Pumps That Predict and Manage Low Blood Glucose Are Superior to Pumps With Stand-Alone CGM for Reducing Hypoglycaemia in Type 1 Diabetes Patients in a Real-World Setting

Diabetes Metab. 2020 Jun 1;S1262-3636(20)30087-2. doi: 10.1016/j.diabet.2020.05.010. Online ahead of print.

Abstract

Background: This study aimed to assess the efficacy of insulin pumps with automated predictive low-glucose insulin suspension in a real-world setting compared with stand-alone flash glucose monitoring (FGM).

Methods: The data analyzed were uploaded by patients with type 1 diabetes (n=195) treated with external insulin pumps [either a MiniMed 640G system (Medtronic) including SmartGuard technology that predicts and manages low glucose (n=61) or an Omnipod patch pump accompanied by a FreeStyle Libre sensor (Abbott) for FGM (n=134)].

Result: The median (25th-75th percentile) time spent with sensor glucose values≤3.9mmol/L was 0.9% (0.4-1.55) vs. 5.6% (3.05-9.55) in the predictive low-glucose suspend group vs. FGM users, respectively (P<0.0001), with similar results obtained for median time spent with sensor glucose values≤3mmol/L (P<0.0001). The group using sensor-integrated pumps had lower % coefficient of variation (CV) values and lower mean amplitude glycaemic excursions (P<0.0001). Mean glucose values as well as measured HbA1c levels were also lower.

Conclusion: These real-world data show that predictive low-glucose insulin suspension is more effective than pumps with stand-alone FGM for reducing hypoglycaemic events, and could be of benefit to patients at risk of hypoglycaemia as well as those lacking in hypoglycaemic awareness.

Keywords: Continuous monitoring; Hypoglycaemia; Impaired awareness of hypoglycaemia; Insulin pump.