Technology in Diabetes Camps in the U.S. and Comparison with Croatia
At the conference of the American Diabetes Association in San Francisco, an incredibly high quality, inspiring and refreshing lecture was held:
If you (or your child) have never been to a diabetes camp, that’s a huge loss that you should, if at all possible, correct. Croatia also has several camps. The Zagreb Diabetic Society organizes one, HSDU another and experts from KBC Zagreb (Rebro) organize the third. The region is not bad either, here is the report from Montenegro, and here from Republic of Serbia.
At the time I was in charge of sports and entertainment organized by the Association of the Big Ones for Diabetics (Rebro), the technology in the camps was based on endless blood glucose measurements, injections, pens and similar benefits of diabetes. One of the problems was the night. First, an assessment was made that the child was at risk of hypoglycemia, and then he had to be woken up, stabbed and blood drawn to measure his glucose level. This approach had two major drawbacks: the nurse had to visit almost all the rooms every night, turn on the lights so she could inadvertently wake up children who were judged not to be stabbed. Another problem was that no one was perfect, so it could happen that a child was misjudged that he did not need to draw blood, and he may have ended up in hypoglycemia due to, for example, intense sports during the day. D0 you know that your chances of nocturnal hypoglycemia are much higher if you had hypo during sports? Another article on the subject from the ADA conference follows.
How is America?
The American Diabetes Association alone organizes as many as 6,677 camps! The average cost of a child’s stay in a multi-day camp where the child sleeps is about $ 1,824. There are also day camps where children stay during the day and sleep at home and their price is lower, about $ 966 per child.
A good part of the organization and implementation of the camps is done by volunteers, of which there are over 2,600!
Numerous positive aspects of participating in camps were presented at the lecture:
- development of skills necessary for successful diabetes self-control,
- the feeling of isolation and “diversity” of children falls,
- there is increasing hope for children and families to lead a “normal” life,
- vacation for parents.
A lot about American camps organized by the ADA is available at this link.
In 2018, in campsites in the U.S., 75% of children wore insulin pumps, while only 15% of them used some form of continuous measurement (CGM sensors). In Croatia, it is estimated that 60% of the total number of children with diabetes have a pump, which is not even that bad. But when it comes to adults, it is only 2 % that have a pump, which is shameful. With sensors, the situation could be much better. Almost all of our children could be on (Libre) sensors thanks to fairly correct HZZO indications, but when we talk about sensors connected to the pump, SAP, the situation is very bad. Only poorly regulated children up to the age of 8 are entitled to SAP.
The philosophy of camps in the US is that children manage their diabetes with the same tools they use at home in a safe and fun environment. They develop independence and self-confidence in children and the intention is for all children to return home more successful in controlling their own illness.
Everything that was available from diabetic technology during 2018 in campsites in the US:
- CGMs that forwards glucose levels to insulin pumps, mobile phones and even families
- CGMs that do not require calibration and are allowed for insulin dosing
- insulin pumps that exclude insulin delivery when hypoglycemia is approaching (we have them in Croatia, Medtronic 640G, whose complete consumables are financed by the Croatian Health Insurance Fund only for children up to the age of 8!)
- commercially available pumps that deliver additional insulin when the sensor measures high glucose levels in Croatia (no child in Croatia has it…)
DIY systems (DIY – Do It Yourself).
It’s really great that they are so open to systems that aren’t approved by the U.S. Regulatory Agency (FDA). In Croatia, “that something” is owned by Ivica Šuran’s child and about three other children. It is called OpenAPS. At the lecture, I noticed many American representatives of Medtronic, but also Insulet (OmniPOD), which is very convenient because everyone must be aware that they must accelerate the development and / or increase the availability of sensor-assisted pump (Sensor Augumented Pump), or SAP.
Desired glucose levels in American camps (safety is priority):
- target range: 80-180 mg / dl (4.4 mmol / L – 10 mmol / L),
- acceptable range: 80 – 250 mg / dl (4.4 mmol / L – 13.8 mmol / L),
- minimize hypoglycemia.
Risks and benefits of technology in campsites
Risks: “I think the camp is the perfect place to take a break from CGM. First of all it is a hassle to take care of CGM in a way that it is not damaged or lost. Secondly, the camp is good and safe place to be without technology, which is otherwise a good thing. ”
Benefits: “I want my son to use CGM anytime, anywhere. Diabetes does not go away during camp. Doctors, staff and counsellors are wonderful, but they don’t have the magic power to know every child’s glucose level without CGM or braces. Although I want my child to enjoy the camp to the fullest and to feel as “normal” as possible I also want CGM to contribute to a sense of security. “
In-camp research on hypoglycemia and modern technology
34 campers participated using the latest 670G pump (which “adjusts” high and low sugars). 18 of them were in manual mode (without automatic adjustment), and 16 in automatic mode (automatic algorithm included).
Note that children that had it in automatic mode had 81% time in range, i.e. 81% of the time they were within the target values. It is phenomenal for adults, let alone children!!! From the second slide it can be seen that children in automatic mode had practically always lower sugars, but within normal limits! Heeeey! Am I the only one who sees the importance of all this?!
Once again – campers in automatic mode had:
- better time in range,
- lower average sugar levels,
- fewer hypoglycemic episodes!
Comparison of campers with CGM and campers without CGM in general:
Those who used CGM (sensors) had a 74% lower chance of at least one serious hypoglycemia! (glucose level lower than 2.7 mmol / L)
Trends and goals in campsites in the USA:
- stricter / narrower glucose levels
- CGM that predicts hypoglycemia
- automated insulin delivery
In 2019, the evolution continues as follows:
- pediatric indication for Flash CGM (Libre) is expected
- more pumps with automatic insulin delivery (SAP) are expected
- greater presence of CGM among campers
- greater presence of mobile phones as the exclusive device for monitoring glucose levels
- greater presence of home-made (DIY) systems
- new methods of using glucagon for severe hypoglycemia are expected
“If we would have a magic wand we would want this” says the chief camper in the United States.
- remote monitoring of campers from a central location
(That’s right! Nurses no longer have to visit sleeping campers at all, and glucose levels are monitored remotely for all campers, not just those who are assessed as at risk),
- signal and wireless internet coverage within the camp and the possibility of shutting down data transmission outside the camp (because of parents 🙂),
- automated insulin delivery that takes physical activity into account (fantastic, I need that!),
- simple devices that enable the delivery of small doses of glucagon for hypoglycemia,
- faster acceptance of modern technology by the US Regulatory Agency (FDA),
- CME points for medical professionals who volunteer in camps,
- all ADA camps should be free!!
Believe it or not, our CHIF used to cover the costs of a camp for people with diabetes in Croatia. So we used to be more advanced in that than the USA!
Want to send your child to a diabetic camp in the USA?
We have been hanging out for some time with Jeff Hitchcock, a former CIA agent who resigned when his child got diabetes. He is the head of Children with Diabetes, and it is particularly interesting that he organizes and runs a very serious camp for children with diabetes at Disney’s Coronado Springs Resort, Orlando, Florida. It is late for 2019, but 2020 is near, information is available here. Collect money and the rest will be easy.
The cover photo was taken from beyondtype1.org/diabetes