Glucose Monitoring In Patients Research Articles

Feasibility of continuous glucose monitoring in patients with type 1 diabetes at two district hospitals in Neno, Malawi: a randomised controlled trial

ObjectivesTo assess the feasibility and change in clinical outcomes associated with continuous glucose monitoring (CGM) use among a rural population in Malawi living with type 1 diabetes.DesignA 2:1 open randomised...

Difference in impact of flash glucose monitoring in patients with type 1 diabetes mellitus and pancreatogenic diabetes

Difference in impact of flash glucose monitoring in patients with type 1 diabetes mellitus and pancreatogenic diabetes

Applicability of intermittent intersticial glucose monitoring in patients admitted to the intensive care unit of the hospital universitario san cecilio in granada

Applicability of intermittent intersticial glucose monitoring in patients admitted to the intensive care unit of the hospital universitario san cecilio in granada

Assessment of Patient-reported Satisfaction and Metabolic Outcomes Following Initiation of the Second Generation of Flash Glucose Monitoring in Patients with Type 1 Diabetes.

This study aims to assess patient-reported satisfaction and metabolic outcomes following the initiation of the second generation of the Freestyle Libre 2 (FSL2) system in patients with type 1 diabetes (T1D). This non-randomized single-arm observation study was conducted on 86 patients with T1D living in Saudi Arabia, who were asked to wear the FSL2 for 12 weeks. The demographic data were collected at baseline, while the continuous glucose monitoring (CGM) metrics were gathered, i.e., Glucose Variability (GV) (%), mean Time in Range (TIR), Time Above Range (TAR), Time Below Range (TBR), and average duration of hypoglycemic events were collected at baseline, 6th week and 12 weeks. Further, the Continuous Glucose Monitoring Satisfaction (CGM-SAT) was collected at the end of the follow-up. Compared to the 6th week, significant differences were observed in the low glucose events (p = 0.037), % TIR (p = 0.045), and % below 70 mg/dL (p = 0.047) at 12 weeks. Improvement was seen in the other glucometric variables, but no significant changes were evident (p > 0.05). On completion of the study period, the ambulatory glucose profile (AGP) metrics showed a 74.3 ± 5.01 (mg/dL) FSL2 hypoglycemia alarm threshold and a 213 ± 38.1 (mg/dL) hyperglycemia alarm threshold. A majority of the patients stated that CGM-SAT had benefits (mean score > 3.58), although they felt FSL2 had 'additional benefits. With regard to the problems with the use of FSL2 majority of the patients stated that FSL2 has minimal discomfort. Using second-generation FSL2 in patients with T1D is positively associated with patient- reported satisfaction and metabolic outcomes.

Is It Time to Move Beyond TIR to TITR? Real-World Data from Over 20,000 Users of Continuous Glucose Monitoring in Patients with Type 1 and Type 2 Diabetes.

The growing use of continuous glucose monitoring (CGM) has been supported by expert consensus and clinical guidelines on glycemic management in diabetes with time in range (TIR 70-180 mg/dL) representing a key CGM-derived glucose metric. Time in tight range (TITR) has also been proposed for clinical use, spanning largely normal glucose levels of 70-140 mg/dL. However, keeping such narrow glucose ranges can be challenging, and understanding the factors modulating TITR can help achieve these tight glycemic targets. Our real-life study aimed to evaluate the relationship between average glucose (AG) and TIR/TITR in a large cohort (n = 22,006) of CGM users, divided into four groups: self-identified as having type 1 diabetes (T1D) treated with insulin using multiple daily injections (MDI) or pumps; type 2 diabetes (T2D) on MDI or insulin pumps; T2D on basal insulin only; and T2D not on insulin treatment. The T2D groups, regardless of treatment type, displayed the highest TIR and TITR values, associated with lowest glycemic variability measured as glucose coefficient of variation (CV; 23-30%). The T1D group showed the lowest TIR and TITR, associated with the highest CVs (36-38%). Overall, higher CV was associated with lower TIR and TITR for AG values below 180 and 140 mg/dL, respectively, with the reverse holding true for AG values above these thresholds. The discordance between AG and TIR/TITR was less pronounced in T2D compared with T1D, attributed to lower CV in the former group. It was also observed that TITR has advantages over TIR for assessing glycemia status and progress toward more stringent A1C, particularly when approaching normal glucose levels. The data detail how CV affects the AG relationship with TIR/TITR, which has implications for CGM interpretation. In many instances TITR, rather than TIR, may be preferable to employ once AG falls below 140 mg/dL and near-normal glucose levels are required clinically.

