Endocrine Abstracts

Introduction: Glycemic variability (GV) has been associated, regardless to A1C levels, to chronic complications of diabetes mellitus (DM).

Objective: To describe baseline characteristics, GV parameters, and microvascular complications rates in a selected simple of type 1 diabetes patients (T1DM) on continuous subcutaneous insulin infusion (CSII).

Methods: We performed a retrospective observational study with 130 T1DM patientson (CSII). Time in range (TIR) was defined as the % of time of glucose levels between 70–180 mg/dl. Low glycemic variability was defined if the coefficient of variation (CV) was lower than 36%. Data of the three previous months from the insulin pump were downloaded and analyzed.

Results: The mean age was 37 ± 13 years-old. 51.5% were female and 19.3% of smokers. Mean BMI was 24.8 ± 4.0 kg/m². Duration of T1DM was 21 ± 10 years. Mean duration of CSII therapy was 6.3 ± 5.4 years. The mean HbA_1c was 7.1 ± 0.8% and the mean HbA_1c before CSII was 7.4 ± 1.0%. 33.8% of patients were on statins, with a mean LDL-c of 100 ± 26 mg/dl. The prevalence of diabetic retinopathy (DR) was 20.8% (95% CI : 14.7–28.5), of whom 19.2% had non-proliferative retinopathy and 1.5% had proliferative retinopathy. The prevalence of diabetic nephropathy (DN) was 10% (95% CI : 5.9–16.36), of whom 77% had microalbuminuria and 23% macroalbuminuria. 24.6% (95% CI : 18.0–32.7) presented cardioautonomic dysfunction. Regarding GV: mean TIR was 60 ± 14%, mean time in hyperglycemia-TIH (>180 mg/dl) was 32 ± 14%, and mean time in hypoglycemia-TIh (<70 mg/dl) was 8 ± 7%. After applying the stepwise logistic regression model (P < 0.001, R² = 0.561), we observed that the association factors for developing DR were LDL-c, ExpB 0.973 (95% CI 0.948–0.999); duration of DM, ExpB 1.256 (95% CI 1.123–1.405); and HbA_1c before CSII, ExpB 2.243 (95% CI 1.168–4.309). The association factors for DN (P < 0,001 y R ² = 0.234) were LDL-c ExpB 0.96 (95% IC 0.94–0.99) y DBP ExpB 1.11 (95% IC 1.03–1.19), and finally, the only factor for CAN was age (ExpB 1.1 95% CI 1.04–1.15). 13.84% of patients got the combined objective of HbA_1c ≤7%, TIR ≥70% and TIh ≤ 10%. 54% of patients had HbA_1C≤ 7% and CV ≤ 36% altogether.

Conclusion: Around half of our patients were on quite good control according to GV parameters, and had less DR and DN comparing to the T1DM general population on multiple injections insulin therapy, despite the long duration of the disease.