The program times are listed in Central European Time (CEST)
Introduction
Management of glucose in the hospital using computerized systems
Adjusting insulin doses in patients who use multiple daily injections: An expert study-Type 1 diabetes
Adjusting insulin doses in patients who use multiple daily injections: An expert study-Type 2 diabetes
The effectiveness of isCGM: comparison of data from RCTs and routine-use
Abstract
Abstract Body
For decades finger prick self-monitoring of blood glucose (SMBG) has been the cornerstone of diabetes self-management, with the expectation that people with diabetes undertake SMBG at multiple points across the day to inform treatment decisions. Intermittently scanned continuous glucose monitoring (isCGM) has more recently become established as an alternative to finger prick SMBG. Individuals wear a sensor on the arm which is scanned with a reader, allowing the user to visualise the glucose information. This contrasts to real time CGM systems which allow direct visualisation of the data without the need to scan. Early randomised controlled trials highlighted the ability of isCGM to reduce hypoglycaemia in people living with Type 1 diabetes and Type 2 diabetes. The uptake of isCGM has since risen exponentially, largely replacing finger prick SMBG for many individuals living with diabetes. The latest generation of isCGM is now available with the additional benefit of optional alarms. A range of randomised controlled trials and real-world studies have been undertaken to explore the potential clinical benefits of the different generations of isCGM on outcomes, including HbA1c, hypoglycaemia and patient related outcome measures. This lecture will aim to review these studies and compare the findings of the randomised controlled trials with those of the published real-world data.
CGM derived data in elderly PwD treated by MDI
Abstract
Abstract Body
Elderly persons with type 1 (PwT1D) or type 2 diabetes (PwT2D) on insulin therapy are at a high risk of hypoglycemia and its poor consequences. The current guidelines for elderly PwD recommend less stringent hemoglobin A1c (A1C) targets to mitigate hypoglycemia.
Recently, continuous glucose monitoring (CGM) has provided a better tool to capture glucose average, glucose variability (coefficient of variation (CV%), and time spent in hypoglycemia (time below range (TBR), compared with A1C. In elderly PwT1D, CGM-derived metrics as CV ≤36% are associated with less TBR and more time in range (TIR), while CV% >36% is associated with less TBR, despite similar A1C levels. Moreover, in elderly PwT1D, personal CGM use, independent of insulin administration method – insulin pump or multiple daily injections (MDI) – is associated with less TBR and lower CV.
Furthermore, in elderly PwT1D, GMI differ from A1C much more than in the general population. When HbA1c > GMI by >0.5%, the difference is associated with greater TBR, while a GMI > HbA1c by >0.5% is associated with higher time above range (TAR). This data highlight the importance of GMI for capturing TBR and TAR, compared to A1C in this vulnerable population.
Thus far, CGM-derived metrics in elderly PwT2D on MDI are scant, however we foresee that CGM-derived data will provide similar insight into glycemic control.
Therefore, in elderly PwD on MDI, compared to A1C, CGM-derived metrics as CV% and GMI help to identify individuals at higher risk for hypoglycemia and to develop more personalized diabetes management plans.