Performance of an interstitial glucose monitoring in patients with type 1 diabetes during haemodialysis

Abstract Background The use of interstitial glucose monitoring devices such as Flash Glucose Monitoring has been shown to be beneficial in patients with type 1 diabetes (T1DM). However, these devices have been little studied in patients with diabetes treated by chronic haemodialysis (HD). Methods The goal of this prospective, observational, multicentric, study was to evaluate the analytical performance of the FreeStyle Libre® 2 (FSL2) sensor in T1DM patients during HD sessions. During three HD sessions, interstitial glucose concentrations (ISFG) given by the FSL2 were compared, every 15 minutes, with blood glucose concentration (BG) obtained simultaneously. BG concentrations were measured by two different glucometers: the Accu-Chek Guide® and the StatStrip® meter. Results Twelve hemodialysis patients were included. Mean age was 54 ± 11 years. Mean diabetes duration was 36.5 ± 11.6 years and dialysis vintage was 35 ± 22 months. A total of 565 pairs of ISFG/BG values were available for analysis. The mean absolute relative difference, defined as the mean of the absolute relative differences between the ISFG and BG measurements, was 17.4% and 20.9% when the ISFG were compared to the StatStrip glucometer or Accu-Chek Guide, respectively. Interstitial results tend to underestimate blood results but all values were classified as having clinically acceptable error. The differences observed remained stable during the dialysis session and were not associated with the ultrafiltration rate. Conclusion The use of the FSL2 interstitial glucose monitoring device in HD patients with T1DM is clinically acceptable, even though the accuracy of the device is generally poorer than in studies including non-dialysis patients.

Neonatal Birth Weight With Daily Compared With Every-Other-Day Glucose Monitoring in Gestational Diabetes Mellitus

OBJECTIVE: To assess whether universal use of every-other-day glucose monitoring in patients with gestational diabetes mellitus (GDM) resulted in similar birth weights and medication use and was preferred by the patient compared with traditional daily glucose monitoring. METHODS: This was a noninferiority randomized controlled trial conducted at a single New York City hospital between April 2021 and May 2022. Patients with singleton pregnancies who were diagnosed with GDM after 20 weeks of gestation and had a minimum of 7 days of previous daily blood glucose testing were randomly assigned to test blood glucose values daily or every other day. The primary outcome was neonatal birth weight. We calculated a total sample size of 196 participants needed for noninferiority to be tested, assuming the mean birth weight in the every-other-day group, compared with the daily group, was no higher than the predefined noninferiority margin of 200 g (80% power and one-sided alpha of 0.05). Postrandomization characteristics, including blood glucose values and medication initiation and timing, were recorded. Satisfaction with treatment group was assessed using the validated Oxford Maternity Diabetes Treatment Satisfaction Questionnaire. RESULTS: A total of 197 patients were randomized: 98 in the daily group and 99 in the every-other-day group. Baseline characteristics were similar between groups. The mean neonatal birth weight was similar between groups (mean±SD 3,090±418 g among newborns in the daily group compared with 3,181±482 g among newborns in the every-other-day group). For the primary outcome, the every-other-day group was found to be noninferior to the daily group with an upper confidence limit for the mean difference in mean birth weight of 197 g, which was below the noninferiority margin of 200 g (P=.046). Postrandomization, there were no significant differences in the number of patients who required medication, the gestational age at which medication was started, or the type of medication used. Average fasting and postprandial glucose values were similar between groups. There was an increase in adherence to treatment group in those randomized to every-other-day blood sugars, but no difference in patient satisfaction. CONCLUSION: In patients with GDM, testing blood glucose values every other day was as effective as testing daily, without apparent effects on birth weight, medication initiation, or glucose control. Reduced frequency of blood glucose monitoring might help decrease the emotional, physical, and financial burden experienced by patients with GDM. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04857073.

