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Krintz C.,University of California at Santa Barbara | Wolski R.,University of California at Santa Barbara | Pinsker J.E.,William Sansum Diabetes Center | Dimopoulos S.,University of California at Santa Barbara | And 2 more authors.
Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering, LNICST | Year: 2016

This paper examines the use of partial least squares regression to predict glycemic variability in subjects with Type I Diabetes Mellitus using measurements from continuous glucose monitoring devices and consumer-grade activity monitoring devices. It illustrates a methodology for generating automated predictions from current and historical data and shows that activity monitoring can improve prediction accuracy substantially. © ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering 2016.

Brown R.J.,U.S. National Institute of Diabetes and Digestive and Kidney Diseases | Chan J.L.,Bristol Myers Squibb | Jaffe E.S.,U.S. National Institutes of Health | Cochran E.,U.S. National Institute of Diabetes and Digestive and Kidney Diseases | And 8 more authors.
Leukemia and Lymphoma | Year: 2016

Acquired generalized lipodystrophy (AGL) is a rare disease thought to result from autoimmune destruction of adipose tissue. Peripheral T-cell lymphoma (PTCL) has been reported in two AGL patients. We report five additional cases of lymphoma in AGL, and analyze the role of underlying autoimmunity and recombinant human leptin (metreleptin) replacement in lymphoma development. Three patients developed lymphoma during metreleptin treatment (two PTCL and one ALK-positive anaplastic large cell lymphoma), and two developed lymphomas (mycosis fungoides and Burkitt lymphoma) without metreleptin. AGL is associated with high risk for lymphoma, especially PTCL. Autoimmunity likely contributes to this risk. Lymphoma developed with or without metreleptin, suggesting metreleptin does not directly cause lymphoma development; a theoretical role of metreleptin in lymphoma progression remains possible. For most patients with AGL and severe metabolic complications, the proven benefits of metreleptin on metabolic disease will likely outweigh theoretical risks of metreleptin in lymphoma development or progression. © 2015 Informa UK, Ltd.

Colberg S.R.,Old Dominion University | Laan R.,William Sansum Diabetes Center | Dassau E.,University of California at Santa Barbara | Kerr D.,William Sansum Diabetes Center
Journal of Diabetes Science and Technology | Year: 2015

While being physically active bestows many health benefits on individuals with type 1 diabetes, their overall blood glucose control is not enhanced without an effective balance of insulin dosing and food intake to maintain euglycemia before, during, and after exercise of all types. At present, a number of technological advances are already available to insulin users who desire to be physically active with optimal blood glucose control, although a number of limitations to those devices remain. In addition to continued improvements to existing technologies and introduction of new ones, finding ways to integrate all of the available data to optimize blood glucose control and performance during and following exercise will likely involve development of "smart" calculators, enhanced closed-loop systems that are able to use additional inputs and learn, and social aspects that allow devices to meet the needs of the users. © 2015 Diabetes Technology Society Reprints and permissions.

Barnard K.D.,University of Southampton | Pinsker J.E.,William Sansum Diabetes Center | Oliver N.,Imperial College London | Astle A.,University of Southampton | And 3 more authors.
Diabetes Technology and Therapeutics | Year: 2015

Background: The primary focus of artificial pancreas (AP) research has been on technical achievements, such as time in range for glucose levels or prevention of hypoglycemia. Few studies have attempted to ascertain the expectations of users of AP technology. Subjects and Methods: Persons with type 1 diabetes and parents of children with type 1 diabetes were invited to take part in an online survey concerning future use and expectations of AP technology. The survey was advertised via Twitter, Facebook, and DiabetesMine, plus advocacy groups and charities including INPUT, Diabetes UK, and the Diabetes Research and Wellness Foundation. Quantitative responses were categorized on a 5-point Likert scale. Free text responses were analyzed using content analysis. Results: Two hundred sixty-six surveys were completed over a 1-month period. Two hundred forty participants indicated they were highly likely to use a fully automated 24-h AP. Approximately half of the respondents indicated they would be likely to use a device that only functioned overnight. Size, visibility, and lack of effectiveness were the top reasons for not wanting an AP. Despite perceived potential downsides, participants expressed a strong need for a device that will help minimize the burden of disease, help facilitate improved psychosocial functioning, and improve quality of life. Conclusions: The views of people who would use an AP are crucial in the development of such devices to ensure they are fit for use alongside biomedical and engineering excellence. Without this, it is unlikely that an AP will be sufficiently successful to meet the needs of users and to achieve their ultimate goals. © 2015, Mary Ann Liebert, Inc.

Pinsker J.E.,William Sansum Diabetes Center | Kraus A.,Type 1 Diabetes Exchange | Gianferante D.,Type 1 Diabetes Exchange | Schoenberg B.E.,William Sansum Diabetes Center | And 4 more authors.
Canadian Journal of Diabetes | Year: 2016

Objectives: People with type 1 diabetes are at risk for early- and late-onset hypoglycemia following exercise. Reducing this risk may be possible with strategic modifications in carbohydrate intake and insulin use. We examined the exercise preparations and management techniques used by individuals with type 1 diabetes before and after physical activity and sought to determine whether use of differing diabetes technologies affects these health-related behaviours. Methods: We studied 502 adults from the Type 1 Diabetes Exchange's online patient community, Glu, who had completed an online survey focused on diabetes self-management and exercise. Results: Many respondents reported increasing carbohydrate intake before (79%) and after (66%) exercise as well as decreasing their meal boluses before (53%) and after (46%) exercise. Most reported adhering to a target glucose level before starting exercise (77%). Despite these accommodations, the majority reported low blood glucose (BG) levels after exercise (70%). The majority of users of both insulin pump therapy (CSII) and continuous glucose monitoring (CGM) (Combined) reported reducing basal insulin around exercise (55%), with fewer participants adjusting basal insulin when using other devices (SMBG only = 20%; CGM = 34%; CSII = 42%; p<0.001). However, CSII and Combined users reported that exercise makes their BG levels harder to control (p<0.05) and makes them feel less able to predict their BG levels while exercising (p<0.001); they show agreement that fear of low BG levels keeps them from exercising (p<0.01). Conclusions: These findings highlight the need for exercise-management strategies tailored to individuals' overall diabetes management, for despite making exercise-specific adjustments for care, many people with type 1 diabetes still report significant difficulties with BG control when it comes to exercise. © 2016 Canadian Diabetes Association.

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