E-POSTER DISCUSSION
Session Type
E-POSTER DISCUSSION
Chair(s)
  • Priya Prahalad, United States of America
Channel
Station 6 (E-Poster Area)
Date
21.02.2020, Friday
Session Time
10:05 - 10:25

INTEGRATED CARE PROGRAM (INCAP) FOR TYPE 1 DIABETES PATIENTS WITH CONTINUOUS SUBCUTANEOUS INSULIN INFUSION SYSTEM (CSII), IMPROVED BY DIGITAL TECHNOLOGIES

Session Name
E-POSTER DISCUSSION 12
Session Type
E-POSTER DISCUSSION
Date
21.02.2020, Friday
Session Time
10:05 - 10:25
Channel
Station 6 (E-Poster Area)
Lecture Time
10:05 - 10:10
Presenter
  • Purificación Ros, Spain
Authors
  • Purificación Ros, Spain
  • Belén Nuñez, Spain
  • Beatriz Merino barbancho, Spain
  • Ainhoa Abad, Spain
  • Aranzazu Serrano, Spain
  • Itziar Martinez-badás, Spain
  • Nerea Lacámara, Spain
  • Ferdoss Esrail, Netherlands
  • Steven Flipse, Netherlands
  • Maria Teresa Arredondo, Spain
  • Giuseppe Fico, Spain

Abstract

Background and Aims

T1D is a complex chronic disease, and requires high level of self-management education to prevent long term complications. Even though there have been different telematics approaches to support diabetes management, none of them have been well integrated into the health care system to date. The aim of this work is to build INCAP solution: to develop a Remote Monitoring Support Centre (CSSR) to optimize the medical outcome of patients based on personal progression and a digital educational program to improve self-management and adherence.

Methods

The algorithm implemented in CSSR uses clustering techniques to classify the data extracted from CSII. A colour code was used for triage (emergency patients in red, alert patients in yellow and stable patients in green). Moreover, a mobile application for patients has been developed including self-management contents and professional support. We included 51 patients (28 children-CH-;23 adults-A-) with T1D treated with CSII.

Results

Preliminary results (4 months of follow-up) from CSSR deployment show a total of 164 remote follow-ups (100CH vs 64A), clustering 49% emergency patients (56%CH vs 38%A), 19% alert patients (17%CH vs 23%A) and 32% stable patients (27%CH vs 39%A). Comparing with baseline follow-up, downloads in red have decreased 12% (from 61% to 49%) and those classified in green have increased 9% (from 23% to 32%).Besides, 5 out of 28 pediatric in-office visits were cancelled or postponed.

Conclusions

The deployment and implementation of the INCAP solution points direct impact on the efficiency of in-office follow-up, as well as on the reduction of the number of unnecessary follow-ups.

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COST OFFSET ANALYSIS (COA) COMPARING REAL-TIME CONTINUOUS GLUCOSE MONITORING (RT-CGM) WITH SELF-MONITORING OF BLOOD GLUCOSE (SMBG) IN PEOPLE WITH TYPE 1 DIABETES IN EIGHT COUNTRIES

Session Name
E-POSTER DISCUSSION 12
Session Type
E-POSTER DISCUSSION
Date
21.02.2020, Friday
Session Time
10:05 - 10:25
Channel
Station 6 (E-Poster Area)
Lecture Time
10:10 - 10:15
Presenter
  • John J. Isitt, United States of America
Authors
  • Michael E. Minshall, United States of America
  • John J. Isitt, United States of America
  • David Price, United States of America
  • Claudia Graham, United States of America
  • Peter Lynch, United States of America

Abstract

Background and Aims

A COA was performed comparing clinical cost offsets for an rt-CGM system with SMBG calibration compared with SMBG alone in people with T1D (n=2,000 per country) and uncontrolled glycemia, in eight countries over a one-year period.

Methods

Clinical effects for HbA1c reduction from rt-CGM and SMBG were -1.0% and -0.4%, respectively, taken from a recently published RCT (Beck, 2017). HbA1c reductions for rt-CGM and SMBG were converted into an economic benefit based on a US study (Wagner, 2001), adjusted for the Organization for Economic Cooperation and Development (OECD) healthcare purchasing power parity and 2019 exchange rates for non-US countries. Reduced hospitalization rates for severe hypoglycemia (SH; -73%) and diabetic ketoacidosis (DKA; -80%) were taken from a recent observational study in Belgium where SMBG was used in the year prior to countrywide reimbursement of rt-CGM and followed for one year (Charleer, 2018). Costs attributable to HbA1c reduction, SH and DKA hospitalizations were taken from country-specific published literature and inflated to 2019 values.

