Особенности углеводного обмена у детей подросткового возраста с сахарным диабетом 1-го типа при коморбидности с ожирением

Application of Flash glucose monitoring (FGM) system to evaluate glycaemic variability (GV), patient satisfaction and clinical utility in pregnant women with diabetes. This prospective study was conducted in a tertiary care teaching hospital on 70 pregnant women with diabetes where blood sugar levels were monitored by FGM and self-monitoring of blood glucose (SMBG). FGM generated 19,950 readings versus 1470 readings by SMBG over 3days. Glucose values measured by FGM and SMBG had significant positive correlation (r > 0.89; p < 0.001). Significant difference (p < 0.001) was present between minimum glucose values by FGM (52.49 ± 15.42mg/dl) and SMBG (72.74 ± 18.30mg/dl). FGM (20.9%) was able to pick exact duration of hypoglycaemia, while one-third of this duration was missed by conventional SMBG (14.7%; p < 0.05). Hypoglycaemic episodes were observed in 92.9% women by FGM as compared to 45.7% by SMBG (p < 0.001). No significant difference was observed in maximum glucose level or duration of hyperglycaemia by both methods. FGM identified hyperglycaemia in 74% women vs. 52% by SMBG (p < 0.001). GV calculated by using MODD by FGM was 118.4 ± 52.4mg/dl and by SMBG was 83.2 ± 53.2mg/dl (p < 0.001). 100% women preferred AGP vs. SMBG. This is the first study to evaluate FGM for GV and patient satisfaction in women with GDM. Significant correlation was observed in glucose values by FGM and SMBG. FGM was more sensitive in detecting GV and hypoglycaemic excursions as compared to SMBG. All women preferred FGM over SMBG. Use of FGM gave new insights in clinical management of challenging cases.

BACKGROUNDIn 2017, 35000 Saudi children and adolescents were living with a type 1 diabetes (T1D) diagnosis. Diabetic complications are minimized upon strengthened glycemic regulation. The annual cost of treating diabetic patients with complications was four-fold higher than for patients without complications. The use of flash glucose monitoring (FGM) enables better diabetes treatment and thereby improves glycemic control. Understanding the factors that affect effectiveness of FGM will help enhance the device’s use and management of hospital resources, resulting in improved outcomes.AIMTo investigate factors that affect effectiveness of the FGM system for glycated hemoglobin (HbA1c) levels/glycemic control among T1D patients.METHODSA retrospective empirical analysis of T1D patient records from King Abdul-Aziz University Hospital and Prince Sultan Military Medical City was performed. T1D patients who began FGM between 2017 and 2019 were included.RESULTSThe data included 195 T1D patients (70 males and 125 females) with a mean age of 23.6 ± 8.1 years. Among them, 152 patients used multiple daily injection and 43 used an insulin pump. The difference in HbA1c level from baseline and after using FGM was -0.60 ± 2.10, with a maximum of 4.70 and a minimum of -6.30. There was a statistically significant negative correlation between the independent variables (age, duration of diabetes, level of engagement) and HbA1c. The group with the highest HbA1c mean (9.85) was 18-years-old, while the group with the lowest HbA1c mean (7.87) was 45-years-old. Patients with a low level of engagement (less than six scans per day) had the highest HbA1c mean (9.84), whereas those with a high level of engagement (more than eight scans per day) had the lowest HbA1c mean (8.33).CONCLUSIONWith proper education, FGM can help people with uncontrolled T1D over the age of 18 years to control their glucose level.

894-P: Intermittent Use of Flash Glucose Monitoring (FGM) and Education Improves Glycemia in Type 2 Diabetes (T2D) in Singapore: Pilot Data from Glimpse Project

