Charles Thivolet, France
Hospices Civils de Lyon Endocrinology and DiabetesPresenter of 1 Presentation
USE OF SENSOR-INTEGRATED PUMP THERAPY IN PEOPLE WITH TYPE 1 DIABETES REDUCES HYPOGLYCEMIA UNAWARENESS AND IMPROVES GENERAL HEALTH
Abstract
Background and Aims
Predictive Low Glucose Management (PLGM) may help prevent hypoglycemia by stopping insulin pump delivery based on predicted sensor glucose (SG) values. However, its capacity to resolve hypoglycemia unawareness and to improve quality of life remains theoretical.
Methods
PLGM was tested for one year in real life conditions with a system composed of a Paradigm 640G insulin pump with SmartGuard technology in a group of 20 patients age 42.5 (20-59) years, with type 1 diabetes duration 26 (7-47) years, mean ± SD BMI (kg/m2) 25.5 ± 3.6 and HbA1C 8.18±0.8%. Patients were contacted monthly by phone with consultations every 3 months.
Results
PLGM reduced hypoglycemia (<70 mg/dL) compared to no insulin suspension with time below range of 1.11±0.32% at one year. Mean (±SEM) sensor glucose value (187.2±3.74 vs 188.1±4.96 mg/dl) and mean±SEM suspension time (128±11.9 min vs 109±19) did not change between 1 and 12 months. Mean HbA1C levels decreased from 8.11±0.17 to 7.81±0.17% (p<0.0001, one way ANOVA). Clarke score decreased from 2.89±0.55 [1.72-4.06, 95%CI] to 1.26±0.39 [0.43-2.09, 95%CI] at one year, (p=0.013). Rand Health quality of life questionnaires (SF-36) show improvements in the general health score (p<0.02) and no change in the 8 other medical outcomes. Both TRIM-D and TRIM-D device questionnaires showed no aggravation of disease burden by devices.
Conclusions
PLGM provides significant improvement beyond HbA1C with marked reduction of time below range, reduction of hypoglycemia unawareness and improvement of general health without increase in disease burden due to external equipment.