Modern methods for assessing compensation of diabetes mellitus. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes

Background. An integral part of diabetes mellitus (DM) management is its timely diagnosis. The reference method to study the quality of glycemic control is evaluating the level of glycated hemoglobin (HbA1c) as one of the most accessible and informative tools. However, the introduction of novel technologies, namely the use of continuous glucose monitoring (CGM), has given patients with DM, their relatives and healthcare professionals an access to new indicators of glycemic control such as time in range (TIR), time above range and time below range. These indicators are criteria for compensation of carbohydrate metabolism according to the 2023 American Diabetes Association guidelines. The purpose of the study was to compare the effectiveness of using glucometers and the FreeStyle Libre system for flash glucose monitoring in patients with DM. Materials and methods. An examination of 60 patients with type 2 DM who received insulin therapy was conducted. They were aged 45–65 years, with DM duration of 5 ± 2 years. All participants were divided into two equal groups of 30 people each. The first group consisted of patients with CGM devices, the second group used glucometers for daily glycemic control. Additional CGM parameters were used: glucose coefficient of variation, glucose management indicator, which shows the probable level of HbA1c. Results. When evaluating the data obtained from patients who used CGM, it is important to note their high adherence to the use of flash glucose monitoring. The use of CGM made it possible to achieve compensation of carbohydrate metabolism faster compared to patients who used glucometers to correct glycemia. Discontinuation of CGM resulted in poorer glycemic control. The obtained results prove that the compensation of patients depends primarily on their motivation, willingness to follow medical prescriptions, careful glycemic control, and compliance with medical recommendations. Conclusions. For better control of the DM course, patients should use CGM. In order to assess diabetes compensation, it is not enough to consider only TIR. Time below range indicating hypoglycemia, time above range indicating hyperglycemia, glucose management indicator should also be taken into account. Discontinuation of CGM resulted in a loss of approximately half of the initial TIR gain achieved while using CGM. CGM is more favored among patients than a 7-point self-monitoring of blood glucose.

Efficacy and Safety of Continuous Glucose Monitoring and Intermittently Scanned Continuous Glucose Monitoring in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis of Interventional Evidence.

Traditional diabetes self-monitoring of blood glucose (SMBG) involves inconvenient finger pricks. Continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems offer CGM, enhancing type 2 diabetes (T2D) management with convenient, comprehensive data. To assess the benefits and potential harms of CGM and isCGM compared with usual care or SMBG in individuals with T2D. We conducted a comprehensive search of MEDLINE, Embase, the Cochrane Library, Web of Science, and bibliographies up to August 2023. We analyzed studies meeting these criteria: randomized controlled trials (RCT) with comparison of at least two interventions for ≥8 weeks in T2D patients, including CGM in real-time/retrospective mode, short-/long-term CGM, isCGM, and SMBG, reporting glycemic and relevant data. We used a standardized data collection form, extracting details including author, year, study design, baseline characteristics, intervention, and outcomes. We included 26 RCTs (17 CGM and 9 isCGM) involving 2,783 patients with T2D (CGM 632 vs. usual care/SMBG 514 and isCGM 871 vs. usual care/SMBG 766). CGM reduced HbA1c (mean difference -0.19% [95% CI -0.34, -0.04]) and glycemic medication effect score (-0.67 [-1.20 to -0.13]), reduced user satisfaction (-0.54 [-0.98, -0.11]), and increased the risk of adverse events (relative risk [RR] 1.22 [95% CI 1.01, 1.47]). isCGM reduced HbA1c by -0.31% (-0.46, -0.17), increased user satisfaction (0.44 [0.29, 0.59]), improved CGM metrics, and increased the risk of adverse events (RR 1.30 [0.05, 1.62]). Neither CGM nor isCGM had a significant impact on body composition, blood pressure, or lipid levels. Limitations include small samples, single-study outcomes, population variations, and uncertainty for younger adults. Additionally, inclusion of <10 studies for most end points restricted comprehensive analysis, and technological advancements over time need to be considered. Both CGM and isCGM demonstrated a reduction in HbA1c levels in individuals with T2D, and unlike CGM, isCGM use was associated with improved user satisfaction. The impact of these devices on body composition, blood pressure, and lipid levels remains unclear, while both CGM and isCGM use were associated with increased risk of adverse events.