To explore the efficacy and safety of intermittent use of flash glucose monitoring (FGM) for improving glycemic control in Chinese elderly patients with type 2 diabetes mellitus (T2DM). This is a prospective observational study involving patients with T2DM aged ≥60 years. The study period spans 12weeks, with participants wearing FGM at weeks 0, 5, and 10. Participants were divided into two subgroups based on HbA1c at enrollment: < 7.0% and ≥7.0%. The primary outcome of the study was HbA1c level. Secondary outcomes included time in range (3.9-10mmol/L) (TIR), time below range (<3.9mmol/L) (TBR), time above range (>10.0mmol/L) (TAR), and glycemic variability (GV). A total of 68 patients completed the 12-week FGM follow-up (age 67.9 ± 5.2 years; BMI 25.4 ± 3.3kg/m²). Overall findings revealed that compared to baseline, HbA1c decreased from 7.81 ± 1.25% to 7.44±1.10% after 12weeks of intermittent wearing of FGM (p <0.001). In the subgroup analysis with HbA1c ≥7.0%, the results showed a significant reduction in HbA1c of 0.51mmol/L after 12weeks (8.36 ± 0.95% vs 7.75 ± 0.97%, p < 0.001). And there was a significant reduction in TBR in the subgroup with HbA1c < 7% (p = 0.028). Multiple linear regression analysis showed that the baseline HbA1c (β = -0.529, P<0.001), duration of T2DM (β = 0.341, P = 0.001), and the frequency of sensor use (β = -0.269, P = 0.043) were associated with the reduction in HbA1c level. Intermittent use of FGM is associated with an improvement in glycemic outcomes and reduces the risk of hypoglycemia in Chinese elderly patients with T2DM.

Continuous glucose monitoring (CGM)/flash glucose monitoring (FGM) use in diabetes management is increasing. Cutaneous complications associated with these devices were reported. We conducted a systematic review to provide an overview of cutaneous complications with CGM/FGM use. We identified observational studies and intervention trials that report on cutaneous complications with CGM/FGM use up to January 14, 2019. Studies were identified through Medline, Embase, and PubMed, or with hand searching of the previous publications. Screening was duplicated and data extracted to consider four main themes: incidence rate and severity, participant perspectives of cutaneous complications, potential solutions, and future directions in diabetic technology relevant to reducing cutaneous complications. A total of 54 eligible studies were identified. The overall event rate of cutaneous complications reported from 19 trials was one event per eight weeks of sensor wear-time of which 1.5% were considered severe. The most common cutaneous complications were wear-related erythema, itching, and induration. Although skin irritations were the most common cause of CGM/FGM discontinuation, most users experienced less pain or discomfort with CGM/FGM than capillary blood glucose testing. Future technological advances may reduce, but not eliminate cutaneous complications. The incidence rate of reported cutaneous complications with CGM/FGM use from the available literature is low, with one event per eight weeks of sensor wear-time. Reported complication severity was also low, leading to low rates of CGM/FGM discontinuation. However, there appear to be discrepancies between reporting in trial and observational data. Greater constancy in reporting is necessary to understand the frequency of this issue.

ABSTRACTObjectives:To evaluate the alternate use of flash glucose monitoring (FGM) with self-monitoring blood glucose (SMBG), in patients with type 1 diabetes (T1D).Materials and methods:Two weeks of open FGM (P2), both preceded (P1) and followed by 2 weeks (P3) of SMBG with a blinded FGM system. Mean absolute relative difference (MARD) was calculated by (|FGMi − SMBGi|) / SMBGi, where it was a paired data sample.Results:In total, 34 patients were evaluated. Time in range (TIR) did not change between P1 and P2. In 12 patients (35.3%), TIR increased from 40% at P1 to 52% at P2 (p = 0.002) and in 22 (64.7%), TIR decreased or did not change. FGM use resulted in decreased % time spent in hypoglycemia (<70 mg/dL) (6.5% vs. 5.0%; p = 0.005), increased % time spent in hyperglycemia (>180 mg/dL) (44.5% to 51%; p = 0.046) with no significant change in % TIR. The proportion of patients who reached sensor-estimated glycated hemoglobin (eA1c) < 7% decreased from 23.5% at P1 to 12.9% at P2, p = 0.028. For the whole sample, the MARD between the two methods was 15.5% (95% CI 14.5-16.6%). For normal glucose range, hyperglycemic levels and hypoglycemic levels MARD were 16.0% (95% CI 15.0-17.0%), 13.3% (95% CI 11.5-15.2%) and 23.4% [95% CI 20.5-26.3%)], respectively.Conclusion:FGM after usual SMBG decreased the % time spent in hypoglycemia concomitant with an undesired increase in % time spent in hyperglycemia. Lower accuracy of FGM regarding hypoglycemia levels could result in overcorrection of hypoglycemia.

