Improved HbA1c and reduced glycaemic variability after 1-year intermittent use of flash glucose monitoring

Flash glucose monitoring (FGM) was introduced in China in 2016, and it might improve HbA1c measurements and reduce glycaemic variability during T1DM therapy. A total of 146 patients were recruited from October 2018 to September 2019 in Liaocheng. The patients were randomly divided into the FGM group or self-monitoring blood glucose (SMBG) group. Both groups wore the FGM device for multiple 2-week periods, beginning with the 1st, 24th, and 48th weeks for gathering data, while blood samples were also collected for HbA1c measurement. Dietary guidance and insulin dose adjustments were provided to the FGM group patients according to their Ambulatory Glucose Profile (AGP) and to the SMBG group patients according to their SMBG measurements taken 3–4 times daily. All of the participants underwent SMBG measurements on the days when not wearing the FGM device. At the final visit, HbA1c, time in range (TIR), duration of hypoglycaemia and the number of diabetic ketoacidosis (DKA) events were taken as the main endpoints. There were no significant difference in the baseline characteristics of the two groups. At 24 weeks, the HbA1c level of the FGM group was 8.16 ± 1.03%, which was much lower than that of the SMBG group (8.68 ± 1.01%) (p = 0.003). The interquartile range (IQR), mean blood glucose (MBG), and the duration of hypoglycaemia in the FGM group also showed significant declines, compared with the SMBG group (p < 0.05), while the TIR increased in the FGM group [(49.39 ± 17.54)% vs (42.44 ± 15.49)%] (p = 0.012). At 48 weeks, the differences were more pronounced (p < 0.01). There were no observed changes in the number of episodes of DKA by the end of the study [(0.25 ± 0.50) vs (0.28 ± 0.51), p = 0.75]. Intermittent use of FGM by T1DM patients can improve their HbA1c and glycaemic control without increasing the hypoglycaemic exposure in insulin-treated individuals with type 1 diabetes in an developing country.

Retrospective Evaluation on the Use of a New Polysaccharide Complex in Managing Paediatric Type 1 Diabetes with Metabolic Syndrome (MetS)

Background: Children and adolescents affected by type 1 diabetes have an increased risk of being overweight or obese and of suffering from cardiometabolic symptoms. Aims: To retrospectively evaluate the effects of a new complex of polysaccharide macromolecules, Policaptil Gel Retard® (PGR), on auxological and metabolic parameters, glycaemic variability and control parameters in paediatric patients with type 1 diabetes and metabolic syndrome (MetS). Patients and Methods: Data for 27 paediatric patients with a diagnosis of type 1 diabetes in conjunction with obesity and MetS of at least 5 years’ standing were collected and retrospectively studied. Of these, 16 (median age 12.9, range 9.5–15.8 years) had been adjunctively treated with PGR and 11 (median age 12.6, range 9.4–15.6 years) had not been treated with PGR. Auxological, metabolic and glycaemic control and variability parameters and insulin dosing were compared after 6 months in the two groups. Results: PGR significantly reduced BMI standard deviation score (SDS) (p < 0.005), waist SDS (p < 0.005), HbA1c (p < 0.05) and daily mean insulin dose requirement (p < 0.005). A significant improvement was also observed in the metabolic and glycaemic variability parameters of mean daily blood glucose (BG) levels (p < 0.005), SD of daily BG levels (p < 0.0001), mean coefficient of variation (p < 0.05), LBGI (p < 0.0001), HBGI (p < 0.0001), J-index (p < 0.005), total cholesterol (p < 0.005), HDL-cholesterol (p < 0.005) and LDL-cholesterol (p < 0.005) and triglycerides (p < 0.05). Conclusions: PGR produces a good auxological and metabolic response in obese patients with MetS who are affected by type 1 diabetes. It led to a significant reduction in BMI SDS, waist SDS and an improvement in glucose control and variability as well as in other MetS parameters. The use of polysaccharide compounds, especially if associated with appropriate dietary changes, may help achieve treatment targets in type 1 diabetes and reduce the risk that patients develop metabolic syndrome.