Abstract #1559189: Assessment of Patient-Reported Satisfaction and Metabolic Outcomes Following Initiation of the Second Generation of Flash Glucose Monitoring in Patients With Type 1 Diabetes

Abstract #1559189: Assessment of Patient-Reported Satisfaction and Metabolic Outcomes Following Initiation of the Second Generation of Flash Glucose Monitoring in Patients With Type 1 Diabetes

Real-time heart rate variability according to ambulatory glucose profile in patients with diabetes mellitus.

Autonomic neuropathy commonly occurs as a long-term complication of diabetes mellitus (DM) and can be diagnosed based on heart rate variability (HRV), calculated from electrocardiogram (ECG) recordings. There are limited data on HRV using real-time ECG and ambulatory glucose monitoring in patients with DM. The aim of this study was to investigate real-time HRV according to ambulatory glucose levels in patients with DM. A total of 43 patients (66.3 ± 7.5 years) with DM underwent continuous real-time ECG monitoring (225.7 ± 107.3 h) for HRV and ambulatory glucose monitoring using a remote monitoring system. We compared the HRV according to the ambulatory glucose profile. Data were analyzed according to the target in glucose range (TIR). There were no significant differences in the baseline characteristics of the patients according to the TIR. During monitoring, we checked ECG and ambulatory glucose levels (a total of 15,090 times) simultaneously for all patients. Both time- and frequency-domain HRVs were lower when the patients had poorly controlled glucose levels (TIR < 70%) compared with well controlled glucose levels (TIR > 70%). In addition, heart and respiratory rates increased with real-time glucose levels (P < 0.001). Poorly controlled glucose levels were independently associated with lower HRV in patients with DM. This was further substantiated by the independent continuous association between real-time measurements of hyperglycemia and lower HRV. These data strongly suggest that cardiac autonomic dysfunction is caused by elevated blood sugar levels.

The Impact of Chronic Heart Failure Treatment on Glycemic Variability in Patients without Diabetes Mellitus

Background. According to statistics, about 26 million people worldwide suffer from heart failure (HF). Currently, sodium-glucose cotransporter 2 inhibitors are widely prescribed for treatment of HF with reduced left ventricular ejec-tion fraction (LVEF) throughout the world. Therefore, prescribing drugs that have anti-hypoglycemic effect in patients without diabetes mellitus still raises some concerns, considering the possible risk of developing hypoglycemia.&#x0D; The aim. To assess the effect of dapagliflozin on glycemic variability in treatment of HF with reduced LVEF in patients without diabetes mellitus.&#x0D; Materials and methods. The study was conducted at the premises of the Department of Cardiometabolic Diseases of the Ukrainian Children’s Cardiac Center. Twenty-three patients with HF with reduced LVEF of various etiologies without diabetes mellitus were evaluated. The variability of glycemia in the study group was assessed using continuous glucose monitoring. For this, the MiniMed iPro2 continuous glucose monitoring system (Medtronic, USA) was used.&#x0D; The sensor was inserted on day 1 and removed on day 7. Average value of glycemia during the day, time in range (TIR) and time below range (TBR) were calculated on the basis of data about the level of glucose in the intercellular fluid obtained for 6 days of monitoring. Dapagliflozin 10 mg once a day was prescribed to all the patients included in the study for the treatment of HF with reduced LVEF. The average follow-up period was 7 months.&#x0D; Results. The examined patients were divided according to clinical and laboratory characteristics. Assessment of daily variability of glycemia during 6 days of observation using continuous glucose monitoring in patients on dapagliflozin revealed average blood glucose level from 4.4 mmol/L (minimum value) to 6.0 mmol/L (maximum value). These results indicate minimal risk of hypoglycemia and safety of using dapagliflozin in case of HF with reduced LVEF without concomi-tant type 2 diabetes mellitus. TIR and TBR indicators were also evaluated in patients with and without prediabetes. The obtained data allows to assert the same safety of taking dapagliflozin in both these groups, due to the fact that time of glycemia &lt;3.9 mmol/l does not exceed the indicator of 5%.&#x0D; Conclusion. The use of dapagliflozin as part of complex therapy of HF with reduced LVEF does not elevate the risk of developing hypoglycemia in patients without diabetes mellitus.

