Cell rigidity sensing—a basic cellular process allowing cells to adapt to mechanical cues—involves cell capabilities exerting force on the extracellular environment. In vivo, cells are exposed to multi-scaled heterogeneities in the mechanical properties of the surroundings. Here, we investigate whether cells are able to sense micron-scaled stiffness textures by measuring the forces they transmit to the extracellular matrix. To this end, we propose an efficient photochemistry of polyacrylamide hydrogels to design micron-scale stiffness patterns with kPa/µm gradients. Additionally, we propose an original protocol for the surface coating of adhesion proteins, which allows tuning the surface density from fully coupled to fully independent of the stiffness pattern. This evidences that cells pull on their surroundings by adjusting the level of stress to the micron-scaled stiffness. This conclusion was achieved through improvements in the traction force microscopy technique, e.g., adapting to substrates with a non-uniform stiffness and achieving a submicron resolution thanks to the implementation of a pyramidal optical flow algorithm. These developments provide tools for enhancing the current understanding of the contribution of stiffness alterations in many pathologies, including cancer.

OBJECTIVE: The use of continuous glucose monitoring (CGM) with remote patient monitoring (RPM) continues to grow. We evaluated the cost-effectiveness of CGM with RPM compared with self-monitoring of blood glucose (SMBG) and CGM alone. RESEARCH DESIGN AND METHODS: We simulated type 1 diabetes progression with a Markov model in 5-year-old patients over a 20-year, 50-year, and lifetime horizon. We tracked diabetic ketoacidosis (DKA), severe hypoglycemia (SH), and seven chronic complications: retinopathy, neuropathy, nephropathy, cardiovascular disease, end-stage renal disease, lower-extremity amputation, and blindness. We compared three interventions: SMBG, CGM, and CGM with RPM. Efficacy estimates were derived from meta-analyses of pediatric CGM studies and the results of the Teamwork, Targets, Technology, and Tight Glycemia Study (4T Study 1). We evaluated quality-adjusted life years (QALYs) and health care costs (2022 U.S. dollars) discounted at 3% annually. We performed extensive sensitivity analyses. RESULTS: Compared with SMBG, CGM increased QALYs by 0.09 and costs by $8,900 over 20 years; CGM with RPM increased QALYs by 0.37, and costs by $10,300. CGM with RPM yielded more QALYs at a lower incremental cost-effectiveness ratio compared with CGM ($27,400/QALY vs. $103,700/QALY, respectively). Results were robust across sensitivity analyses and time horizons. CGM with RPM remained cost-effective when achieving at least 30% of 4T’s clinical efficacy. CONCLUSIONS: CGM with RPM delivers superior health outcomes compared with SMBG and CGM and is likely cost-effective for patients with newly diagnosed type 1 diabetes. Despite higher intervention costs, CGM with RPM can reduce complications costs and generate net health care savings.

Introduction: The Virtual Diabetes Specialty Clinic (VDiSC) study demonstrated the feasibility of providing comprehensive diabetes care entirely virtually by combining virtual visits with continuous glucose monitoring support and remote patient monitoring (RPM). However, the financial sustainability of this model remains uncertain. Methods: We developed a financial model to estimate the variable costs and revenues of virtual diabetes care, using visit data from the 234 VDiSC participants with type 1 or type 2 diabetes. Data included virtual visits with certified diabetes care and education specialists (CDCES), endocrinologists, and behavioral health services (BHS). The model estimated care utilization, variable costs, reimbursement revenue, gross profit, and gross profit margin per member, per month (PMPM) for privately insured, publicly insured, and overall clinic populations (75% privately insured). We performed two-way sensitivity analyses on key parameters. Results: Gross profit and gross profit margin PMPM (95% confidence interval) were estimated at $−4 ($−14.00 to $5.68) and −4% (−3% to −6%) for publicly insured patients; $267.26 ($256.59-$277.93) and 73% (58%-88%) for privately insured patients; and $199.41 ($58.43-$340.39) and 67% (32%-102%) for the overall clinic. Profits were primarily driven by CDCES visits and RPM. Results were sensitive to insurance mix, cost-to-charge ratio, and commercial-to-Medicare price ratio. Conclusions: Virtual diabetes care can be financially viable, although profitability relies on privately insured patients. The analysis excluded fixed costs of clinic infrastructure, and securing reimbursement may be challenging in practice. The financial model is adaptable to various care settings and can serve as a planning tool for virtual diabetes clinics.

Introduction Clinics continue to adopt remote patient monitoring for type 1 diabetes (T1D) and care models shaped by algorithmic CGM data analysis. No clinic-facing quantitative framework currently exists to track the impact of such algorithm-directed care on patient outcomes and clinical workload. The Teamwork, Targets, Technology, and Tight Control (4T) Study provides precision, whole-population care enabled by algorithms that use continuous glucose monitoring (CGM) data to direct clinician attention to patients with deteriorating glucose management. Methods We used data from the 4T Pilot (n=133) and 4T Study 1 (n=135), in which algorithms use CGM data to identify youth with T1D meeting criteria for clinical review and potential clinician contact. Through iterative data analysis and interviews with diabetes educators and clinicians, we identified metrics for reviewing and revising clinical workloads, glucose management, and timeliness of care. For each metric, we developed an interactive dashboard to provide clinical and administrative leaders with an overview of the program. Results The metrics to track clinical workload were the total number of youths: (1) in the program, (2) in each study, and (3) cared for by each clinician. The metrics to track glucose management were the number of youths meeting each criterion for review: (4) in total, (5) for each clinician, and (6) for each study. The metric to track timeliness of care was (7) the number of days since meeting criteria for clinical review. When presented at weekly program leadership meetings, the metrics facilitated data-driven decision making about clinical and operational components of the program. Conclusion We propose a novel quantitative framework for diabetes care teams to supervise and enhance algorithm-directed whole-population T1D care. As the role of algorithms grows in directing clinical effort and prioritizing patients for care, this framework may help clinics track clinical workload, patient outcomes, and the timeliness of care.

Clinics continue to adopt care models shaped by the algorithmic analysis of continuous glucose monitoring (CGM) data, such as remote patient monitoring for type 1 diabetes. No clinic-facing quantitative framework currently exists to track the impact of such algorithm-directed care on patient outcomes and clinical workload. We used CGM data from the Teamwork, Targets, Technology, and Tight Control (4T) Study (Pilot n=135 and Study 1 n=133), in which algorithms enable precision, whole-population care by directing clinician attention to patients with deteriorating glucose management. Youth meeting criteria for clinical review are then contacted by Certified Diabetes Care and Education Specialists. Through iterative data analysis and meetings with a variety of stakeholders, we identified metrics for reviewing and revising clinical workloads, glucose management, and timeliness of care. For each metric, we developed an interactive dashboard to provide clinical and administrative leaders with an overview of the program. The metrics to track clinical workload were the total number of youths (1) in the program, (2) in each study, and (3) cared for by each clinician. The metrics to track glucose management were the number of youths meeting each criterion for review, including (4) total, (5) for each clinician, and (6) for each study. The metric to track timeliness of care was (7) the number of days since meeting criteria for clinical review. When presented at regular program leadership meetings, the metrics facilitated data-driven decision-making about clinical and operational components of the program. In this paper, we describe the process of developing and operationalizing this reproducible, clinician-facing key performance indicator tool to monitor an algorithm-enabled remote patient monitoring program. As the role of algorithms grows in directing clinical effort and prioritizing patients for care, this framework may help clinics track clinical workload, patient outcomes, and the timeliness of care.