Use of the predictive low glucose management (PLGM) algorithm in Italian adolescents with type 1 diabetes: CareLink™ data download in a real-world setting

Scaramuzza, Andrea; Arnaldi, C.; Cherubini, Valentino; Piccinno, Elvira; Rabbone, Ivana; Toni, Sonia; Tumini, Stefano; Candela, G; Cipriano, Paola; Ferrito, Lucia; Tinti, Davide; Cohen, Ohad; Lombardo, Fortunato

doi:10.1007/s00592-016-0927-0

Cited by 24 publications

(18 citation statements)

References 5 publications

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“…The average suspension period in all subjects was higher than the ones observed in our previous experience with PLGM in 2015 and in other studies . We can hypothesize that the increase in suspensions were triggered by the emphasis on programmed exercise performed during the present study and the relative high suspend thresholds utilized.…”

Section: Discussionsupporting

confidence: 89%

“…Thus, a PLGM threshold at 70 mg/dL seems to be a good choice to keep BG within the euglycemic range with other glucose metrics, including median and glucose variability, as good even when adolescents practice aerobic and mixed physical activity in free‐living conditions. Moreover, choosing a higher glucose threshold, a rebound hyperglycemia could affect glucose control, as shown in other studies, but not in our study, although more pump suspensions were observed than in other studies . However, it is noteworthy that during this camp, adolescents did not practice high intensity physical activity; therefore, it is difficult to generalize our results to all types of physical activities.…”

Section: Discussioncontrasting

confidence: 58%

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Optimal predictive low glucose management settings during physical exercise in adolescents with type 1 diabetes

Cherubini¹,

Gesuita

Skrami

et al. 2018

Pediatr Diabetes

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Objectives To assess the optimal setting of the predictive low glucose management (PLGM) algorithm for preventing exercise‐induced hypoglycemia in adolescents with type 1 diabetes. Methods Thirty‐four adolescents, 15 to 20 years, wearing PLGM system, were followed during 3 days exercise during a diabetes camp. PLGM threshold was set at 70 mg/dL between 8 am and 10 pm and 90 mg/dL during 10 pm and 8 am Adolescents were divided into group A and B, with PLGM threshold at 90 and 70 mg/dL, respectively, during exercise. Time spent in hypoglycemia and AUC for time slots 8 am to 1 pm, 1 to 4 pm, 4 to 11 pm, 11 pm to 3 am, 3 to 8 am, in 3 days were compared between groups by Wilcoxon rank sum test. Results We analyzed 31 patients (median age 15.0 years, 58.1% males, median diabetes duration 7.0 years, hemoglobin A1c [HbA1c] 7.1%). No significant difference has been observed in time spent in hypoglycemia between groups using threshold 70 or 90. Time spent in target was similar in both groups, as well as time spent in hypo or hyperglycemia. The trends of blood glucose over the 3 days in the 2 groups over‐lapped without significant differences. Conclusions A PLGM threshold of 90 mg/dL during the night was associated with reduced time in hypoglycemia in adolescents doing frequent physical exercise, while maintaining 65.1% time in range during the day. However, a threshold of 70 mg/dL seems to be safe in the duration of the physical exercise. PLGM system in adolescents with type 1 diabetes was effective to prevent hypoglycemia during and after exercise, irrespective of the PLGM thresholds used.

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Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 58%

Optimal predictive low glucose management settings during physical exercise in adolescents with type 1 diabetes

Cherubini¹,

Gesuita

Skrami

et al. 2018

Pediatr Diabetes

Self Cite

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“…In the absence of patient interference, following pump suspension, the insulin infusion resumes after a maximum suspend period of 2 hours or earlier if the auto‐resumption parameters are met. PLGM reduced hypoglycemia under in‐clinic conditions and in short‐ and long‐term home studies. There was also no deterioration of glycemic control with the use of the system in a 6 month randomized controlled home trial …”

Section: Hypoglycemia Treatmentmentioning

confidence: 96%

ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes

et al. 2018

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“…These recommendations are based on our experience gained from a summer camp designed to educate and motivate patients on the use of PLGM. This recently published experience showed that, after 6 months of follow up after the camp, 65.5% of the adolescents (25 of the original group of 38) were still using the sensor 70%‐100% of the time with 74.2% of the time spent on target (70‐160 mg/dL) . After this experience, each child who started therapy with a PLGM system underwent the educational path proposed here.…”

Section: Introductionmentioning

confidence: 92%

Recommendations for the use of sensor-augmented pumps with predictive low-glucose suspend features in children: The importance of education

Scaramuzza

Arnaldi

Cherubini³

et al. 2017

Pediatr Diabetes

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Sensor-augmented pumps, which consist of a pump and a continuous glucose monitoring system, offer considerable therapeutic opportunities, despite requiring close attention in the early phase of their use. The aim of this paper is to provide recommendations on the use of a predictive low glucose management (PLGM) system (Minimed 640G™, Medtronic, Northridge, CA, USA) in adolescents with type 1 diabetes either at the start of therapy or during follow-up. Sound clinical recommendations on PLGM are of increasing importance since several recent papers have reported significant clinical improvements in patients with PLGM, especially in adults. These recommendations are based on the experience of a group of pediatric endocrinologists who collaborated to closely and intensively study the on-boarding of adolescent patients with type 1 diabetes on automated systems to gain first-hand experience and peer-to-peer insights in a unique free-living environment. The suggestions provided here are indicative, so can be adapted to the individual realities and experiences of different diabetes centers. However, we believe that close adherence to the proposed scheme is likely to increase the chances of improving the clinical and metabolic outcomes of patients treated with this therapy.

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Use of the predictive low glucose management (PLGM) algorithm in Italian adolescents with type 1 diabetes: CareLink™ data download in a real-world setting

Cited by 24 publications

References 5 publications

Optimal predictive low glucose management settings during physical exercise in adolescents with type 1 diabetes

Optimal predictive low glucose management settings during physical exercise in adolescents with type 1 diabetes

ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes

Recommendations for the use of sensor-augmented pumps with predictive low-glucose suspend features in children: The importance of education

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