Progress and indication for use of continuous glucose monitoring in patients with diabetes in pregnancy: a review.

Gestational diabetes mellitus is one of the most common endocrine diseases that occur during pregnancy. Disorders of blood glucose metabolism during pregnancy can increase the risk of adverse pregnancy outcomes, such as pregnancy-related hypertension, preeclampsia, eclampsia, miscarriage, macrosomia, and neonatal hypoglycemia. Continuous glucose monitoring (CGM) can safely and effectively monitor blood glucose changes in patients with gestational hyperglycemia, thereby reducing adverse pregnancy outcomes. Hence, this article aimed to provide a comprehensive review of the progress and indications for using CGM in pregnant patients with diabetes. CGM can reduce blood glucose fluctuations and the occurrence of serious hypoglycemia and hyperglycemia events and can provide time in range (TIR). TIR is an important indicator of blood glucose level. Patients with a higher TIR during pregnancy have better gestational outcomes.

Effectiveness of flash glucose monitoring in patients with type 1 diabetes and recurrent hypoglycemia between early and late stages after flash glucose monitoring initiation

AimsEvaluate the effectiveness of reimbursed flash glucose monitoring with optional alarms (FGM) in preventing severe hypoglycemia (SH) and reducing hypoglycemia exposure in T1D patients prone to hypoglycemia. MethodsAmbispective study in T1D patients treated with multiple daily injections (MDI) and prone to hypoglycemia, initiating reimbursed FGM (FreeStyle Libre 2). The primary outcome was the number of SH events (requiring third party assistance) and main secondary outcomes were time below range < 70 (TBR < 70) and < 54 mg/dL (TBR < 54), impaired awareness of hypoglycemia (IAH) and quality of life (QoL). Logistic regression models were constructed to explore variables associated with success of the intervention. ResultsWe included 110 patients (52.7 % women, mean age 47.8 ± 17.0 years). SH events at 1-year follow-up decreased from 0.3 ± 0.6 to 0.03 ± 0.2 (p < 0.001). Significant reductions in patients presenting an SH (26.4 % vs. 2.9 %, p < 0.001) and IAH (47.1 % vs. 25.9 %, p = 0.002) were observed, as well as improvements in QoL. TBR < 70 and TBR < 54 were not significantly reduced. Baseline GMI was inversely associated with a decrease in TBR < 70 [OR 0.37 (0.15–0.93)] and directly with an increase in time in range 70–180 mg/dL [OR 2.10 (1.03–4.28)]. ConclusionsFGM decreased SH and improved hypoglycemia awareness and QoL. Initial tight glycemic control was associated with a decrease in hypoglycemia, while patients with suboptimal control reduced hyperglycemia.

Use of Continuous Glucose Monitoring in Patients Following Bariatric Surgery: A Scoping Review.

The objective of this scoping review was to summarize the emerging literature on the use of continuous glucose monitoring (CGM) in post-bariatric surgery patients, with a focus on its features (e.g., device, mode, and accuracy), as well as purposes and outcomes of utilization. Three databases (PubMed, EMBASE, and Web of Science) were searched to obtain relevant studies. Results suggested that most studies used CGM for 3-7 days under blinded mode. Accuracy data were available in only one study, which reported a mean absolute relative difference of 21.7% for Freestyle Libre. The primary applications of CGM were for elucidating glucose patterns and assessing glycemic treatment outcomes. No study has tested the effect of CGM as an intervention strategy to enhance glucose control.

