Endocrine Abstracts

Background and aims: To evaluate the efficacy and safety of switching from rapid acting insulins to ultra rapid insulin l ispro (URLi ) in a real world clinical practice in adult s with type 1 diabetes (T1D) using intermittently scanned or real time continuous glucose monitoring (isCGM or rtCGM respectively).

Materials and methods: In this real world, prospective, multicentre, 12 month study data from 22 patients with T1D (M/F 12/10; MDI/CSII 21/1; isCGM/rtCGM 19/ 3), who initiated URLi from January 2022 to January 2024, were analysed The primary objective was the evolution of time in range (70 180 mg/dl or 3.9 10.0 mmol/l) at 6 and 12 months. The secondary objectives included the change in HbA1c, time below range (TBR; < 70 and < 54 mg/dl), time above range (TAR; > 180 and > 250 mg/dl), number and timing of hypoglycaemic events, coefficient of variation (CV) of glycaemia and composite endpoints of reaching TIR > 70% of time and TBR < 70 mg/dl of < 4% of time at 6 and 12 months.

Results: TIR evolved from 54.7 ± 13.8% to 56.4 ± 16.9% at 12 months ( P = 0.304). Time below 70 mg/dl (6.0 ± 5.2% at baseline) dropped significantly to 3.5 ± 2.5% and 3.3 ± 3.8% at 6 and 12 months ( P = 0.009). A significant decrease was also found for time below 54 mg/dl from 2.0 ± 2.2% to 0.6 ± 0.8% and 0.8 ± 1.8% at 6 and 12 months ( P < 0.001). Additionally, the number of hypoglycaemi c events dropped significantly from 27.0 ± 16.0 to 18.9 ± 9.5 and 19.4 ± 13.3 at 6 and 12 months ( p = 0.019). No significant difference s were observed for timing of hypoglycaemia, time above 180 mg/dl and 250 mg/dl, HbA1c and GMI. For the CV a significant decrease from 39. 5 ± 6.8 % to 9 ± 1 % at 12 months was seen ( P = The number of people spending more than 70% of time in range increased from 13.6% to 27.3% ( P = 0.174) and those a chieving less than 4% of time below 70 mg/dl increased numerically from 50.0% to 72.7% ( P = 0.150).

Conclusion: We performed a 12 month, multicentre, prospective, real world study in which adults with T1D, using CGM, were switched from rapid acting insulins to URLi. Despite the small population and no significant improvement in TIR, a reduction in TBR (< 70 mg/dl and < 54 mg/dl) with 2.7% and 1.2% respectively, corresponding to 39 and 17 minutes less time spent in hypoglycaemia, was observed. Also the number of hypoglycaemic events and glucose variability improved.