Alexander V. Dreval, Russian Federation

M. F. Vladimirsky Moscow Regional Research and Clinical Institute Endocrinology department

Presenter of 3 Presentations

THE FREQUENCY OF UNLIMITED FLASH GLYCEMIA SCANS BY PATIENTS WITH TYPE 1 DIABETES ON PUMP INSULIN THERAPY

Session Name
GLUCOSE SENSORS
Session Type
E-POSTER VIEWING (EXHIBITION HOURS)
Date
20.02.2020, Thursday
Session Time
09:30 - 15:30
Channel
E-Poster Area
Lecture Time
09:30 - 09:30

Abstract

Background and Aims

The development of devices that free patients from finger piercing and from using of test-strips in diabetes control, can demonstrate us the real daily need for glycemic self-control in patients with T1D on insulin pump therapy.

Methods

58 adult patients with T1D undergoing insulin pump therapy used the FreeStyle Libre flash glucose monitoring systems (FGM) over the period of 4-15 days (the first and the last days (incomplete) were not analyzed) in both inpatient and outpatient care, followed by a retrospective assessment of the frequency of glycemic scans per day.

Results

The average number of glycemia scans on the 1-st day was 27.5±22.4 times, on the 7-th day - 27.8±21.1 times, on the 14-th day - 25.8±18.7 times (p>0.05). The average number of scans per day during the first six days was 29.1±24.5 times, during the next seven days – 27.3±26.1 times (p>0.05). The average number of scans during 13 days – 28.2 ±25.3 times. Over all period of the study: the average glucose level – 8.8±2.1 mmol/l, time in range (TIR) – 47.6±18.6%, above TIR – 42.5±21.8%, below TIR – 9.7±10.4%, the average number of hypoglycemia events per day – 11.9±9.2, the average duration – 94.3±46.3 min. Baseline HbA1c was at 8.2±1.2%. Prognostic HbA1c by FreeStyle Libre at the end of the study – 7.2±1.5%.

Conclusions

The obtained results show that the recommended standard glycemia self-control frequency at least 4 times a day, is actually 7 times lower than the real need in patients with T1D for optimization of the pump insulin therapy.

Hide

INDIVIDUALIZATION OF DECISION-MAKING ALGORITHMS ON TREND ARROWS IN FREESTYLE LIBRE FLASH GLUCOSE MONITORING SYSTEMS

Session Name
GLUCOSE SENSORS
Session Type
E-POSTER VIEWING (EXHIBITION HOURS)
Date
20.02.2020, Thursday
Session Time
09:30 - 15:30
Channel
E-Poster Area
Lecture Time
09:30 - 09:30

Abstract

Background and Aims

The FreeStyle Libre continuous flash glucose monitoring system (FGM) provides a unique opportunity to evaluate glucose trends to optimize insulin therapy compared to the glycemic self-control by glucometer. However, working with trends requires individualization.

The main purpose of this study is the development of customized decision-making algorithms based on FGM trend arrows for T1D patients.

Methods

T1D patients on insulin pump therapy used FGM over the period of 10-14 days. At the first stage, endocrinologists used standard algorithms of action on trend arrows, evaluated their effectiveness and in case of unsatisfactory results, began to select individualized algorithm rules. At the second stage, the effectiveness of the developed individual algorithms was checked, and further corrections were made if necessary.

Results

For 5 patients out of 15 (33.3%), the standard (developed by the company) algorithms were effective. For the rest 10 patient (66.6%), the modification of standard algorithms was required as follows: 5 patients (33.3%) needed the development of almost completely individualized algorithms (75-80% - changes), and for the other 5 patients (33.3%) some corrections (15-30% - changes) were needed. For 10 patients the insulin doses correction in the standard algorithms was 59%, and bread unit correction - was 2%. In patients trained to assess trends, the average value of TIR was 40.9%, for untrained patients - 34.6%.

Conclusions

Standard trending algorithms are suitable for only one-third of T1D patients who receive insulin pump therapy, indicating the actuality of the problem of diabetes treatment based on trend arrows.

Hide

COMPARISON FLASH (FGM), CONTINUOUS GLUCOSE MONITORING (CGM) AND SELF MONITORING BLOOD GLUCOSE (SMBG) IN PREGNANT WOMAN WITH DIABETES MELLITUS TYPE 1.

Session Name
GLUCOSE SENSORS
Session Type
E-POSTER VIEWING (EXHIBITION HOURS)
Date
20.02.2020, Thursday
Session Time
09:30 - 15:30
Channel
E-Poster Area
Lecture Time
09:30 - 09:30

Abstract

Background and Aims

There is only few study FGM in pregnant woman with T1DM.

Aim. Compare FGM with SMBG and CGM in pregnant woman with T1DM.

Methods

31years-old woman with T1DM, 9ws of pregnancy. HbA1c 5,4%. SMBG(AccuCheck Performa), FGM(FreeStyleLybre) and CGM(iPro) was performed. We aligned each glucose value of SMBG with the closest glucose value FGM and CGM. 109pairs of SMBG with FGM/CGM and 739pairs of FGM and CGM was obtained.

Results

Mean glucose value of FGM was significantly lower than CGM and SMBG (4,9±2,1mmol/l; 5,8±2,2mmol/l and 6,3±2,4mmol/l accordingly, p=0,001). MAD between FGM and SMBG values was slightly more than between CGM and SMBG: 1,2±0,9mmol/l&0,9±1,4mmol/l, р=0,09. MARD between groups were significantly different, p=0,009. CGM showed better accuracy than FGM: MARD between CGM and SMBG was 13,9±13,4%, between FGM and SMBG 20,8±13,8%, p<0,001. MARD was the worst in the 1stday: 39,4±12,4% between FGM and SMBG, 33,8±16,8% between CGM and SMBG. Without 1stday MARD decreases: 20,7±13,7% in the pairs of FGM and SMBG, 11,5±9,2% in the pairs of CGM and SMBG, p<0,001. Consensus Error Grid analysis demonstrated 89,9%values of CGM and 88,1%values of FGM in zone A and B. 74,3%results of CGM and 58,7%results of FGM were in zone A, p=0,03. Most the results in zone C were on the f1stday. The Pearson correlation with SMBG was high: 0,918 for FGM and 0,911 for CGM.

Conclusions

FGM shows as high correlation with SMBG as CGM. Error results were often on the 1stday sensor inserting. About 90%results of FGM were in zone A and B so its clinically acceptable.

Hide