Since few years Glucose monitoring, which contributes to good metabolic control, has available a new tool, sensors, which automatically and continuously measure interstitial glucose levels in two modes: continuous (Continuous Glucose Monitoring) and flash (Flash Glucose Monitoring). Flash Glucose Monitoring has been shown to be efficient and improve the quality of life in type 1 diabetic patients; and also for type 2 diabetic patients there are a growing number of studies, which have evaluated efficacy, the frequency of hypoglycemia and glycemic variability in these patients. The purpose of this review is to take stock of use of Flash Glucose Monitoring in type 2 diabetic patients by examining international studies and Italian experiences, also reporting data on the costs and savings generated by use of this new technology. KEY WORDS Flash Glucose Monitoring; type 2 diabetes; basal-bolus insulin therapy; elderly with type 2 diabetes; diabetes costs.

BackgroundThe use of flash glucose monitoring (FGM) in conjunction with proper education has been reported to improve glycemic control in people with diabetes on insulin therapy. However, there are still few randomized controlled trials on the educational effect, and an ideal educational model has not been established. This study aimed to estimate the efficacy of remote intervention for glycemic control in adults with type 1 diabetes using FGM.MethodsIn this single-center, randomized controlled trial, we enrolled adults with type 1 diabetes (HbA1c ≥7.0%). The participants were randomly assigned (1:1) to either FGM use with remote intervention (intervention group) or FGM use only (control group). Changes in glycemic outcomes such as HbA1c levels and continuous glucose monitoring metrics were evaluated at 12 weeks.ResultsAmong 36 randomized participants (mean age, 44.3 years; mean baseline HbA1c, 8.9%), 34 completed the study. The remote intervention did not significantly reduce HbA1c levels. FGM use significantly improved HbA1c levels by −1.4% and −0.8% in both groups with and without remote intervention, respectively (P=0.003 and P=0.004, respectively). However, the intervention group showed significant increases in time with glucose in the range of 70–180 mg/dL (TIR; from 49.8% to 60.9%, P=0.001) and significant decreases in time with hyperglycemia (P=0.002) and mean glucose (P=0.017), but the control group did not. Moreover, the TIR (P=0.019), time with hyperglycemia >250 mg/dL (P=0.019), and coefficient of variation (P=0.018) were significantly improved in the intervention group compared to the control group. In particular, the CGM metrics improved gradually as the remote intervention was repeated. Furthermore, the intervention group reported higher treatment satisfaction (P=0.016).ConclusionsOngoing, personalized education during FGM use may lead to amelioration of glycemic control in adults with type 1 diabetes, even remotely.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04936633, identifier NCT04936633.

Improved glycemic control after the use of flash glucose monitoring accompanied by improved treatment satisfaction in patients with non-insulin-treated type 2 diabetes: A post-hoc analysis of a randomized controlled trial

Stiff Person Syndrome and Brittle Type 1 Diabetes: Report of 2 Cases

Our aim was to assess the potential of flash glucose monitoring (FGM) for diagnostic workup of suspected post-bariatric hypoglycaemia (PBH). Patients (N = 13) with suspected PBH underwent a food and symptoms diary (FSD) record along with FGM over 14 days. Targeted data analysis confirmed the occurrence of low glucose events in parallel to meal-triggered symptoms. Glycaemic variability, as assessed by Mean Absolute Glucose change (MAG change), was increased, while a higher risk of glycaemic excursions towards both hyper and hypoglycaemia (ADRRFGMGT) was observed in those with more frequent and severe hypoglycaemia. The herein described hypoglycaemia risk index (LBGIFGMGT) with a cut-off value of 4.6 showed to have 100% sensitivity and 100% specificity for PBH. This pilot proof-of-concept study highlighted that FSD coupled with FGM followed by targeted data analysis, provides relevant insights towards PBH diagnosis and grading in a user-friendly and easy to implement study protocol. Furthermore, LBGIFGMGT demonstrated to be an excellent index for PBH diagnosis. The unexpected improvement of glucose profile noticed along the monitoring time also unravels a possible application for PBH management.

OBJECTIVETo assess height and body mass index standard deviation scores up to 20 years after treatment for acute lymphoblastic leukaemia (ALL).SUBJECTS AND METHODSHeight and body mass index standard deviation scores...

