Browsing by Author "Mader, Julia K."

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    Consensus Report on Glucagon-Like Peptide-1 Receptor Agonists as Adjunctive Treatment for Individuals With Type 1 Diabetes Using an Automated Insulin Delivery System
    (Sage, 2024-11-08) Shah, Viral N.; Peters, Anne L.; Umpierrez, Guillermo E.; Sherr, Jennifer L.; Akturk, Halis Kaan; Aleppo, Grazia; Bally, Lia; Cengiz, Eda; Cinar, Ali; Dungan, Kathleen; Fabris, Chiara; Jacobs, Peter G.; Lal, Rayhan A.; Mader, Julia K.; Masharani, Umesh; Prahalad, Priya; Schmidt, Signe; Zijlstra, Eric; Ho, Cindy N.; Ayers, Alessandra T.; Tian, Tiffany; Aaron, Rachel E.; Klonoff, David C.; Medicine, School of Medicine
    With increasing prevalence of obesity and cardiovascular diseases, there is a growing interest in the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) as an adjunct therapy in type 1 diabetes (T1D). The GLP-1RAs are currently not approved by the US Food and Drug Administration for the treatment of T1D in the absence of randomized controlled trials documenting efficacy and safety of these agents in this population. The Diabetes Technology Society convened a series of three consensus meetings of clinicians and researchers with expertise in diabetes technology, GLP-1RA therapy, and T1D management. The project was aimed at synthesizing current literature and providing conclusions on the use of GLP-1RA therapy as an adjunct to automated insulin delivery (AID) systems in adults with T1D. The expert panel members met virtually three times on January 17, 2024, and April 24, 2024, and August 14, 2024, to discuss topics ranging from physiology and outcomes of GLP-1RAs in T1D to limitations of current sensors, algorithms, and insulin for AID systems. The panelists also identified research gaps and future directions for research. The panelists voted to in favor of 31 recommendations. This report presents the consensus opinions of the participants that, in adults with T1D using AID systems, GLP-1RAs have the potential to (1) provide effective adjunct therapy and (2) improve glycemic and metabolic outcomes without increasing the risk of severe hypoglycemia or diabetic ketoacidosis.
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    Expert Clinical Interpretation of Continuous Glucose Monitor Reports From Individuals Without Diabetes
    (Sage, 2025-02-12) Spartano, Nicole L.; Prescott, Brenton; Walker, Maura E.; Shi, Eleanor; Venkatesan, Guhan; Fei, David; Lin, Honghuang; Murabito, Joanne M.; Ahn, David; Battelino, Tadej; Edelman, Steven V.; Fleming, G. Alexander; Freckmann, Guido; Galindo, Rodolfo J.; Joubert, Michael; Lansang, M. Cecilia; Mader, Julia K.; Mankovsky, Boris; Mathioudakis, Nestoras N.; Mohan, Viswanathan; Peters, Anne L.; Shah, Viral N.; Spanakis, Elias K.; Waki, Kayo; Wright, Eugene E.; Zilbermint, Mihail; Wolpert, Howard A.; Steenkamp, Devin W.; Medicine, School of Medicine
    Background: Clinical interpretation of continuous glucose monitoring (CGM) data for people without diabetes has not been well established. This study aimed to investigate concordance among CGM experts in recommending clinical follow-up for individuals without diabetes, based upon their independent review of CGM data. Methods: We sent a survey out to expert clinicians (n = 18) and asked them to evaluate 20 potentially challenging Dexcom G6 Pro CGM reports (and hemoglobin A1c [HbA1c] and fasting venous blood glucose levels) from individuals without diabetes. Clinicians reported whether they would recommend follow-up and the reasoning for their decision. We performed Fleiss Kappa interrater reliability to determine agreement among clinicians. Results: More than half of expert clinicians (56-100%, but no clear consensus) recommended follow-up to individuals who spent >2% time above range (>180 mg/dL), even if HbA1c <5.7% and fasting glucose <100 mg/dL. There were no observed trends for recommending follow-up based on mean glucose or glucose management indicator. Overall, we observed poor agreement in recommendations for who should receive follow-up based on their CGM report (Fleiss Kappa = 0.36). Conclusions: High discordance among expert clinicians when interpreting potentially challenging CGM reports for people without diabetes highlights the need for more research in developing normative data for people without diabetes. Future work is required to develop CGM criteria for identifying potentially high-risk individuals who may progress to prediabetes or type 2 diabetes.