Klemen Dovc, Slovenia
University Children’s Hospital, and Faculty of Medicine, University of Ljubljana Endocrinology, Diabetes and Metabolic Diseases (Pediatric Clinic)Presenter of 5 Presentations
REAL-WORLD DATA ON TIME IN RANGE AMONG CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES: DATA FROM THE INTERNATIONAL SWEET REGISTRY
- Klemen Dovc, Slovenia
- Stefanie Lanzinger, Germany
- Roque Cardona Hernandez, Spain
- Martin Tauschmann, Austria
- Marco Marigliano, Italy
- Valentino Cherubini, Italy
- Romualdas T. Preikša, Lithuania
- Ulrike Schierloh, Luxembourg
- Helen Clapin, Australia
- Fahed AlJaser, Kuwait
- Julie Pelicand, Chile
- Rishi Shuklar, India
- Torben Biester, Germany
Abstract
Background and Aims
An international consensus proposed time in range 70–180 mg/dl (TIR), below (<70 mg/dl) and above (>180 mg/dl) range as compound metrics of glycemic control to complement HbA1c regardless of age in individuals with Type 1 Diabetes (T1D). The aim of this study was to evaluate real-world data from an international network for pediatric diabetes centers (SWEET).
Methods
We retrospectively analyzed data from four age groups: 1–6y (n=185), 7–13y (n=1,195), 14–17y (n=996) and 18-21y (n=347) with T1D using CGM. Linear regression models adjusted for gender, diabetes duration, age, BMI and insulin therapy modality were performed to identify potential predictors of TIR.
Results
CGM data from 2,723 individuals (mean 229 sensor-days/person) from 22 centers were analyzed. Overall median TIR was 54.5%. Time in/below/above ranges were 59.3/3.0/37.9% among 1–6y, 57.4/3.0/38.5% among 7–13y, 51.7/3.6/42.8% among 14–17y and 50.7/4.7/42.5% among 18-21y. We observed a significant positive association between TIR and insulin therapy modality, an inverse association between T1D duration and TIR, while there was no association with gender or BMI. Adjusted mean (95%CI) TIR was 57% (54;59) in insulin pump users and 51% (47;54) in non-users. Pearson correlation coefficients showed strong correlations between HbA1c and TIR (R=-0.746, P<0.0001).
Conclusions
Data from the SWEET registry demonstrate that only a minority of young individuals with T1D achieve recommended goals for TIR. We observed higher TIR at younger age groups, a significant decline in TIR with longer T1D duration and a positive association with insulin pump therapy.
Closed-loop and physical activity in youth with type 1 diabetes
Abstract
Abstract Body
Closed-loop glycemic control, characterized by glucose-responsive automated insulin, is now a part of regular clinical reality for many individuals living with type 1 diabetes. The management of type 1 diabetes during exercise is complex. At the same time, dosing insulin adequately either in advance of activity or in real-time can generate positive outcomes and reduce the likelihood of hypoglycemia.The performance of closed-loop glycemic control in individuals with type 1 diabetes during and after the physical activity has been extensively evaluated, especially in the controlled environment, while there is less data regarding unsupervised physical activity in home settings. Closed-loop therapy was in the past challenged with different exercise protocols of different durations and intensity, in heterogeneous age groups, with additional devices to detect physical activity, such as activity and heart rate monitoring, and adding glucagon to prevent hypoglycemia.
In this presentation, we will present contemporary data on closed-loop glycemic control challenged by physical activity in children, adolescents and young adults with type 1 diabetes.
Faster acting insulin analogues in closed-loop insulin delivery
Abstract
Abstract Body
Diabetes technology options have greatly increased for individuals with type 1 diabetes, with the commercialization of multiple advanced insulin pumps, including hybrid closed-loop devices. Hybrid closed-loop insulin therapy consists of an insulin pump, a connected continuous glucose monitor, and an algorithm that enables automated insulin delivery apart from prandial boluses in response to glucose levels. While improvements seen in glycemic control are reassuring, users of these treatment modalities still experience the everyday burden of feed-forward actions, such as carbohydrate counting or exercise announcement, and still require premeal insulin dosing (bolus) to prevent postprandial glycemic excursion. To fully close the loop, these systems might benefit from a faster insulin action and clearance rate, which are recently reported with novel faster insulin analogues.In this presentation, we will present current data on closed-loop glycemic control with faster insulin formulations in individuals with type 1 diabetes.
Continuous and Intermittent Glucose Monitoring
CONTINUOUS GLUCOSE MONITORING USE AND GLUCOSE VARIABILITY IN VERY YOUNG CHILDREN WITH TYPE 1 DIABETES: THE VIBRATE STUDY
- Klemen Dovc, Slovenia
- Michelle A. Van Name, United States of America
- Ewa Rusak, Poland
- Claudia Piona, Italy
- Gul Yesiltepe-Mutlu, Turkey
- Rosaline Mentink, Netherlands
- Guilio Frontino, Italy
- Maddalena Macedoni, Italy
- Sofia H. Ferreira, Portugal
- Joana Serra-Caetano, Portugal
- Julia Galhardo, Portugal
- Julie Pelicand, Chile
- Francesca Silvestri, Italy
- Barbara Jenko Bizjan, Slovenia
- Agata Chobot, Poland
- Torben Biester, Germany
- Jen Sherr, United States of America
Abstract
Background and Aims
While data on the efficacy and safety of CGM is evident across a broad age spectrum, there is a limited assessment in very young children with type 1 diabetes (T1D). This study aimed to assess real-world data in this high-risk population, focusing on glycemic variability and time in ranges.
Methods
The study adopted a prospective, multi-national, registry-based population cohort design to compare glycemia metrics over 12 months between very young children with T1D using real-time CGM and those using intermittent fingerstick blood glucose monitoring (BGM) alone. Major eligibility criteria included T1D diagnosed at least 6 months prior, age 1 to 7 years, insulin pump therapy for at least 3 months and at least 10 days of CGM/BGM data. The primary endpoint was assessment of glycemic variability as measured by the difference in coefficient of variation (CV) between the CGM users and BGM cohort and time in ranges as other pre-specified endpoints calculated for each group.
The trial is registered with Clinicaltrials.gov: NCT04558710
Results
Data from 229 individuals (44% were female, mean age 5.1±1.6 years) from 15 centers were analyzed.Results of the primary and pre-specified secondary efficacy outcomes are presented in Table 1 over the full 24-hour period.
Conclusions
The use of CGM was associated with reduced glucose fluctuations and increased time in range and decreased time above and below range. In our study, very young children with T1D using CGM were more likely to approach the targeted glycemia as measured by time in range.