Ales Skvarca, Slovenia
University Medical Centre Ljubljana Department of Endocrinology, Diabetes and Metabolic DiseasesPresenter of 2 Presentations
THE INTRODUCTION OF MINIMED 670G HYBRID CLOSED LOOP INSULIN PUMP AUTO MODE SYSTEM IMPROVES GLYCAEMIC CONTROL IN ROUTINE CLINICAL PRACTICE
Abstract
Background and Aims
Good glycaemic control is often difficult to achieve in patients with type 1 diabetes mellitus (T1DM), especially without increasing time spent in hypoglycaemia. Recently, MiniMed 670G hybrid closed loop insulin pump system has been introduced into clinical practice. The aim of this analysis was to evaluate the effect of MiniMed 670G Auto Mode (AM) on the glycaemic control in the first 12 weeks after AM initiation in routine clinical practice.
Methods
Twelve T1DM patients (aged 42.0±15.6 years, duration of diabetes 27.5±15.9 years) using Medtronic MiniMed 670G hybrid insulin pump and continuous glucose monitoring (CGM) system were included in the analysis. HbA1c level was measured at baseline and after 12 weeks. The CGM data of the preceding two weeks were analysed at the time of the AM initiation and after 12 weeks of treatment. Several parameters were determined and analysed: time in range (TIR; % of readings 3.9-10.0 mmol/l), time above range (TAR; % of readings >10.0 mmol/l), time below range (TBR; % of readings <3.9 mmol/l) and time in AM.
Results
Twelve weeks after AM initiation HbA1c level significantly decreased from 7.8±0.8% to 7.1±0.6 (p=0.002). TIR increased from 69.4±7.5 to 71.8±7.6 % (NS). TAR increased only slightly from 26.5±8.0 to 26.7±7.8 % (NS). TBR significantly decreased from 4.1±4.5 to 1.5±1.0 (p=0.04). Average percentage of time in AM after twelve weeks was 89.2±9.1 %.
Conclusions
The introduction of MiniMed 670G hybrid closed loop insulin pump AM system quickly improves overall glycaemic control and decreases time spent in hypoglycaemia, without increasing time spent in hyperglycaemia.
GLUCAGON-LIKE PEPTIDE-1 RECEPTOR IMAGING IN THE LOCALIZATION OF INSULINOMA
Abstract
Background and Aims
Endogenous hyperinsulinism caused by an insulinoma is a rare condition, potentially causing severe hypoglycaemia. The definite therapy for insulinoma is a pancreas-sparing surgery. That is why accurate preoperative localization of the tumour is important. However, most insulinomas are solitary, benign and rather small in size, which often makes their localization difficult. In about 10% of insulinomas, conventional imaging (CT, EUS, MRI, somatostatin receptor scintigraphy) is negative. Glucagon-like peptide-1 receptors (GLP-1R) are expressed in high percentage and density in virtually all insulinomas. The aim of this study was to evaluate GLP-1R imaging with the use of [Lys40(Ahx-HYNIC-99mTc/EDDA)NH2]-exendin-4 in localization of insulinoma, when conventional imaging was negative or inconclusive.
Methods
Whole-body GLP-1R SPECT/CT was performed four hours after administration of [Lys40(Ahx-HYNIC-99mTc/EDDA)NH2]-exendin-4 in patients with suspected insulinoma and negative or inconclusive conventional imaging (CT/EUS/MRI/SRS). The results of the GLP-1R scintigraphy were evaluated by an experienced nuclear medicine physician. Following surgical excision of the lesion, the diagnostic performance of the GLP-1R scintigraphy was analysed using histopathological evaluation and patient’s symptoms resolution as the gold standard.
Results
Seven female patients with biochemically confirmed endogenous hyperinsulinism during fasting test were enrolled in our study. In all patients, focal uptake of the radiopharmaceutical in the pancreas was found and surgery was performed. No metastases were found. In all cases, insulin-producing neuroendocrine tumors were confirmed by histopathological analysis and patient’s symptoms resolved after surgery. The sensitivity and specificity of GLP-1R scintigraphy were 100%.
Conclusions
GLP-1R imaging with the use of [Lys40(Ahx-HYNIC-99mTc/EDDA)NH2]-exendin-4 is a highly efficient diagnostic modality for localization of insulinoma.