Background: Fear of hypoglycemia is a major constraint on achieving a good metabolic control in T1D. Sensor augmented insulin pump therapy with threshold-suspended features (MiniMed 640G-SG) might alleviate burden of hypoglucemia and improve outcomes.
Objective and hypotheses: Evaluate the effectiveness of this system to prevent day and night hypoglycemia and its impact on HbA1c in a pediatric population with T1D.
Method: Descriptive and retrospective study including 21 children treated with MiniMed 640G-SG (age 10.0±3.4 years (2.416.3), 57% female, diagnosis age 4.3±3.2 years (0.911.9, previous therapy: 8 CSII+CGM, 10 CSII alone, 3 MDI). We compared before and after 640G-SG use: HbA1c, average glucose levels, variation coefficient (VC), hypoglycemia (<70 mg/dl) and hyperglycemia (>180 mg/dl) events, and number of capillary blood glucose (CBG). Last month period: fasting glucose, sensor use, and suspension pump events. Statistical analysis: SPSS 17.0, Data expressed by absolute value, mean±S.D., median, range and percentage.
Results: Time of CSII use before 640G: 5.3±2.9 years (0.210.4). None of the patients presented previous episodes of severe hypoglycemia or DKA. Indications for 640G-SG: frequent hypoglycemic events (>10%) 48%, hypoglycemia unawareness 19% and improve quality of life 33%. All patients wore the system continuously: 5.0±2.1 months, sensor use 92% (5397). Duration of pump suspension 3.1±1.2 h/day (0.65.4), with 40.4% of overnight stops. We found a significant decrease in the number of hypoglycemias (P=0.044) and CBG (P<0.001) without increasing hyperglycemia; moreover, a trend towards lower fasting glucose (Table 1). There were non-significant changes in HbA1c, average glycemia level nor VC. Three patients removed 640G-SG as family decision.
|PRE- MiniMed 640G-SG||MiniMed 640G-SG||P|
|Average glycemia (mg/dl)||149.3±12.5||147.1±13.8||NS|
|Variation coefficient (%)||43±6||44±5||NS|
|N° BCG (n)||11.3±2.2||8.1±2.2||0.0001|
|Fasting glycemia (mg/dl)||139.7±27.3||130.9±18.6||NS|
|Fasting glycemia (mg/dl) after overnight suspension||||138.9±14.6||NS|
Conclusion: Automatic insulin pump suspension as implemented in the MiniMed 640G system can help avoid hypoglycemia, without significantly increasing hyperglycemia, and reduce the burden of additional capillary glucose controls in our pediatric population.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology