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Background/aim Prevention of hypoglycemia remains a major challenge in diabetic management, despite the introduction of modern insulin pumps in daily clinical practice. The Low Glucose Suspend (LGS) and the newer Predictive Low Glucose Management (PLGM) systems incorporated in the Medtronic insulin pumps have shown promising results in prevention of hypoglycemia. Our aim was to evaluate the effect of the 2 systems relative to the frequency of clinically significant hypoglycemia in Type 1 diabetes (T1DM). In addition, we investigated the events preceding clinically significant hypoglycemia episodes. Methods A cross-sectional study was conducted in 30 T1DM patients using the MiniMed 640G vs. 30 using the MiniMed Veo sensor-augmented insulin pump. All data was recorded during patients’ normal daily activity and living conditions. The patients were matched for age and duration of diabetes. Results PLGM use was associated with lower incidence of clinically significant hypoglycemia (1.9±1.4 vs. 3.6±1.9 episodes per week), along with reduced exposure to hypoglycemia. The data indicated that both pump systems are effective in preventing severe hypoglycemic episodes. In both groups the most common events preceding hypoglycemic episodes included adjustment of hyperglycemia, basal rate increase and miscalculation of carbohydrates. Conclusions The results indicated that the use of the Minimed 640G pump system can help reduce the frequency of clinically significant hypoglycemia. Management of hyperglycemia must be addressed in diabetes education programs in order to encourage proper adjustment of high blood glucose levels. Future studies would be useful in exploring the details of the events preceding hypoglycemia episodes in insulin pump users.

The importance of attachment has been studied extensively as a frame for understanding the self-care behaviours of people with diabetes and their relations with practitioners. A component of attachment is the ability to reflect upon one’s mental state and understand what one is feeling and why. Aim of the study was to investigate attachment patterns and their relation with the reflective function of people with type 1 diabetes. 102 people (age 38.6±10 years, 63% females, diabetes duration 21.3±13 years, HbA1c 7.5±1.2%, Gold Score 2.2±1.5) completed measures of attachment (ECR-R) and reflective functioning (RFQ). Results suggested that there were differences in the attachment styles (χ2= 9.04, p= 0.02) between individuals who were able to detect hypoglycemia symptoms quickly enough to avoid progression to a severe hypoglycemic episode and those with hypoglycemia unawareness. 63.6% (p< 0.001) of participants with hypoglycemia unawareness were characterized as fearfully attached, a pattern associated with emotional dysregulation and problems in interpersonal relationships. People with impaired reflective functioning were more likely to report hypoglycemia unawareness (t= 2.74, p= 0.007) suggesting that impairments in identifying and expressing emotional states are associated with the ability to recognize hypoglycemic symptoms. Mediation analysis revealed significant indirect effects with a point estimate of b= 0.128 (SE= 0.055), excluding zero (95% CI= 0.033, 0.248) for anxiety and b= 0.109 (SE= 0.052), excluding zero (95% CI = 0.019, 0.226) for avoidance, indicating that attachment insecurities indirectly influence hypoglycemia awareness via the capacity to recognize and understand one’s own and other’s psychological state. Overall, the results indicate that impaired reflective processes may be involved in the recognition of hypoglycemia. Therapeutic interventions designed to enhance reflective functioning could improve hypoglycemia awareness. Disclosure P. Thomakos: None. F. Griva: None. O. Kepaptsoglou: None. A. Mitrakou: None. G. Vaslamatzis: None. C. Zoupas: None.

The prevalence of adverse outcomes in GDM pregnancies compared to the general population are still high in studies, which used ADA treatment criteria. Our goal was to compare outcomes of tight controlled GDM pregnancies achieving optimal glycemic patterns with normal pregnancies. A cross-sectional study of 280 singleton pregnancies: 140 GDM with a mean FBG ≤90 and 1h PP ≤ 120mg/dL vs. 140 normal pregnancies, age and BMI matched. FBG and 1h PP BG for each participant was determined by the average of their SMBG readings. Clinical characteristics - age: 35.7±5 vs. 35.4±5 years; BMI: 23.1±5 vs. 23.7±4 kg/m2; OGTT 0’: 94.1±14.4, 60’: 186.1±27.7, 120’: 161,2±20.4 mg/dL; HbA1c: 5.2±0.6 vs. 4.8±0.3 %, p<0.001; FBG: 83.7±8 mg/dl; 1h PP BG: 106.5±11 mg/dl; GDM diagnosis week: 25.8±4; starting insulin week: 26.8±5; insulin dose: 46.3±13 iu/day. Obstetric and neonatal history between groups: Weight gain: 11.8±4 vs. 10.4±2 kg, p=0.03; delivery week: 37.7±2 vs. 38.1±1, p=0.01; neonatal birth weight: 3050±327 vs. 3200±355 g, p<0.001; SGA: 5.7 vs. 4.3%; LGA: 5.7 vs. 3.6 %; women hypoglycemia episodes: 21.4 %; pre-eclampsia rate: 4.2 vs. 2.8 %; RDS: 10 vs. 7.1 %; Neonatal hypoglycemia: 6.4 vs. 5.7%, NICU admittance: 17.8 vs. 6.4%, p=0.02, Caesarean section: 60 vs. 23.6 %, p<0.001. No cases of severe maternal hypoglycemia and perinatal mortality. An association between: maternal-fetal complications and increased 1h PP BG (r=303), 1h (r=348), 2h (r=228) OGTT values. No association between adverse fetal outcome and maternal hypoglycemia. Tight metabolic control with early insulin therapy minimizes adverse pregnancy outcomes. Performing GDM screenings before 24-28 weeks in women >35 years of age is recommended. Outcome of the pregnancies was not adversely affected by maternal hypoglycemia. 1h PP BG and 1h and 2h OGTT values predicts outcome in GDM pregnancies. More research is needed to understand the optimal BG targets in GDM management. Disclosure P. Thomakos: None. O. Kepaptsoglou: None. C. Barreto: None. A. Trouva: None. D. Trouvas: None. C.S.P. Zoupas: None.