Endocrine Abstracts

Objective: Personal continuous glucose monitoring (pCGM) with interstitial fluid glucose sensing is rapidly becoming the standard of care for real-time, intensive insulin therapy of diabetes. We report our experience of glycemic control in patients in an academic setting using minimally invasive pCGM with continuous s.c. insulin infusion (CSII, or insulin pump) vs CSII alone.

Methods: Over a two-year period, we reviewed all patients treated with insulin pumps at the Diabetes Unit of the Palmetto Health-University of South Carolina Medical Group. Group A (CSII alone) used only meters to self-monitor blood glucose, and while Group B additionally used pCGM integrated with CSII to adjust pump settings, including basal rate and/or short-acting bolus insulin doses, and change insulin-to-carbohydrate ratio and supplemental factor. The data was analyzed with respect to age, gender, glucose control as assessed by glycosylated hemoglobin (HbA1c), and severe hypoglycemia.

Results: There were 54 patients in group A and 59 in group B. They were comparable in mean age and gender breakdown (47.3 vs 45.2 years, and 66.8% vs 62.7% females, respectively). The average glycosylated hemoglobin (HbA1c) changed from 8.8% to 8.2% and from 8.2% to 7.3% from baseline to the end of one year in the two groups respectively. The number of severe hypoglycemic episodes per patient during the one year was 0.2 and 0.07 respectively (Table 1).

Discussion: CSII patients who used pCGM were similar in demographics to those who used insulin pumps alone, but had a lower baseline A1c, exhibited a larger decrease in A1c at one year (0.9% vs 0.6%), and had fewer severe hypoglycemic events.

Conclusions: The better outcomes with pCGM-integrated pump therapy may be explained by a higher motivation ability for self-monitoring and care, and by the pCGM being a valuable informational tool in assessing glucose trends when used in properly chosen insulin pump patients who are managed by qualified experts.