Glycemic Control and Hypoglycemia in Patients Treated with Insulin Pump Therapy: An Observational Study

Abstract

Introduction. Diabetes mellitus (DM) is a highly prevalent disease worldwide. It has been associated with an important morbimortality due to its complications and sometimes as a result of adverse events related to treatment. Insulin pump therapy (IPT) is one of the options used to control this disease and reduces one of the most frequent complication associated with treatment: hypoglycemia, which has also a great impact on life quality and clinical status of patients. Materials and Methods. A descriptive and retrospective study was performed including patients treated and followed by the department of endocrinology from a high-complexity university hospital in Cali, Colombia, between 2012 and 2017. Patients were on IPT and continuous glucose monitoring (CGM): MiniMed Paradigm® Veo™ Insulin Pump (Medtronic®) and MiniMed 640G Insulin Pump-Enlite™ Sensor (Medtronic®). Presentation of hypoglycemia and variables associated with its development were evaluated. Results. 51 patients were included. The main indication for IPT initiation was the report of hypoglycemic episodes and inappropriate metabolic control. Initiation of IPT was related with a decrease in glycosylated hemoglobin (HbA1c) and also a decrease in severe hypoglycemic events and hospitalization due to hypoglycemia. The risk factors linked with clinically significant hypoglycemia were male gender, and standard deviation of glucose measures calculated by CGM. A diminished glomerular filtration rate (GFR) (<60 mL/min/1.73 m2) was correlated with higher risk of severe hypoglycemia. Conclusion. IPT with CGM is a useful strategy in the management of patients with DM; it is associated with a reduction of adverse hypoglycemic events and hospitalizations due to hypoglycemia.

Association of Body Fat Percentage with Time in Range Generated by Continuous Glucose Monitoring during Continuous Subcutaneous Insulin Infusion Therapy in Type 2 Diabetes

“…Continuous subcutaneous insulin infusion (CSII) therapy has been of value in T2DM patients who fail to achieve adequate glycemic control [ 30 ]. More physiological delivery of insulin by continuous subcutaneous infusion has been proven for reduction of glucose toxicity and prevention of progressive β -cell dysfunction in T2DM [ 31 ].…”

Diabetes mellitus effect on rates of perioperative complications after operative treatment of distal radius fractures

“…Diabetes type, level of glucose control, and staging can have important implications in a patient's organ functionality, degree of functional independence, and risk of infection. Early stage diabetic patients who are compliant with treatment generally have much better outcomes than later stage patients or those who are not compliant with monitoring their glucose levels [15,16]. This study did not account for perioperative complications in those with undiagnosed diabetes, which may be important when considering the vast number of people in the USA who are unaware that they even have diabetes [5].…”

“…This study did not account for perioperative complications in those with undiagnosed diabetes, which may be important when considering the vast number of people in the USA who are unaware that they even have diabetes [5]. These limitations are important to consider when evaluating the aptness of a surgical candidate, as a patient with low-stage disease that is well-managed could have a significantly lower risk of complication than a patient with high-stage, poorly managed, or unidentified disease [15]. Future studies can be aimed at determining whether other factors, such as high or low BMI, the use of steroids, and history of COPD, have an impact on patients with DM undergoing operative treatment of distal radius fractures.…”

Association of Body Fat Percentage With Time in Range Generated by Continuous Glucose Monitoring During Intensive Insulin Pump Therapy in Type 2 Diabetes

“…Intensive insulin pump therapy has been of value in T2DM who fail to achieve optimal glycemic control [27] . More physiological delivery of insulin by the pump has been proven for reduction of glucose toxicity, resulting in improvement of insulin resistance in obese T2DM patients [28] .…”