William Sansum Diabetes Center

Santa Barbara, CA, United States

William Sansum Diabetes Center

Santa Barbara, CA, United States
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PubMed | Bournemouth University, William Sansum Diabetes Center, JDRF, T1D Exchange and 2 more.
Type: Journal Article | Journal: Journal of diabetes science and technology | Year: 2016

The aim was to explore the impact of diabetes-related technology to ensure that such devices are used in a way that returns maximum benefit from a medical and psychological perspective.Spouses and caregivers of people with type 1 diabetes were invited to complete an online questionnaire about their experiences with diabetes technologies used by their family members. Participants were recruited via the Glu online community website. Questions explored impact on daily living, frequency and severity of hypoglycemia, and diabetes-related distress.In all, 100 parents/caregivers and 74 partners participated in this survey. Average (mean) duration of living with a person with type 1 diabetes was 16 years (SD = 13) for partners, with duration of diabetes for children being 4.2 3.2 years. Average duration of current therapy was 8.3 7.3 years for adults and 3.4 2.9 years for children. Of the participants, 86% partners and 82% parents/caregivers reported diabetes technology had made it easier for their family members to achieve blood glucose targets. Compared to partners, parents/caregivers reported more negative emotions (P < .001) and decreased well-being (P < .001) related to their family members type 1 diabetes. Diabetes-related distress was common, as was sleep disturbance associated with device alarms and fear of hypoglycemia. Reduced frequency and severity of hypoglycemia related to device use was reported by approximately half of participants.There is little doubt about the medical benefit of diabetes technologies and their uptake is increasing but some downsides were reported. Barriers to uptake of technologies lie beyond the mechanics of diabetes management. Supporting users in using diabetes technology to achieve the best possible glycemic control, in the context of their own life, is crucial. Furthermore, understanding these issues with input from the type 1 diabetes community including family members and caregivers will help innovation and design of new technology.


PubMed | Santa Barbara Cottage Hospital, William Sansum Diabetes Center, Type 1 Diabetes Exchange and University of California at Santa Barbara
Type: Journal Article | Journal: Canadian journal of diabetes | Year: 2016

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.We studied 502 adults from the Type 1 Diabetes Exchanges online patient community, Glu, who had completed an online survey focused on diabetes self-management and exercise.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).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.


Castorino K.,William Sansum Diabetes Center | Bradley P.K.,William Sansum Diabetes Center | Truong L.,William Sansum Diabetes Center | Martinez J.,William Sansum Diabetes Center
Minerva Endocrinologica | Year: 2016

Gestational diabetes affects up to one in five pregnancies and can have significant consequences for both mother and baby. There have been great efforts to identify strategies to prevent gestational diabetes during pregnancy. These efforts have been extended to the pre-pregnancy and postpartum periods to address limitations during pregnancy. In this review we explore how diet, exercise and lifestyle modification can be used to prevent gestational diabetes. © 2016 EDIZIONI MINERVA MEDICA.


Popova P.,St. Petersburg State Medical University | Castorino K.,William Sansum Diabetes Center | Grineva E.,St. Petersburg State Medical University | Kerr D.,William Sansum Diabetes Center
Minerva Endocrinologica | Year: 2016

Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed during pregnancy that is not clearly overt diabetes. It is the most common complication of pregnancy and is the most common type of diabetes during pregnancy. Its high prevalence is determined by the increasing epidemic of obesity and by the diagnostic criteria applied. New criteria are currently accepted by a number of professional societies, but considerable controversies still exist concerning diagnosis of GDM. GDM can cause significant short term and long term problems for mother and offspring, including but not limited to cesarean delivery, birth trauma, as well as the development of type 2 diabetes in mother and offspring in the future. Although the consequences of poorly controlled GDM are evident, there continues to be controversy regarding the most appropriate diagnostic criteria, the metabolic aims in controlling GDM, the ability to diagnose GDM in early pregnancy, and the efficiency of treatment in order to improve pregnancy outcomes. This review focuses on current recommendations of professional medical societies and evidence base for GDM diagnosis and glycemic goals of treatment. Available evidence for the optimal time and frequency of self-monitoring of blood glucose and the role of glycated hemoglobin in GDM are provided in this review. © 2016 EDIZIONI MINERVA MEDICA.


Bradley P.K.,William Sansum Diabetes Center | Duprey M.,William Sansum Diabetes Center | Castorino K.,William Sansum Diabetes Center
Current Diabetes Reports | Year: 2016

Diabetes in pregnancy is associated with significant and sometimes devastating acute complications. It is important that all health care providers are aware of possible complications at each stage of pregnancy so that we can prevent these complications whenever possible and reduce morbidity when they do occur. Most complications associated with diabetes during pregnancy have reduced incidence when blood glucose and blood pressure are optimally controlled. Yet, it is always best to try to optimize diabetes and any comorbidities prior to conception. © 2016, Springer Science+Business Media New York.


