Sensor-augmented CSII therapy with predictive low-glucose suspend following total pancreatectomy

Scott, Emma; Fulcher, Greg; Clifton-Bligh, Rory

doi:10.1530/edm-17-0093

Cited by 8 publications

(9 citation statements)

References 10 publications

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“…21,22 High rates of hypoglycemia were observed in previous studies in patients with diabetes following pancreatic resection. [27][28][29] Although the frequency of hypoglycemic episodes was higher in the FCPD group, we did not observe significant differences in hypoglycemic indices between the two groups. This discordance could be attributed to three factors: (a) relative preservation of endocrine and exocrine function and counterregulatory responses in FCPD compared to that following total pancreatectomy.…”

Section: Discussioncontrasting

confidence: 73%

“…41 In another study, predictive low-glucose suspend using CGM and sensor-augmented continuous subcutaneous insulin infusion improved glycemic control and reduced hypoglycemia in patients with pancreatogenic diabetes following total pancreatectomy. 28 CGM using artificial endocrine pancreas during perioperative period improved glycemic control and reduced hypoglycemia in pancreatogenic diabetes after pancreatic resection. 42 The limitations of this study include application of CGM during hospitalization, which might differ from that of ambulatory home values.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of CGM-Derived Measures of Glycemic Variability Between Pancreatogenic Diabetes and Type 2 Diabetes Mellitus

Shivaprasad

Aiswarya

Shah

et al. 2019

J Diabetes Sci Technol

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Background: To compare glycemic variability (GV) indices between patients with fibrocalculous pancreatic diabetes (FCPD) and type 2 diabetes mellitus (T2D) using continuous glucose monitoring (CGM). Methods: We measured GV indices using CGM (iPro™2 Professional CGM, Medtronic, USA) data in 61 patients each with FCPD and T2D who were matched for glycated hemoglobin A1c (HbA1c) and duration of diabetes. GlyCulator2 software was used to estimate the CGM-derived measures of GV (SD, mean amplitude of glycemic excursion [MAGE], continuous overall net glycemic action [CONGA], absolute means of daily differences [MODD], M value, and coefficient of variance [%CV]), hypoglycemia (time spent below 70 mg/dL, AUC below 70 mg/dL, glycemic risk assessment diabetes equation hypoglycemia, Low Blood Glucose Index), and hyperglycemia (time spent above 180 mg/dL at night [TSA > 180], AUC above 180 mg/dL [AUC > 180], glycemic risk assessment diabetes equation hyperglycemia, High Blood Glucose Index [HBGI], and J index). The correlation of GV indices with HbA1c, duration of diabetes, and demographic and biochemical parameters were also assessed. Results: All the CGM-derived measures of GV (SD, MAGE, CONGA, MODD, and %CV), except M value, were significantly higher in the FCPD group than in the T2D group ( P < 0.05). Measures of hyperglycemia (TSA >180, AUC >180, HBGI, and J index) were significantly higher in the FCPD group than in the T2D group ( P < 0.05). The measures of hypoglycemia were not significantly different between the two groups. All the hyperglycemia indices showed a positive correlation with HbA1c in both groups. Conclusions: FCPD is associated with higher GV than is T2D. The findings of higher postprandial glycemic excursions in patients with FCPD could have potential therapeutic implications.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Comparison of CGM-Derived Measures of Glycemic Variability Between Pancreatogenic Diabetes and Type 2 Diabetes Mellitus

Shivaprasad

Aiswarya

Shah

et al. 2019

J Diabetes Sci Technol

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“…Bei Patienten/-innen mit CFRD und MODY, die eine Insulintherapie benötigen, werden diese Hilfsmittel im Vergleich zu Patienten/-innen mit Diabetes Typ 1 weniger häufig genutzt. Bei Patienten/-innen mit pankreoprivem Diabetes sind Insulinpumpe und CGM ebenfalls nur selten Bestandteil der Therapie, obwohl bei dieser Gruppe auch Störungen der Gegenregulation mit ausgeprägten Hypoglykämien zu erwarten sind [48,49]. Von den Patienten/-innen mit Diabetes Typ 2 und Insulintherapie ist trotz positiver Studienergebnisse [8,50] bisher unter 1 % mit diesen Hilfsmitteln versorgt.…”

Section: Diskussionunclassified

Insulinpumpe, kontinuierliche und kapilläre Glukosemessung bei Kindern, Jugendlichen und Erwachsenen mit Diabetes mellitus: Daten des DPV-Registers zwischen 1995 und 2019

