Thomas Zueger, Switzerland
Inselspital, Bern University Hospital Department of Diabetes, Endocrinology, Nutritional Medicine and MetabolismPresenter of 2 Presentations
WHITE COAT ADHERENCE EFFECT ON GLUCOSE CONTROL IN ADULT INDIVIDUALS WITH DIABETES USING CONTINUOUS/FLASH GLUCOSE MONITORING
Abstract
Background and Aims
White coat adherence (WCA) is defined as an increased adherence to treatment regimens in the days prior to the visit with a healthcare provider. Little is known on the effect of WCA on glucose control in adult patients with diabetes mellitus. Continuous glucose monitoring (CGM/FGM) provides a novel approach for a detailed analysis of a potential WCA effect on glycemia.
Methods
The present study is based on CGM/FGM-data of 279 patients with diabetes treated between January 2013 and July 2018 in a tertiary referral center. The analysis compares data from the 3 days prior to a visit (p1) with the preceding 25 days (p2). Patients were included in the analysis if CGM-/FGM-data were available for at least 50% of the two single time periods, resulting in a total of 817 data sets.
Results
Sensor use was higher during p1 than p2 (89.8±10.7% [53mmol/mol] vs 83.0±13.0%; p<0.001). Mean glucose [MG] and coefficient of variation [CV] were lower in p1 compared to p2 (MG 167.1±44.8 mg/dL vs 168.8±38.8 mg/dL, p=0.046; CV 33.4±8.7% vs 36.0±7.1%, p<0.001; respectively). Time in range (70-180mg/dL) was higher in p1 than p2 (60.2±22.1% vs 59.1±19.0%, p=0.014). Sensitivity-analysis showed a predominant WCA effect in patients with HbA1c > 7% (53mmol/mol).
Conclusions
The present study reveals a statistically significant WCA effect on pre-visit glucose control. The absolute effect-size was comparably small, indicating that CGM/FGM data from the time period immediately before a clinical visit reliably reflects glycemic control of a longer pre-visit period.
IMPROVED GLYCAEMIC CONTROL AFTER TRANSITION TO THE HYBRID-CLOSED-LOOP (HCL) SYSTEM MINIMED 670G – REAL-WORLD EXPERIENCE OF A TERTIARY REFERRAL CENTRE
Abstract
Background and Aims
Improved glycaemia in patients using the hybrid-closed-loop system MiniMed 670G (MM670G) has been demonstrated in clinical trials, but only limited real-world data is available yet. The aim of the present study was to analyse glycaemic control after the transition to the new MM670G and to compare it to the preceding treatment.
Methods
This was an 8-month analysis of 25 patients. A structured training program was set up for the transition to MM670G. CGM data were downloaded from the proprietary manufacturer’s software, analyzed with the Glyculator-2 script and compared to pre-transition CGM-data (30-day periods) if available.
Results
Average operation time of CGM-sensor after transition to MM670G was 78%, and mean time in auto mode was 75%. HbA1c was 6.9±1.1%, mean glucose 8.2±0.8mmol/L, CV 31.4±5.8%, time in range (TIR, 3.9-10mmol/L) 76.1±11.6%, time > 10mmol/L 21.6±11.5% and time < 3.9mmol/L 2.3±2.2%, respectively. HbA1c significantly decreased using MM670G (7.4±1.5% vs 6.9±1.1%, p=0.002). Paired CGM data before and after transition to MM670G was available for 14 patients (all prior MM640G users). TIR was higher after change to MM670G (77.4±11.7% vs 70.0±14.5%, p=0.024), whereas time > 10.0mmol/L was lower (19.6±11.3% vs 26.4±15.3%, p=0.013). Coefficient of variation [CV] and interday-variability (MODD) were lower under MM670G compared to the preceding treatment (CV 32.7±6.2% vs 35.6±6.2%, p=0.013; MODD 2.7±0.8 vs 3.2±1.1mmol/L, p=0.04; respectively).
Conclusions
After switching to the new MM670G system, glycaemic control significantly improved in an already well-controlled cohort of diabetic patients. This improvement is reflected in particular by a higher time in range, decreased HbA1c and reduced glycemic variability.