961-P: Glycemic Control and Glycemic Variability Before and After Hypoglycemia in Patients with T1D Treated with MDI or CSII

Abstract

Studies on CGM assume equal glycemic control between MDI and CSII. However, observation periods are often short and the impact of hypoglycemia on glycemic control and variability is unclear. In this study, we analyzed 12846 days (35 years; CSII 2232 days [6 years]; MDI 10614 days [29 years]) of CGM readings obtained from 99 patients with T1D. In the overall analysis mean glucose was 169.6 ± 18.9mg/dl for CSII and 175.0 ± 29.5 mg/dl for MDI. Estimated A1c was 7.54 ± 0.66% (CSII) and 7.7 ± 1.0% (MDI). Percentage of readings in target range (70-180mg/dL) was 54.0 ± 15.5% for CSII and 57.4 ± 11.4% for MDI. In total, 3.1/2.2% of readings were < 54 mg/dL and 14.9/12.4% were > 250mg/dL for CSII and MDI, respectively. In total, 464 hypoglycemic events (< 54mg/dL) occurred in CSII (day: 305 [64%]; night: 170 [36%]), corresponding to 0.21 hypoglycemic events daily. In MDI, 2297 hypoglycemic events occurred (day: 1507/66%; night: 783/34%), corresponding to 0.22 hypoglycemic events daily. Mean duration of hypoglycemia was 146.5 ± 65.9 minutes (CSII) and 132.8 ± 42.8 minutes (MDI); 233 (CSII) vs. 982 (MDI) events were prolonged (>120 minutes). CV was 41.1 ± 6.7% for CSII and 40.8 ± 3.8% for MDI. In the 24 hours prior to hypoglycemia, mean glucose was higher (182.9 ± 30.5 vs. 166.9 ± 26.6mg/dl; p<0.001 for CSII and 167.2 ± 14.7 vs. 152.7 ± 19.1mg/dl; p=0.013 for MDI) and CV was lower (p<0.001 for both treatments) compared to the subsequent 24 hours. Age correlated to CV (r=-.254; p=0.028 for MDI), HbA1c to eA1c (r=.611; p=0.009 for CSII; r=.482; p=0.028 for MDI), and C-peptide to CGM-readings in target range (r=.246; p=0.042 for MDI), which negatively correlated to HbA1c (r=-.484; p<0.001 for MDI). Glycemic control was comparable between MDI and CSII in T1D. Glycemic variability was lower prior to a hypoglycemic event and in older patients, while remaining insulin secretion was associated with longer time in target range. Disclosure A. Melmer: None. T. Züger: None. T. Pöttler: None. H. Kojzar: None. M. Cigler: None. F. Aberer: None. M. Laimer: None. J.K. Mader: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Prediktor Medical, Roche Diabetes Care, Sanofi. Speaker's Bureau; Self; Abbott, AstraZeneca, Dexcom, Inc., Novo Nordisk Inc. Stock/Shareholder; Self; decide Clinical Software GmbH.