New technologies and metabolic control in type 1 diabetes mellitus

Abstract

The introduction of more rigorous criteria of metabolic control, rapid- and long-acting insulin analogues and the advances in diabetes technology (improved insulin deliv­ery systems and blood glucose monitoring) have not been translated into better glycaemic control in patients with type 1 diabetes, which is quite similar to that observed 20–30 years ago in the Diabetes Control and Complica­tions Trial (DCCT). Continuous subcutaneous insulin infusion (CSII) provided by personal insulin pumps may improve glycaemic control; however, observed results are not so good as it has been expected and are only slightly better or similar to these obtained with multiple daily insulin injections (MDII). Real-time continuous glucose monitoring (CGM) seems to be very useful to achieve target glycaemic control and to avoid hypoglycaemia in both CSII and MDII patients. While using CGM, levels of HbA 1c are lower, time spent in hypoglycaemia is shorter and frequency of hypoglycaemia episodes is reduced. To receive optimum benefit, excellent compliance and fre­quent readings of measurements are required. The most common real-time sensors used in Poland are: Medtronic Enlite, Dexcom G4 Platinum and Abbott FreeStyle Libre. Unfortunately, for majority of patients with type 1 diabe­tes CGM devices have no reimbursement. (Clin Diabetol 2017; 6, 3: 111–114)