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Predictive low-glucose suspend system makes hypoglycemia less frequent
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A cohort of individuals with diabetes who used a continuous glucose monitor with predictive low-glucose suspend insulin delivery technology spent less time with blood glucose below 70 mg/dL and experienced fewer hypoglycemic episodes than when they were not using the system, according to findings published in Diabetes Technology & Therapeutics.
“Beyond CGM, predictive low-glucose suspend (PLGS) algorithms offer an additional and automated layer of hypoglycemia prevention,” Eliah Aronoff-Spencer, MD, PhD, an associate professor in the department of medicine at the University of California, San Diego, and colleagues wrote. “PLGS systems use CGM values to predict hypoglycemia and automatically suspend insulin delivery to help prevent hypoglycemia. This alleviates the burden of diabetes management and can be impactful for those with hypoglycemia unawareness.”
According to Aronoff-Spencer and colleagues, the PLGS system incorporates an algorithm and Basal-IQ technology into a t:slim X2 insulin pump (Tandem Diabetes Care). The researchers retrospectively reviewed how often hypoglycemia occurred among 8,123 individuals aged 6 to 90 years (mean age, 32.4 years; 52% female) with either type 1 diabetes (96%) or type 2 diabetes (4%) who used the system. From Aug. 31, 2018, to March 14, 2019, participants used the system’s upload feature to log a minimum of 21 days of data that was then evaluated by the researchers.
While using the system, participants averaged 1.66% of time with a glucose level of less than 70 mg/dL, 59.1% of time with a level between 70 mg/dL and 180 mg/dL, and 38.8% of the time with a glucose level above 180 mg/dL.
The researchers found that participants in the study population who had previously used an insulin pump and CGM (n = 1,371) averaged 1.76% of time with a glucose level below 70 mg/dL while using the PLGS system compared with 3% prior to using the system (P < .001). These participants also spent a median of 1.1% of the time with glucose below 70 mg/dL compared with a median of 2.02% of the time in such a range prior to using the system. Based on these findings, the researchers calculated that relative risk for hypoglycemia decreased by 45% and absolute risk decreased by 1.23% for these participants.
In terms of time in range, these participants spent 61.9% of the time with a target glucose level between 70 mg/dL and 180 mg/dL while using the system, which was up from 60.6% of the time prior to use (P < .001). These participants also experienced a decrease from a mean of 171 mg/dL before using the system to 170 mg/dL while using the system in corrected mean glucose (P < .002), although glucose measures “remained stable” prior to correction. In addition, average total glucose levels increased over time for the total population and for a second subset of participants who used the PLGS system for 9 weeks or more.
The relative risk for an episode of hypoglycemia fell by 71% in experienced participants, as they averaged 0.03 episodes of hypoglycemia per day while using the system compared with 0.11 per day before use (P < .001). This rate was similar to that of those in the total population and those in the additional subset who used the PLGS system for 9 weeks or more. Using these daily estimates, the researchers observed that episodes of hypoglycemia decreased from an average of one every 9 days to one every 30 days.
“The study results indicate that Basal-IQ technology might be a viable option for an ambulatory insulin-dependent population,” the researchers wrote. “Overall, these data support the use of algorithm-enhanced automated insulin delivery systems to improve health outcomes in patients with insulin-dependent diabetes. These may be appropriate for people with diabetes with difficult to control disease or those at particular risk for hypoglycemia.” – by Phil Neuffer
Disclosures : Aronoff-Spencer reports he has received a grant from Dexcom. Please see the study for all other authors’ relevant financial disclosures.
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