Schöttler

Auzanneau

Best³

et al. 2020

Diabetologie und Stoffwechsel

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ZusammenfassungZiel dieser Beobachtungsstudie ist die Beschreibung der aktuellen Nutzung von Diabetestechnologien bei Patienten/-innen mit Diabetes mellitus. Methode Auswertung von Daten des DPV-Registers zur Nutzung der Insulinpumpentherapie (CSII), kontinuierlicher Glukosemessung (CGM) und der Selbstmessung der Blutglukose (SMBG) aus 497 teilnehmenden Zentren in Deutschland, Österreich, Luxemburg und der Schweiz zwischen 1995 und 2019. Die Daten wurden bei Patienten/-innen mit Diabetes Typ 1 (Alter ≥ 0,5 Jahre) für 5 Altersgruppen ausgewertet. Zusätzlich wurden aktuelle (zwischen 2017 und 2019) Geschlechtsunterschiede in der Verwendung von Diabetestechnologie bei Typ-1-Patienten/-innen untersucht, ebenso wie die Nutzung von Insulinpumpen und CGM für Patienten/-innen mit Insulintherapie bei Typ-2-DM, bei zystischer Fibrose (CFRD), bei anderen Pankreaserkrankungen, neonatalem Diabetes und Maturity Onset Diabetes of the Young (MODY). Ergebnisse Es zeigte sich bei Patienten/-innen mit Diabetes Typ 1 ein Anstieg der CSII-Nutzung von 1995 bis 2019 von 1 % auf 55 % (2019: < 6 Jahre: 89 %; 6–< 12 Jahre: 67 %; 12–< 18 Jahre: 52 %; 18–< 25 Jahre: 48 %; ≥ 25 Jahre: 34 %). Die CGM-Nutzung erhöhte sich ab 2016 bis 2019 von 9 % auf 56 % (2019: 67 %; 68 %; 61 %; 47 %; 19 % der jeweiligen Altersgruppe). Die SMBG nahmen von 1995 bis 2015 insbesondere in den jüngeren Altersgruppen zu, gefolgt von einem Rückgang seit dem Jahr 2016 (Alle Patienten: 1995: 3,3/Tag; 2016: 5,4/Tag; 2019: 3,8/Tag). Weibliche Patienten mit Typ-1-Diabetes führten häufiger eine CSII und mehr SMBG als männliche Patienten durch (56 %/48 %, jeweils p-Wert: < 0,0001), während sich bei der CGM-Nutzung keine signifikanten Unterschiede zeigten.Zwischen 2017 und 2019 erfolgte eine Nutzung von Insulinpumpen und CGM bei neonatalem Diabetes (CSII 87 %; CGM 38 %), bei MODY (CSII 14 %; CGM 28 %) und bei CFRD (CSII 18 %; CGM 22 %). CGM und CSII wurden dagegen nur selten von Menschen mit Insulintherapie und Diabetes Typ 2 (CSII < 1 %; CGM 1 %) und bei anderen Pankreaserkrankungen (CSII 3 %; CGM 4 %) genutzt. Schlussfolgerung Moderne Diabetestechnologien werden derzeit insbesondere von pädiatrischen Patienten/-innen mit Diabetes Typ 1, aber auch von Menschen mit neonatalem Diabetes breit genutzt, von Patienten/-innen mit MODY und CFRD sowie Erwachsenen mit Diabetes Typ 1 in etwas geringerem Maße mit ansteigendem Trend. Dagegen sind diese Technologien in der Therapie des Typ-2-Diabetes und bei anderen Pankreaserkrankungen zurzeit nur wenig verbreitet.

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“…In recent years, growing evidences suggest that CSII also shows superiority over MDI during the perioperative period in patients with type 2 diabetes or pancreatogenic diabetes . This aroused great interest in developing a proper protocol for CSII use during surgery …”

Section: Introductionmentioning

confidence: 99%

“…26 This aroused great interest in developing a proper protocol for CSII use during surgery. [27][28][29][30] Our previous study showed that CSII improved hyperglycemia in perioperative patients. 31 However, it is important to investigate whether improvement of hyperglycemia leads to reduction of surgery-related complications in perioperative patients.…”

mentioning

confidence: 98%

Continuous subcutaneous insulin infusion reduces the risk of postoperative infection

Mou

Zhang

et al. 2019

Journal of Diabetes

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Highlights• In our study, we adopted propensity matching, which included 1015 patients and 30 types of surgeries. • The results show that patients who receive continuous subcutaneous insulin infusion (CSII) therapy have a lower incidence of perioperative fever, a lower positive rate of postoperative secretion culture, and a shorter duration of antibiotic use. • These results indicate that CSII therapy reduces the risk of postoperative infection and improves the prognosis of patients. AbstractBackground: Perioperative hyperglycemia was associated with postoperative infection, and proper management of perioperative glucose has become critical in improving the prognosis of patients.Methods: A total of 1015 diabetic patients who underwent surgery and received insulin treatment for their hyperglycemia in our hospital were retrospectively reviewed. According to propensity matching, we obtained 253 pairs of patients from the group which received continuous subcutaneous insulin infusion (CSII) therapy (CSII group) and the group which received insulin injection therapy (non-CSII group). Perioperative glucose levels and corresponding outcomes were compared between the two groups.Results: Compared with the non-CSII group, the CSII group had lower fasting and mean glucose levels, lower incidence of fever (operation day: 18.6% vs 10.2%; P = .014; first postoperative day: 55.1% vs 34.7%; P < .001), a positive rate of postoperative secretion culture (6.3% vs 1.2%; P = .004), and a shorter time of antibiotics use (total antibiotics use: P = .002; postoperative antibiotics use: P < .001) and hospital stays (P < .001). However, there was no difference in the total medical expenditure between the two groups (P = .499). Further analysis showed that CSII therapy was superior to multiple daily insulin Yune Mou and Delin Ma made similar contributions to the manuscript.

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Sensor-augmented CSII therapy with predictive low-glucose suspend following total pancreatectomy

Cited by 8 publications

References 10 publications

Comparison of CGM-Derived Measures of Glycemic Variability Between Pancreatogenic Diabetes and Type 2 Diabetes Mellitus

Comparison of CGM-Derived Measures of Glycemic Variability Between Pancreatogenic Diabetes and Type 2 Diabetes Mellitus

Insulinpumpe, kontinuierliche und kapilläre Glukosemessung bei Kindern, Jugendlichen und Erwachsenen mit Diabetes mellitus: Daten des DPV-Registers zwischen 1995 und 2019

Continuous subcutaneous insulin infusion reduces the risk of postoperative infection

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