Results

The reduction in SH hospitalization rate using rt-CGM over SMBG yielded an annual 491 fewer SH hospitalizations per country. The reduction in DKA hospitalization rate using rt-CGM over SMBG yielded an annual 201 fewer DKA hospitalizations per country. Projected annual cost offsets per person with T1D using rt-CGM over SMBG are as follows: Australia, $1,216-$1,435; Canada, $1,195-$1,404; France, €953-€1,096; Germany, €911-€1,079; Italy, €960-€1,064; Spain, €722-€821; UK, £605-£720; USA, $1,535-$1,867.

Conclusions

Our modelling study demonstrates potential clinical and economic benefits for rt-CGM compared with SMBG in people with T1D from eight countries.

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OLDER ADULTS WITH TYPE 1 DIABETES DEMONSTRATE HIGH UTILIZATION OF CGM AND HIGH CONFIDENCE IN CGM DATA

Session Name
E-POSTER DISCUSSION 12
Session Type
E-POSTER DISCUSSION
Date
21.02.2020, Friday
Session Time
10:05 - 10:25
Channel
Station 6 (E-Poster Area)
Lecture Time
10:15 - 10:20
Presenter
  • Lauren G. Kanapka, United States of America
Authors
  • Lauren G. Kanapka, United States of America
  • Kellee Miller, United States of America
  • Michael R. Rickels, United States of America
  • Richard Pratley, United States of America

Abstract

Background and Aims

To assess CGM use among older adults with T1D we analyzed data from the Wireless Innovation for Seniors with Diabetes Mellitus (WISDM) study, a 6-month multi-center randomized trial of CGM with a 6 month observational extension study.

Methods

The cohort included the 103 adults ≥60 years old with T1D randomized to use Dexcom G5 CGM for up to 12 months (median age 68 years, median T1D duration 39 years, 59% female, 92% non-Hispanic white, 56% insulin pump use, mean HbA1c 7.6%). Device data were downloaded to assess CGM use and participants reported use of device features.

Results

CGM use remained high throughout the study with 92% still using CGM at 12 months and 82% using CGM 6 or more days per week (Table). At 12 months, among those still using the device, 37% reported using the smartphone application to view glucose values. Only 12% chose to share their data with another person via the smartphone application (31% of app users). 51% reported reviewing retrospective CGM data at least 1 time per month, up from 33% at 4 weeks. At 4 weeks, 69% were using the CGM to dose insulin without fingerstick confirmation, and this increased further to 95% by 12 months.table.png

Conclusions

In this study, older adults with T1D had high CGM adherence and trust after 12 months of use. Sharing CGM glucose values with another person could be particularly beneficial in this vulnerable population, however this feature was not adopted by a large majority of participants.

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ACUTE METABOLIC COMPLICATIONS DURING THE FAST OF THE MONTH OF RAMADAN

Session Name
E-POSTER DISCUSSION 12
Session Type
E-POSTER DISCUSSION
Date
21.02.2020, Friday
Session Time
10:05 - 10:25
Channel
Station 6 (E-Poster Area)
Lecture Time
10:20 - 10:25
Presenter
  • Faika Ben mami, Tunisia
Authors
  • Chaima Jemai, Tunisia
  • Faika Ben mami, Tunisia

Abstract

Background and Aims

The results reported by the literature regarding the frequency and characteristics of acute metabolic complications during fasting in Ramadan are discordant. The objective of our study was to characterize these complications during fasting.

Methods

This is a prospective study that involved 140 patients who wish to fast the month of Ramadan, organized at the Tunis National Institute of Nutrition (C departement). These patients were given an interview, a thorough clinical examination and a biological assessment and were well informed about the risks they face. They had the appropriate therapeutic adaptation (recommendations of the ADA 2016) , as well as an adequate hygiene and dietary education. We have totally banned fasting for unbalanced patients.

Results

The average number of days fasted was 24.57 ± 10.5 days. Diabetes were poorly balanced in 71% of cases. The overall frequency of hypoglycaemia during fasting was 12.1% (n=17). The hyperglycaemia was 11.4% (n =16). No other metabolic complication (ketoacidosis, hyperosmolar coma) has occurred. No patient had been hospitalized. Hypoglycaemia was significantly more frequent in subjects who had hypoglycaemia before fasting (33.3%, 8.4%, p = 0.005). It wes significantly more frequent in patients at high and very high risk (16.2% versus 2.4%) (p = 0.017) with a risk multiplied by 7.71. Hyperglycemia was more frequent in high and very high risk patients, but with no statistically significant difference.

Conclusions

The frequency of acute complications was low thanks to therapeutic adaptation and prior education.

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