Endocrine Abstracts

Living with type 1 diabetes (T1D) is challenging and requires intensive glucose monitoring and titration of insulin in order to obtain near-normal glucose levels to reduce the risk of complications. However, changes in dietary intake and level of activity can cause large glucose excursions. Continuous glucose monitoring systems, either intermittently scanned either real-time, can provide a comprehensive picture of glucose profiles, allowing patients to make therapeutic adjustments to improve metabolic control. The use of CGM systems has proven to positively impact the management of type 1 diabetes with the potential to lower HbA1c, enhance time spent in range, reduce frequency and time spent in hypo- and hyperglycemia, lower glycemic variability, and improve quality of life. Intermittently scanned CGM or flash glucose monitoring (FGM) is beneficial for patients using multiple daily injections (MDI). For patients being treated by continuous subcutaneous insulin infusion (CSII), RT-CGM devices are better suited. Several stand-alone RT-CGM devices exist, but the next step is the combination of both, called sensor-augmented pump (SAP) therapy. Low glucose suspend (LGS = Paradigm Veo pump) and predictive low glucose suspend (PLGS =640G pump) have shown improvements in HbA1c, hypoglycaemia and quality of life, and are particularly advantageous for people with hypoglycaemia unawareness. However, for brittle type 1 diabetic patients with erratic life style, a hybrid closed-loop system (670G pump) seems the best option so far. In this review we will highlight benefits and limitations of use of FGM/CGM for open-loop control and recent progress in closed-loop control systems. We will also discuss different patient profiles for the different systems, educational aspect which are key to successful use of the systems and touch upon costs.