Relationship between time in range, glycemic variability, HbA1c and complications in adults with type 1 diabetes mellitus

Purpose Real-time continuous glucose monitoring (RT-CGM) provides information on glycaemic variability (GV), time in range (TIR) and guidance to avoid hypoglycemia, thereby complimenting HbA1c for diabetes management. We investigated whether GV and TIR were independently associated with chronic and acute diabetes complications. Methods Between September 2014 and January 2017 515 subjects with type 1 diabetes using sensor-augmented pump therapy were followed for 24 months. The link between baseline HbA1c and CGM-derived glucometrics (TIR [70-180 mg/dL], coefficient of variation [CV] and standard deviation [SD]) obtained from the first 2 weeks of RT-CGM use and the presence of complications was investigated. Complications were defined as: composite microvascular complications (presence of neuropathy, retinopathy or nephropathy), macrovascular complications, and hospitalization for hypoglycemia and/or ketoacidosis. Results Individuals with microvascular complications were older (P&lt;0.001), had a longer diabetes duration (P&lt;0.001), a higher HbA1c (7.8±0.9 vs 7.5±0.9%, P&lt;0.001) and spent less time in range (60.4±12.2 vs 63.9±13.8%, P=0.022) compared to those without microvascular complication. Diabetes duration (OR=1.12 [1.09-1.15],P&lt;0.001) and TIR (OR=0.97 [0.95-0.99], P=0.005) were independent risk factors for composite microvascular complications, while SD and CV were not. Age (OR=1.08 [1.03-1.14],P=0.003) and HbA1c (OR=1.80 [1.02-3.14], P=0.044) were risk factors for macrovascular complications. TIR (OR=0.97 [0.95-0.99], P=0.021) was the only independent risk factor for hospitalizations for hypoglycaemia or ketoacidosis. Conclusions Lower TIR was associated with the presence of composite microvascular complications and with hospitalization for hypoglycemia or ketoacidosis. TIR, SD and CV were not associated with macrovascular complications.

Continuous subcutaneous insulin infusion alters microRNA expression and glycaemic variability in children with type 1 diabetes

To determine whether continuous subcutaneous insulin infusion (CSII) vs. multiple daily injections (MDI) therapy from near-diagnosis of type 1 diabetes is associated with reduced glycaemic variability (GV) and altered microRNA (miRNAs) expression. Adolescents (74% male) within 3-months of diabetes diagnosis (n = 27) were randomized to CSII (n = 12) or MDI. HbA1c, 1-5-Anhydroglucitol (1,5-AG), high sensitivity C-peptide and a custom TaqMan qPCR panel of 52 miRNAs were measured at baseline and follow-up (median (LQ-UQ); 535 (519–563) days). There were no significant differences between groups in baseline or follow-up HbA1c or C-peptide, nor baseline miRNAs. Mean ± SD 1,5-AG improved with CSII vs. MDI (3.1 ± 4.1 vs. − 2.2 ± − 7.0 mg/ml respectively, P = 0.029). On follow-up 11 miRNAs associated with diabetes vascular complications had altered expression in CSII-users. Early CSII vs. MDI use is associated with lower GV and less adverse vascular-related miRNAs. Relationships with future complications are of interest.

A comparative study of glycaemic variability using four different Point-of-Care Testing (POCT) devices

Background: Blood glucose measurement is a way of monitoring changes in glycaemia. Different point-of-care testing (POCT) glucose meters are on the market and hence there is an increase in variability of the results given by these meters. This study sought to measure the glycaemic variability using four different point-of-care glucose meters Methods: Four point of care glucometers namely; Accu-chek performer nano, OneTouch select plus flex, OneTouch Ultra 2 and Easy Check were used test blood samples from a total of 100 patients visiting the collection point of the Tamale Teaching Hospital Laboratory. A chemistry analyzer (Mindray BS 240 fully automated) was used as the reference method. Results: The median (interquartile range), Bland Altman Plot and Regression Equation were used to assess the agreement between the various meters and the reference method. The OneTouch Select plus had the least bias (-0.85) and the the OneTouch Ultra 2 had the highest bias (1.49). The OneTouch select had the best limits of agreement (-2.51 – 0.82) and the OneTouch Ultra 2 had the widest limits of agreement (-1.91 – 4.89) when compared to the reference method. Conclusion: OneTouch Select plus had the best agreement with the reference method and the OneTouch Ultra 2 had the least agreement with the reference method. Blood glucose meters should be used for the monitoring of blood glucose however, it should not be used as a diagnostic tool. Annals of Medical Laboratory Science (2021) 1(2), 1 - 8 Keywords: glucometer, point-of-care, blood glucose, glycaemia