Stephanie Anne Amiel, United Kingdom

Kings College London Diabetes Research Group
Stephanie Amiel is Emeritus Professor of Diabetes Research at King’s College London and honorary consultant to King’s College Hospital NHS Foundation Trust. She trained in medicine at Guy’s Hospital, London with Harry Keen and started her research career at Yale University, USA with Bob Sherwin and Bill Tamborlane. She is an experimental medicine researcher focussing particularly on the pathogenesis and prevention of hypoglycaemia in diabetes, with physiological studies and neuroimaging, development of the UK’s DAFNE structured education programme, deployment of new technologies for insulin administration and clinical islet transplantation, with current work addressing cognitive barriers to hypoglycaemia avoidance. In King’s clinical diabetes services, she led development of the type 1 diabetes service, islet transplantation and, with obstetric colleagues, improving outcomes of pregnancy. She is author of over 200 research papers, book chapters on diabetes management and reviews. She edited Diabetic Medicine and Diabetes Voice and worked on national and international consensus documents and guidelines including chairing the UK’s 2015 NICE guideline development committee for the diagnosis and treatment of type 1 diabetes in adults. She is CI for the HARPdoc trial funded by JDRF, and a co-investigator on the EU-IMI HypoRESOLVE project and on NIH’s impaired awareness of hypoglycaemia project.

Author Of 2 Presentations

OP047 - ASSOCIATION BETWEEN PERSON-REPORTED HYPOGLYCAEMIA AND TIME BELOW RANGE: THE HYPO-METRICS STUDY. (ID 594)

Lecture Time
10:34 - 10:42
Session Type
ORAL PRESENTATIONS SESSION
Date
Sat, 25.02.2023
Session Time
09:30 - 11:00
Room
Hall A4

Abstract

Background and Aims

Time below range from continuous glucose monitoring (CGM), is widely used to assess hypoglycaemia risk. However, its relationship with personal experience of hypoglycaemia is unclear. We investigated the association between time <3.9 mmol/l (TBR3.9) and person-reported hypoglycaemia; symptomatic episodes that resolved on carbohydrate ingestion and/or a measured glucose ≤3.9mmol/l.

Methods

This analysis included 401 adults with insulin-treated diabetes (n=204 with type 1 diabetes (T1D); n=197 with type 2 diabetes (T2D)), who reported ≥1 hypoglycaemic episode in the past 3 months. For 10 weeks, they wore blinded CGM and recorded person-reported hypoglycaemia in real time using the Hypo-METRICS app. Data were analysed using generalised linear regression.

Results

Participants had a median (IQR) age 58 (47-66) years and 45% were women. HbA1c was 7.4% (6.8-8.0%), 23% had impaired awareness of hypoglycaemia, and 43% used capillary glucose monitoring only. During 658,802 hours of CGM, TBR3.9 was 3.0% (1.1-5.9%) and 11,600 person-reported hypoglycaemia episodes were recorded. Using a generalised linear regression model, TBR3.9 explains 25% of the variation of person-reported hypoglycaemia (21% in T1D, 12% in T2D). With every 1% change in TBR3.9, the weekly rate of person-reported hypoglycaemia changes by 9.4% (p<0.0001), with a 6.2% change in T1D (p<0.0001) and 9.4% change in T2D (p<0.0001).

Conclusions

While TBR3.9 is a valuable tool to understand hypoglycaemia risk, it explains a relatively small proportion of the variation in person-reported hypoglycaemia rates and highlights the limitation of using this metric as a surrogate marker for the experience of hypoglycaemia by the person living with diabetes.

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OP085 - AN INTERVENTION TO ADDRESS TREATMENT-RESISTANT HYPOGLYCAEMIA BECOMES COST-EFFECTIVE THROUGH IMPROVED QUALITY OF LIFE AND FEWER ADMISSIONS. THE HARPDOC RANDOMISED CONTROLLED TRIAL. (ID 603)

Lecture Time
17:04 - 17:12
Session Type
ORAL PRESENTATIONS SESSION
Date
Fri, 24.02.2023
Session Time
16:40 - 18:10
Room
Hall M1

Abstract

Background and Aims

Aim: to assess cost effectiveness of HARPdoc (Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes (T1D) and problematic hypoglycaemia persisting despite optimised care), which addresses attitudinal barriers to hypoglycaemia avoidance, vs Blood Glucose Awareness Training (BGAT, psychoeducation not addressing cognitions) as adjunctive treatments for adults with T1D and treatment-resistant problematic hypoglycaemia in a randomised controlled trial.

