Endocrine Abstracts

Introduction

The development of flash glucose monitoring system (FGM) has led to a change in the paradigm of diabetes control, beyond the evaluation of glycosylated hemoglobin (HbA1c). FGM allows to improve control of type 1 diabetes mellitus (T1DM) and the quality of life of patients.

Objective

Describe the baseline characteristics of patients with T1DM in a regional hospital in the southern area of the province of Cordoba and study changes after the start of FGM.

Design and methods

A retrospective observational study of patients we implant FGM, from the opening of the consultation (June 2020) to the present. Statistical analysis was performed using the SPSS program (SPSS, inc, v21.0) (Student’s t-test for related samples).

Results

We evaluated 36 patients, a mean age of 36 ± 14.11 years, 58.3% women, BMI 26.46 ± 4.77 kg/m², 13.9% with thyroid pathology. Cardiovascular risk factors: 6.9% smokers, 11.1% hypertensive, 19.4% dyslipidemic. Previous follow-up of T1DM: 88.9% Endocrinology, 8.3% Internal Medicine and 2.8% Primary Care.

Baseline characteristics

20.83 ± 12.11 years of evolution, 38.9% performed between 4–6 daily blood capillary glucose, 30.6% diet by rations, basal insulin: 80.6% insulin Glargine U300; prandial insulin: 55.6% insulin Aspart; total daily insulin dose 0.70 ± 0.22IU/kg/day, 8.3% treatment with metformin. Microvascular complications: 19.44% (retinopathy); Macrovascular complications: 2.78% (ischemic heart disease). 5.6% of the patients required recycling of diabetes education. 94.4% had not used FGM and were referred to start it (86.1% in the first visit, 5.9% in the second). Biochemical and ambulatory glucosa profile (AGP) comparison from FGM implantation to successive revisions (first vs second, both with FGM): HbA1c 7.51 ± 0.72% vs 7.65 ± 0.65%, glucose 142.50 ± 36.65 vs 183.08 ± 63.88 mg/dl, P = NS both; no positive microalbuminuria data at follow-up. Coefficient of variation (CV) 38.54 ± 8.26 vs 36.55 ± 6.09%, GMI 7.06 ± 0.94 vs 7.36 ± 1.19%, time in hyperglycemia 31.09 ± 21.9 vs 35.18 ± 24.54%, time in hypoglycemia 6.73 ± 4.92 vs 9.91 ± 15.04%, time in range 62.18 ± 20.82 vs 5 4.91 ± 28.13%, P = NS in all. Average glucose 154.55 ± 35.64 vs 164.27 ± 45.83 mg/dl, P = 0.039.

Conclusions

In this cohort, the use of FGM has allowed a decrease in CV (although not significantly). However, the biochemical control and the glucometric data don’t show an improvement trend, despite the increase in progressive use, possibly due to the low availability of data at present (more than half of patients have not yet undergone review after start FGM). In this regard, adequate diabetes education is essential, which we must emphasize more in our patients, increasing the rate of referral to nursing.