatever … subject to availability, the best practice is a matter of personal choice and preference. What really matters the most is not so much the technology but motivation and attitude, and that’s what distinguishes people on this and other good DOC forums.
Mean A1C is indeed depressing, but this paper could be great ammunition for anyone struggling to get insurance to pay for a CGM. Very clear correlations between CGM use and lower A1Cs.
I agree that there’s no single “best” approach- I should have emphasized the plurality of “best practices” somehow. The idea was to show what level of control is possible and provides some guidance as to how we (and others) can get there using the variety of means that we do. If motivation and attitude matter more how could we quantify them? How do we use the same technology to get so much better results than the people in this paper? Or are we all so individualized that any compilation of data and practices is a fool’s errand that would not be useful to anyone?
I suspect most people with T1D (and probably T2D for that matter) simply do not pay nearly as much attention to their blood glucose control compared to the people who do much better than the averages reported in the paper. The most significant problem, I suppose, is that people do not check their bg often enough, which is why CGM makes such a noticeable difference, as it makes it so much easier to become aware of what’s actually happening. If people do not check their bg, they may let it stay high for long periods of time. On the other hand, there is almost no chance one would just ignore a CGM alert, or seeing their high bg on a CGM screen. The CGM screen is a stronger motivator and educator than any medical professional.
That lines up with my experience- when I got a smartwatch to display my CGM data the information became much easier to check and my A1C dropped again. Aside from CGMs, there’s also evidence of a strong association between the number of test strip checks and lower A1C (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687326/pdf/2009.pdf).
But this highlights a key problem with the papers I’ve seen on CGMs- it’s not a treatment, it’s only information. You could do nothing with it or it could completely change your life. But I have yet to see a paper that makes any attempt to control for what users do with this information, how often they check it, or what they learn from it. I understand that these variables would be difficult to quantify, but the attempt should be made since they are key mediating variables to the overall beneficial effects of CGMs .