Methods

Eligible adults were randomised to either intervention and followed for 24 months. Quality of life (QoL, EQ-5D-5L) was measured at baseline, 12 and 24 months; utilisation of health services (Client Services Receipt Inventory) at 12 and 24 months; time spent by educators by interview and costs from UK databases. Incremental net benefit (INB), HARPdoc over BGAT, at 12 and 24 months calculated as cost per QALY, differences adjusted for group clustering using a mixed-effects random intercepts model using Stata 17.

Results

Delivery costs for HARPdoc were higher (mean±SD £1697±290 vs £541±82) but EQ-5D-5L total scores were higher and service utilization lower with HARPdoc. Over 24 months, mean[95%CI] expected difference in QALYs +0.067 per participant [ -0.024 to 0.155], equivalent to a gain of 24 days in full health over 24 months; expected difference in mean [95%CI] total cost (adjusted) -£194/participant [-£2498 to £1942]; adjusted difference in QALYs =-0.067/participant [-0.024 to 0.155], giving INBs £1,057 - £2,184 with 80-85% probability of cost-effectiveness at 24 months.

Conclusions

Addressing unhelpful health cognitions around hypoglycaemia in people with treatment-resistant hypoglycaemia likely achieves cost-effectiveness at 2 years, through improved QoL and reduced need for medical services

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Presenter of 1 Presentation

OP085 - AN INTERVENTION TO ADDRESS TREATMENT-RESISTANT HYPOGLYCAEMIA BECOMES COST-EFFECTIVE THROUGH IMPROVED QUALITY OF LIFE AND FEWER ADMISSIONS. THE HARPDOC RANDOMISED CONTROLLED TRIAL. (ID 603)

Lecture Time
17:04 - 17:12
Session Type
ORAL PRESENTATIONS SESSION
Date
Fri, 24.02.2023
Session Time
16:40 - 18:10
Room
Hall M1

Abstract

Background and Aims

Aim: to assess cost effectiveness of HARPdoc (Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes (T1D) and problematic hypoglycaemia persisting despite optimised care), which addresses attitudinal barriers to hypoglycaemia avoidance, vs Blood Glucose Awareness Training (BGAT, psychoeducation not addressing cognitions) as adjunctive treatments for adults with T1D and treatment-resistant problematic hypoglycaemia in a randomised controlled trial.

Methods

Eligible adults were randomised to either intervention and followed for 24 months. Quality of life (QoL, EQ-5D-5L) was measured at baseline, 12 and 24 months; utilisation of health services (Client Services Receipt Inventory) at 12 and 24 months; time spent by educators by interview and costs from UK databases. Incremental net benefit (INB), HARPdoc over BGAT, at 12 and 24 months calculated as cost per QALY, differences adjusted for group clustering using a mixed-effects random intercepts model using Stata 17.

Results

Delivery costs for HARPdoc were higher (mean±SD £1697±290 vs £541±82) but EQ-5D-5L total scores were higher and service utilization lower with HARPdoc. Over 24 months, mean[95%CI] expected difference in QALYs +0.067 per participant [ -0.024 to 0.155], equivalent to a gain of 24 days in full health over 24 months; expected difference in mean [95%CI] total cost (adjusted) -£194/participant [-£2498 to £1942]; adjusted difference in QALYs =-0.067/participant [-0.024 to 0.155], giving INBs £1,057 - £2,184 with 80-85% probability of cost-effectiveness at 24 months.

Conclusions

Addressing unhelpful health cognitions around hypoglycaemia in people with treatment-resistant hypoglycaemia likely achieves cost-effectiveness at 2 years, through improved QoL and reduced need for medical services

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Moderator of 1 Session

PARALLEL SESSION
Session Type
PARALLEL SESSION
Date
Thu, 23.02.2023
Room
Hall A8
Session Time
13:00 - 14:30
Session Icon
Live Q&A