Switching from premixed insulin to glargine-based insulin regimen improves glycaemic control in patients with type 1 or type 2 diabetes: a retrospective primary care-based analysis

AimTo describe trends in modifiable and non-modifiable unfavorable factors affecting pregnancy outcomes, over time (years 2004–2017), in women with diabetes of childbearing age from an English primary care perspective.MethodsWe identified women with diabetes aged 16–45 years from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network, an English primary care sentinel database. Repeated annual cross-sectional analyses (2004–2017) assessed the prevalence of unfavorable factors for pregnancy, such as obesity, poor glycaemic control, microalbuminuria, hypertension, use of medications for treating diabetes, and associated comorbidities not recommended for pregnancy.ResultsWe identified 3,218 women (61.5% with Type 2 diabetes) in 2004 and 6,657 (65.0% with Type 2 diabetes) in 2017. The proportion of women with ideal glycaemic control for conception (HbA1c<6.5%) increased over time, in patients with Type 1 diabetes from 9.0% (7.1%–11.0%) to 19.1% (17.2%–21.1%), and in those with Type 2 diabetes from 27.2% (24.6%–29.9%) to 35.4% (33.6%–37.1%). The proportion of women with Type 2 diabetes prescribed medications different from insulin and metformin rose from 22.3% (20.5%–24.2%) to 27.3% (26.0%–28.6%).In 2017, 14.0% (12.6%–15.4%) of women with Type 1 and 30.7% (29.3%–32.0%) with Type 2 diabetes were prescribed angiotensin-modulating antihypertensives or statins. We captured at least one unfavorable factor for pregnancy in 50.9% (48.8%–52.9%) of women with Type 1 diabetes and 70.7% (69.3%–72.0%) of women with Type 2 diabetes. Only one third of women with Type 1 diabetes (32.2%, 30.3%–34.0%) and a quarter of those with Type 2 diabetes (23.1%, 21.9%–24.4%) were prescribed hormonal contraception. Contraception was prescribed more frequently to women with unfavorable factors for pregnancy compared to those without, however, the difference was significant only for women with Type 1 diabetes.ConclusionsDespite significant improvements in general diabetes care, the majority of women with Type 1 or Type 2 diabetes have unfavorable, although mostly modifiable, factors for the start of pregnancy. Good diabetes care for women of childbearing age should include taking into consideration a possible pregnancy.

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797-P: Impact of Carbohydrate Counting on Glycaemic Control in People with Type 1 and Type 2 Diabetes on Intensified Insulin Therapy

Diabetes ◽

10.2337/db20-797-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 797-P

Author(s):

NORBERT HERMANNS ◽

DOMINIC EHRMANN ◽

BERNHARD KULZER

Keyword(s):

Type 2 Diabetes ◽

Glycaemic Control ◽

Insulin Therapy ◽

Carbohydrate Counting ◽

Intensified Insulin Therapy

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Conversations and Reactions Around Severe Hypoglycaemia (CRASH): Results from the German Cohort of a Global Survey of People with Type 1 Diabetes or Insulin-Treated Type 2 Diabetes and Caregivers

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1310-7963 ◽

2020 ◽

Author(s):

Elisabeth Mönnig ◽

Erik Spaepen ◽

Beatrice Osumili ◽

Beth D. Mitchell ◽

Frank Snoek ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Online Survey ◽

Healthcare Professionals ◽

Severe Hypoglycaemia ◽

Insulin Regimen ◽

Hypoglycaemic Event ◽

Cross Sectional Survey

Abstract Background A global cross-sectional survey (CRASH) was designed to provide information about the experiences of people with diabetes (PWD) and their caregivers in relation to severe hypoglycaemic events. Methods Adults with type 1 diabetes or insulin-treated type 2 diabetes who had experienced one or more severe hypoglycaemic events within the past 3 years, and adult caregivers for such people, were recruited from medical research panels using purposive sampling. We present here results from Germany. Results Approximately 100 individuals in each of the four participant groups completed a 30-minute online survey. Survey results indicated that the most recent severe hypoglycaemic event made many participants feel scared (80.4%), unprepared (70.4%), and/or helpless (66.5%). Severe hypoglycaemia was discussed by healthcare professionals at every visit with only 20.2% of participants who had ever had this conversation, and 53.5% of participants indicated that their insulin regimen had not changed following their most recent event. 37.1% of PWD/people with diabetes cared for by caregivers owned a glucagon kit at the time of survey completion. Conclusions The survey identified areas for improvement in the prevention and management of severe hypoglycaemic events. For healthcare professionals, these include enquiring more frequently about severe hypoglycaemia and adjusting blood glucose-lowering medication after a severe hypoglycaemic event. For individuals with diabetes and their caregivers, potential improvements include ensuring availability of glucagon at all times. Changes in these areas could lead not only to improved patient wellbeing but also to reduced use of emergency services/hospitalisation and, consequently, lower healthcare costs.

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