PubMed | William Sansum Diabetes Center and University of California at Santa Barbara
Type: Journal Article | Journal: Diabetes care | Year: 2016

To evaluate two widely used control algorithms for an artificial pancreas (AP) under nonideal but comparable clinical conditions.After a pilot safety and feasibility study (n = 10), closed-loop control (CLC) was evaluated in a randomized, crossover trial of 20 additional adults with type 1 diabetes. Personalized model predictive control (MPC) and proportional integral derivative (PID) algorithms were compared in supervised 27.5-h CLC sessions. Challenges included overnight control after a 65-g dinner, response to a 50-g breakfast, and response to an unannounced 65-g lunch. Boluses of announced dinner and breakfast meals were given at mealtime. The primary outcome was time in glucose range 70-180 mg/dL.Mean time in range 70-180 mg/dL was greater for MPC than for PID (74.4 vs. 63.7%, P = 0.020). Mean glucose was also lower for MPC than PID during the entire trial duration (138 vs. 160 mg/dL, P = 0.012) and 5 h after the unannounced 65-g meal (181 vs. 220 mg/dL, P = 0.019). There was no significant difference in time with glucose <70 mg/dL throughout the trial period.This first comprehensive study to compare MPC and PID control for the AP indicates that MPC performed particularly well, achieving nearly 75% time in the target range, including the unannounced meal. Although both forms of CLC provided safe and effective glucose management, MPC performed as well or better than PID in all metrics.


PubMed | Bournemouth University, Unitio Inc and T1 Diabetes Exchange, William Sansum Diabetes Center and Gothenburg University
Type: Journal Article | Journal: Journal of diabetes science and technology | Year: 2016

The aim was to explore personal experiences and to determine the impact of impaired sleep on well-being and diabetes-related activities/decision making among a cohort of people living with T1D.Adults with T1D over the age of 18 and parents/carers of children with T1D were invited to complete an online questionnaire about their quality and quantity of sleep. Questions included impact of sleep on diabetes-related decision making, effective calculation of bolus doses, important aspects of psychosocial functioning, and frequency of waking. Diasend download data were used to objectively determine frequency of nocturnal blood glucose testing in children.A total of 258 parent/carer participants (n = 221 female, 85.6%) and 192 adults with T1D (n = 145, 75.5% female, age range 19 to 89 years) took part. In all, 239 parents/carers and 160 adults believed waking in the night has an impact on their usual daily functioning. Of these, 236 parents/carers and 151 (64%) adults reported the impact as negative. Chronic sleep interruption was associated with detrimental impact on mood, work, family relationships, ability to exercise regularly, ability to eat healthily, and happiness.Chronic sleep interruption is highly prevalent in adults with T1D and parents/carers of children with T1D with negative effects on daily functioning and well-being. Appropriate interventions are required to alleviate this burden of T1D, address modifiable risk factors for nocturnal hypoglycemia, and reduce the (perceived) need for nocturnal waking.


PubMed | William Sansum Diabetes Center
Type: Journal Article | Journal: Minerva endocrinologica | Year: 2016

Gestational diabetes affects up to one in five pregnancies and can have significant consequences for both mother and baby. There have been great efforts to identify strategies to prevent gestational diabetes during pregnancy. These efforts have been extended to the pre-pregnancy and postpartum periods to address limitations during pregnancy. In this review we explore how diet, exercise and lifestyle modification can be used to prevent gestational diabetes.


PubMed | William Sansum Diabetes Center, University of California at Santa Barbara and Harvard University
Type: Journal Article | Journal: Industrial & engineering chemistry research | Year: 2016

Development of an effective artificial pancreas (AP) controller to deliver insulin autonomously to people with type 1 diabetes mellitus is a difficult task. In this paper, three enhancements to a clinically validated AP model predictive controller (MPC) are proposed that address major challenges facing automated blood glucose control, and are then evaluated by both


PubMed | William Sansum Diabetes Center
Type: Journal Article | Journal: Current diabetes reports | Year: 2016

Diabetes in pregnancy is associated with significant and sometimes devastating acute complications. It is important that all health care providers are aware of possible complications at each stage of pregnancy so that we can prevent these complications whenever possible and reduce morbidity when they do occur. Most complications associated with diabetes during pregnancy have reduced incidence when blood glucose and blood pressure are optimally controlled. Yet, it is always best to try to optimize diabetes and any comorbidities prior to conception.

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