Factors associated with clinically significant hypoglycemia in patients with type 1 diabetes using sensor-augmented pump therapy with predictive low-glucose management: A multicentric study on iberoamerica
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Date
2021
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Abstract
Background and aims: Despite using sensor-augmented pump therapy (SAPT) with predictive lowglucose management (PLGM), hypoglycemia is still an issue in patients with type 1 Diabetes (T1D). Our aim was to determine factors associated with clinically significant hypoglycemia (<54 mg/dl) in persons with T1D treated with PLGM-SAPT.
Method: ology: This is a multicentric prospective real-life study performed in Colombia, Chile and Spain. Patients with T1D treated with PLGM-SAPT, using sensor >= 70% of time, were included. Data regarding pump and sensor use patterns and carbohydrate intake from 28 consecutive days were collected. A bivariate and multivariate Poisson regression analysis was carried out, to evaluate the association between the number of events of <54 mg/dl with the clinical variables and patterns of sensor and pump use.
Results: 188 subjects were included (41 +/- 13.8 years-old, 23 +/- 12 years disease duration, A1c 7.2% +/- 0.9). The median of events <54 mg/dl was four events/patient/month (IQR 1-10), 77% of these events occurred during day time. Multivariate analysis showed that the number of events of hypoglycemia were higher in patients with previous severe hypoglycemia (IRR1.38; 95% CI 1.19-1.61; p 0.001), high glycemic variability defined as Coefficient of Variation (CV%) 0.001) and hypoglycemia unawareness. A protector effect was identified for adequate sensor calibration (IRR 0.77; 95%CI 0.66-0.90; p:0.001), and the use of bolus wizard 60% (IRR 0.74; 95%CI 0.58-0.95; p:0.017).
Conclusion: In spite of using advanced SAPT, clinically significant hypoglycemia is still a non-negligible risk. Only the identification and intervention of modifiable factors could help to prevent and reduce hypoglycemia in clinical practice (C) 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Method: ology: This is a multicentric prospective real-life study performed in Colombia, Chile and Spain. Patients with T1D treated with PLGM-SAPT, using sensor >= 70% of time, were included. Data regarding pump and sensor use patterns and carbohydrate intake from 28 consecutive days were collected. A bivariate and multivariate Poisson regression analysis was carried out, to evaluate the association between the number of events of <54 mg/dl with the clinical variables and patterns of sensor and pump use.
Results: 188 subjects were included (41 +/- 13.8 years-old, 23 +/- 12 years disease duration, A1c 7.2% +/- 0.9). The median of events <54 mg/dl was four events/patient/month (IQR 1-10), 77% of these events occurred during day time. Multivariate analysis showed that the number of events of hypoglycemia were higher in patients with previous severe hypoglycemia (IRR1.38; 95% CI 1.19-1.61; p 0.001), high glycemic variability defined as Coefficient of Variation (CV%) 0.001) and hypoglycemia unawareness. A protector effect was identified for adequate sensor calibration (IRR 0.77; 95%CI 0.66-0.90; p:0.001), and the use of bolus wizard 60% (IRR 0.74; 95%CI 0.58-0.95; p:0.017).
Conclusion: In spite of using advanced SAPT, clinically significant hypoglycemia is still a non-negligible risk. Only the identification and intervention of modifiable factors could help to prevent and reduce hypoglycemia in clinical practice (C) 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved.
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Keywords
Hypoglycemia Insulin infusion system, Sensor-augmented pump therapy (SAPT) with predictive low-glucose management (PLGM), Type 1 diabetes