Audit of the use of continuous glucose monitoring in patients with type 1 diabetes at Broom Lane Medical Centre.

On 2 August 2022, it was announced by the NHS that all patients suffering from type 1 diabetes (T1DM) would be eligible for continuous glucose monitoring (CGM). Patients previously would have needed to scan or take a finger prick test at fixed time intervals to monitor their blood glucose. To investigate the number of patients registered to the practice who were eligible to switch over to CGM, and how many patients had already done so. Broom Lane Medical Centre (Rotherham, South Yorkshire) uses SystmOne to store patient notes. A search was conducted on 13 September 2022 generating data of 73 patients suffering from T1DM. The data were filtered to determine whether patients were using Libre glucose sensors or the traditional blood glucose testing strips. It was found that roughly half (50.7%) were on Freestyle Libre 1/2 sensors, which allow for flash glucose monitoring (FGM); 49.3% were using blood glucose testing strips. None of the patients was using CGM such as the Libre 3 sensor. It was noted that the group of individuals on the Libre sensor were of a younger age group (average age: 38.9) whereas the blood glucose testing strips age group were slightly older (average age: 45.8). Patients no longer need to live in fear of hyperglycaemia and maintain need for routine glucose measurements, allowing patients to live a more convenient and stress-free lifestyle.All of the T1DM patients (100%) registered at Broom Lane Medical Centre are eligible to be switched over to the CGM.

957-P: Continuous Glucose Monitoring in Patients with End-Stage Kidney Disease and Burnt-Out Diabetes

Patients with long-standing type 2 diabetes and end-stage kidney disease (ESKD) on dialysis may experience resolution of their hyperglycemia, as defined by an HbA1c &amp;lt; 6.5%, without antidiabetic therapy. This phenomenon is known as “burnt-out diabetes”. Because HbA1c may be falsely low in patients with ESKD/dialysis therapy, we conducted a prospective study to compare glycemic control as measured by Dexcom G6 CGM in patients with ESKD and burnt-out diabetes and those without history of diabetes. We hypothesize that the use of CGM may provide better assessment of glycemic control than HbA1c (standard-of-care) in these patients and clarify the glycemic characteristics of burnt-out diabetes. We included adults with ESKD on dialysis, with (n=20) and without (n=10) a known history of diabetes, and with HbA1c &amp;lt;6.5% without antidiabetic therapy for &amp;gt; 6 months. All subjects wore a blinded Dexcom G6 CGM for 10 days. Their clinical characteristics and CGM metrics are shown in Table 1. Conclusion: CGM provides better assessment of glycemic excursions, compared to HbA1c, in patients with ESKD and diabetes. Most patients with burnt-out diabetes (HbA1c &amp;lt;6.5%, off therapy) have frequent and significant hyperglycemic excursions as detected by CGM. Further research will need to examine whether these excursions require pharmacotherapy. Disclosure C.Kaminski: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. Z.E.Zabala: None. B.Moazzami: None. A.Y.G.Gerges: None. R.G.Mccoy: Consultant; Emmi. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. Funding Jacob's Fund for Education

359-OR: Variation in Utilization of Continuous Glucose Monitoring in Patients with Type 1 Diabetes

Background: Continuous glucose monitoring (CGM) is recommended by the American Diabetes Association for patients with type 1 diabetes (T1D) but remains underutilized. Prior studies suggest ~30% of patients with T1D use CGM with variation by race/ethnicity reported. Methods: We used electronic health record data from an academic medical center (1/1/2018-12/31/2021) to examine variation in CGM utilization in patients with T1D and describe demographic factors associated with CGM use via multivariate logistic regression adjusted for clinical variables outlined in Table 1. Results: Among 3,382 patients with T1D (aged 28.6 ± 17.8 y; 51% female; 83% non-Hispanic White), 52% used CGM during study period. CGM utilization was significantly lower in older (age 65+) versus younger patients (age 0-13; OR=0.15, 95% CI: 0.09, 0.26), Hispanic versus non-Hispanic White patients (OR=0.44, 95% CI: 0.21, 0.94) and patients with commercial versus government-issued insurance coverage (Medicaid, OR=0.44, 95% CI: 0.37, 0.52; Medicare, OR=0.42, 95% CI: 0.30, 0.50). Conclusions: In this population of patients with T1D, 1 in 2 patients used CGM to manage their diabetes but there was significant variation. Identifying populations with lower-than-expected utilization is a necessary first step in developing targeted interventions to increase CGM uptake and, ultimately, improve short and long-term T1D-related outcomes. Disclosure M.E.Lacy: None. J.Fowlkes: None. K.Heier: None. M.Sohn: None. A.J.Kruse-diehr: None. T.Waters: None. D.C.Moga: None. Funding National Institutes of Health (UL1TR001998, KL2TR001996)

252-OR: Continuous Glucose Monitoring in Patients with Post-bariatric Hypoglycemia Reduces Hypoglycemia and Glycemic Variability

Post-bariatric hypoglycemia (PBH) is an increasingly recognized complication of bariatric surgery, with prevalence of up to 36% after gastric bypass. Hypoglycemia typically follows postprandial glycemic spikes. Continuous glucose monitors (CGM) can alert patients to high or low sensor glucose (SG), allowing treatment and prevention of severe hypoglycemia. The aim of this study (NCT03353415) was to determine whether CGM, currently indicated only for diabetes, could reduce hypoglycemia in PBH. In an open label, nonrandomized, pre-post design, sensor glucose data were collected using Dexcom CGM in two sequential phases: (1) masked (no access to SG or alarms); and (2) unmasked (access to SG and alarms for low or rapidly declining SG). Data were available for paired analysis for 22 individuals with PBH (mean±SD age 51.1±13.0 yrs, 20F/2M, BMI 30.6±6.2 kg/m2, 82% with level 3 hypoglycemia and 100% with neuroglycopenia). Participants with PBH spent a lower percentage of time in hypoglycemia with unmasked vs masked CGM (&amp;lt;60 mg/dL, median [MAD]: 0.7 [0.8] vs 1.4 [1.7]%, p=0.03; &amp;lt;70 mg/dL: 2.9 [2.5] vs 4.7 [4.8]%, p=0.04), with similar trends overnight. Likewise, there was more time between 70-180 mg/dL (94.8 [3.9] vs 90.8 [5.2]%, p=0.004), and lower glycemic variability (mean amplitude of glycemic excursion: 74.0 [17.7] vs 79.6 [17.8] mg/dL, p=0.04) during unmasked wear. During the day (6:00 AM-11:59 PM), participants spent more time in normoglycemia with unmasked CGM (94.2 [4.8] vs 90.9 [6.2]%, p=0.005), largely due to reduced hyperglycemia (&amp;gt;180 mg/dL: 1.9 [2.2] vs 3.9 [3.6]%, p=0.02). Availability of real-time CGM data and alarms is associated with reductions in low SG, elevated SG, and glycemic variability. This suggests CGM helps patients detect hyperglycemic peaks and imminent hypoglycemia, allowing dietary modification and self-treatment to reduce hypoglycemia. CGM may thus improve safety in PBH, particularly for patients with hypoglycemia unawareness. Disclosure C.J.Cummings: None. A.Jiang: None. A.L.Sheehan: None. R.Ferraz-bannitz: None. A.Puleio: None. D.C.Simonson: Stock/Shareholder; Phase V Technologies, Inc., GI Windows. J.Dreyfuss: None. M.Patti: Consultant; MBX Biosciences, AstraZeneca, Hanmi Pharm. Co., Ltd., Other Relationship; Fractyl Health, Inc. Funding Diabetes Research Center (P30DK036836)

Flash glucose monitoring in patients with DM3c

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)