Endocrine Abstracts

Objective: Glycemic control of patients with type 1 diabetes is mainly based on insulin administration. The ongoing technological developments in continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) provide new treatment strategies, with better glycemic control. This study assessed the clinical impact of two treatment strategies in adults with type 1 diabetes (T1D): multiple daily insulin injections (MDII) vs continuous subcutaneous insulin infusion (CSII).

Material and methods: This is a retrospective cohort study of 70 patients with type 1 diabetes (PWT1D), after their care has been transferred to two Diabetes centers, one in Athens and one in Thessaloniki, between January 2017 and May 2021. PWT1D were divided according to insulin administration mode i.e. MDII (n=40) or CSII (n=30). They were trained in carb counting and were offered continuous glucose monitoring (CGM), either real-time (rtCGM), or intermittently scanned (isCGM). Among patients on CSII, 43.3% used rtCGM and all the other patients used isCGM, due to prescription restrictions. HbA1c was measured at the beginning of patient care and after 6 to 12 months of monitoring. CGM data were analyzed according to predefined glycemic indices: percentage of time within range (TIR), below range (TBR), and above glucose target range (TAR), also at the beginning and after 6 to 12 months of follow-up.

Results: Baseline characteristics of the two groups of PWT1D did not differ in median age and duration of disease (P>0.05), except for BMI which was lower in those using MDII (25.05±5.97 vs 28.28±5.92 kg/m², P=0.028). Baseline HbA1c was 8.3% for MDII users and 8.34% for CSII (P=0,863). After 6-12 months of monitoring, HbA1c decreased to 7.5% in both groups, with a non-significant difference (P=0.863). TIR was also similar for both groups (MDII 55.58%, SD=0.95 vs CSII 58.94% SD=16.64, P=0.418). Conversely, TBR was significantly lower for patients on CSII (2.64±3.80 vs 5.66±4.94%, P=0.001). CGM use was more consistent in CSII users than in MDII (58.94±1.10 vs 55.58±17.04, P<0.001).

Conclusions: Care of patients with type 1 diabetes in Diabetes Centers combined with continuous glucose monitoring results in HbA1c decrease. The utilization of MDII or CSII does not seem to impact HbA1c reduction degree or TIR. Patients on CSII exhibit fewer hypoglycemic episodes and TBR compared to those on MDII.