BackgroundType 2 diabetes mellitus (T2DM) is highly prevalent within the Indigenous Australian community. Novel glucose monitoring technology offers an accurate approach to glycaemic management, providing real-time information on glucose levels and trends. The acceptability and feasibilility of this technology in Indigenous Australians with T2DM has not been investigated.ObjectiveThis feasibility phenomenological study aims to understand the experiences of Indigenous Australians with T2DM using flash glucose monitoring (FGM).MethodsIndigenous Australians with T2DM receiving injectable therapy (n = 8) who used FGM (Abbott Freestyle Libre) for 6-months, as part of a clinical trial, participated in semi-structured interviews. Thematic analysis of the interviews was performed using NVivo12 Plus qualitative data analysis software (QSR International).ResultsSix major themes emerged: 1) FGM was highly acceptable to the individual; 2) FGM’s convenience was its biggest benefit; 3) data from FGM was a tool to modify lifestyle choices; 4) FGM needed to be complemented with health professional support; 5) FGM can be a tool to engage communities in diabetes management; and 6) cost of the device is a barrier to future use.ConclusionsIndigenous Australians with T2DM had positive experiences with FGM. This study highlights future steps to ensure likelihood of FGM is acceptable and effective within the wider Indigenous Australian community.

Flash Glucose Monitoring in Children–One-Year Experience

Aim and scopeGlycemic variability (GV) denotes the fluctuations in the glucose values around the baseline. High glycemic variability is associated with a higher risk of diabetes-associated complications. In this study, we sought to determine the impact of therapeutic interventions based on flash glucose monitoring on rapid, short-term glycemic variability. We also studied the prevalent albuminuria in diabetic kidney disease and its effect on glycemic variability.MethodsIn a 14-day, single-center, prospective intervention study, we measured the GV indices at baseline (days 1–4) and ten days after ambulatory glucose profile-based intervention using flash glucose monitoring (Abbott Libre Pro, Abbott Diabetes Care, Alameda, California, USA) in patients with type 2 diabetes. An EasyGV calculator was used to estimate the flash glucose monitoring (FGM)-derived measures of GV. The primary outcome was to assess the impact of FGMS-based therapeutic interventions on glycemic variability markers: SD, mean amplitude of glycemic excursion [MAGE], continuous overall net glycemic action [CONGA], absolute means of daily differences [MODD], M value, and coefficient of variance [%CV], AUC below 70 mg/dl, low blood glucose index, AUC above 180 mg/dl [AUC >180], high blood glucose index [HBGI], and J index. Time-related matrices (time in range (%), time above range (%), and time below range (%) were also calculated from the ambulatory glucose profile. Renal function parameters (serum creatinine, estimated glomerular filtration rate, urine albumin excretion) were calculated. The GV with regard to albumin excretion rate was compared.ResultsFifty-eight T2DM patients (63.8%, males) with a mean age of 51.5 ± 11.9 years were studied. When compared with baseline (days 1–4), on day 14, there was a significant improvement in mean sensor glucose (mg/dl) median (IQR) [155 (116–247) vs 131 (103–163) (p ≤0.001)], JINDEX [15,878 (7,706–28,298) vs 8,812 (5,545–14,130) (p ≤0.001)], HBGI [361 (304–492) vs 334 (280–379) (p ≤0.001)], MAGE (mg/dl) [112 (8–146) vs 82 (59–109) (p ≤0.001)], M-value [2,477 (1,883–3,848) vs 2,156 (1,667–2,656) (p ≤ 0.001)], MAG (mg/dl) [111 (88–132) vs 88 (69–102) (p ≤ 0.001)]. Patients with albuminuria at baseline had high mean sensor glucose (mg/dl) median (IQR) [190 (131–200) vs 131 (112–156) (p = 0.001)], CONGA (mg/dl) median (IQR) [155 (101–165) vs 108 (83–120) (p = 0.001)], JINDEX, HBGI, MAGE (mg/dl), and M-value are, median (IQR) [20,715 (10,970–26,217 vs 91,118 (6,504–15,445)) (p ≤ 0.01)], [415 (338–423) vs 328 (292–354) (p = 0.001)], [125 (102–196) vs 103 (74–143) (p ≤ 0.01)], [3,014 (2,233–3,080) vs 2,132 (1,788–2,402) (p ≤0.01)], respectively.ConclusionIn type 2 diabetes, flash glucose monitoring-guided therapeutic interventions can reduce glycemic variability in a brief span (10 days) of time. Also, albuminuria in type 2 diabetes is associated with high glycemic variability. Reduced diabetes complications may ultimately result from this reduced glycemic variability.