Hypoglycemia is under-reported by many patients; but the time in hypoglycemia among patients with type 2 diabetes (T2D) using pre-mixed (biphasic) insulin is not clear. This pilot study aimed to determine the amount of time in hypoglycemia in this patient cohort. The study included people with T2D, aged 18 or over, treated with pre-mixed (biphasic) insulin for at least 6 months with their most recent HbA1c <7.5% (58 mmol/mol) recorded in medical notes in the last 12 months. Pregnant patients were excluded, as were patients on dialysis. A total of 43 participants (65.1% male) from 12 primary and secondary care sites in the UK enrolled in the 2-week single arm study using the FreeStyle Libre Pro Flash Glucose Monitoring SystemTM. Mean HbA1c was 6.9±0.8% (52.1±8.3 mmol/mol), age was 68.8±8.3 years, BMI was 35.0±9.2 kg/m2, average duration of pre-mixed insulin was 6.8±4.8 years with a mean daily dose of 53.4±40.7 units (mean±SD). The number of blood glucose tests performed per day (self-reported) was 1.9±1.1. Time in hypoglycemia <70 mg/dL (3.9 mmol/L) was 1.35±1.56 hours per day, biological hypoglycemia was experienced by 34 patients. Approximately half of the time in hypoglycemia (<70 mg/dL [3.9 mmol/L]; 0.82±1.06 hours) was during night time hours (23:00 to 06:00). Time in hyperglycemia >180 mg/dL (10.0 mmol/L) was 3.55±3.07 hours per day, which mostly occurred was during daytime hours (06:00 to 23:00) (3.15±2.83 hours per day) (mean±SD). Five anticipated sensor insertion site symptoms were experienced by four participants: erythema (n=2 [1 slight pink, 1 well-defined redness]), pain (n=1), bruising (n=1) and bleeding (n=1), all were mild in severity. This population, with HbA1c in target range, have a greater amount of hypoglycemia than the International Consensus and ADA targets of <1 hour per day, excursions occurred both during the day and at night. Further improvements on this level of glycemic control is challenging for this type of insulin therapy due to further escalation of the risk of nocturnal hypoglycemia. Disclosure I.R. Idris: None. N. Annamalai: None. T. Aung: None. I. Binnian: None. F.W. Gibb: None. M.I. Malik: None.

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The use of continuous glucose monitoring has been suggested as a method of determining glucose control in prediabetes, including understanding glucose variability, which may be a risk factor in the progression to type 2 diabetes. This pilot research study aimed to determine glycemic variability (%CV) in people diagnosed with impaired glucose tolerance (IGT)/prediabetes. The study included people aged 18 or over, with their most recent HbA1c 5.7-6.4% (39-47 mmol/mol) recorded in medical notes in the last 12 months. Pregnant patients were excluded, as were patients with diabetes. A total of 43 participants (60.5% female) from 5 primary care sites in the UK enrolled in the 2-week single arm study, wearing a FreeStyle Libre Pro Flash Glucose Monitoring SystemTM (glucose data was not available to participants). On average, HbA1c was 6.06±0.25% (42.7±2.6 mmol/mol), age was 62.5±8.3 years, BMI was 32.1±6.6 kg/m2, average time since diagnosis was 18±19 months, average Q diabetes score was 28.4±23.7% (mean±SD). Glucose variability (%CV) was 17.3±3.8%, %CV was greater during daytime hours (06:00 to 23:00) than at night (23:00 to 06:00), 17.7±4.1% and 12.9±3.5% respectively (mean±SD). %CV was greater in those with BMI<30 kg/m2 compared to those ≥30 kg/m2; 18.9±3.3% and 15.8±3.5% respectively (mean±SD). Mean glucose was 101.2±10.0 mg/dL, time in hyperglycemia (>180 mg/dL, 10.0 mmol/L) was 0.09±0.23 hours per day (mean±SD). Ten anticipated sensor insertion site symptoms were experienced by five participants: erythema (n=2, well-defined redness), pain (n=1), bruising (n=1), itching (n=2), rash (n=2), bleeding (n=1) and other (n=1, ‘skin irritation’), all were mild in severity and resolved. This population, with prediabetes experienced glucose variability of 17.3% (%CV). This was greater during daytime hours and in those with lower BMI (<30 kg/m2). Disclosure K. Douglas: None. N. Annamalai: None. P.J. Moore: None. S. Thomson: Research Support; Self; Abbott. Research Support; Spouse/Partner; Abbott.

Funding Acknowledgements Type of funding sources: None. Introduction Peripartum cardiomyopathy (PPCM), as defined by the study group on PPCM of Heart Failure Association of the European Society of Cardiology (ESC), is an idiopathic Cardiomyopathy with systolic heart failure occurring towards the end of pregnancy or in the months following delivery, in previously healthy women. The current diagnostic criteria are: - heart failure in the last month of pregnancy or in the first 5 postpartum months - absence of other causes of heart failure - absence of known heart disease predating the development of heart failure. - reduced Left Ventricular Ejection Faction (LVEF) of < 45% or Fractional Shortening < 30% The global incidence of PPCM is variable, the least reported in Japan and the most in Nigeria. The estimates of the incidence in India need more scrutiny because of the difficulties in diagnosing the condition. The current incidence in literature is 1 in 1374 live births. We conducted the study to characterize PPCM among women delivered at a resource-limited setting in South India. Aim To estimate the incidence of PPCM To describe the risk factors and Feto-maternal outcomes and associated mortality To estimate the recovery of cardiac function at the end of one year. Materials and Methods This was a prospective longitudinal study conducted in a rural public hospital in South India, from 2017 to 2020. PPCM was diagnosed in pregnant and puerperal women, in concurrence with global standards. Data included were Age, Parity, Gestational age, Risk factors, Medical Management, Pregnancy outcome and Echocardiography data on diagnosis and at 1-year follow-up. Results - 32 out of 14505 women in the 4-year study period were diagnosed with PPCM. - The incidence of PPCM was 1 in 453 live births. - The mean age was 23.2 years. - 46.8% were primigravidae. - 21.8% had pre-eclampsia. - 100% had breathlessness at presentation (62.5% were in New York Heart Association – Class III). - The mean LVEF on diagnosis was 24.5%. - The Fractional Shortening was 16%. - The Left Ventricular End Diastolic Dimension was 5.8cm. - 18.75% of women were diagnosed antenatally, 75% in the early puerperium and 6.25% in the late puerperium. - 81.3% were delivered by caesarean section. - At 1-year follow up, complete recovery of cardiac function was observed in 65.6% of the women. - There was no maternal mortality or adverse perinatal outcomes. Conclusion Although rare, PPCM is an important cause for Maternal Mortality. Being a diagnosis of exclusion, a high index of suspicion and involvement of a multi-disciplinary team will aid to optimize the Feto-maternal outcomes. Setting up a National PPCM registry will help in establishing the clinical epidemiology, risk factor assessment, screening strategies, diagnostic criteria and management options for mothers suffering from the condition.