Hyperglycemia Associated With Raynaud Phenomenon and Liver Dysfunction After COVID-19 Vaccination in Type 1 Diabetes Mellitus.

Background/Objective: The association of COVID-19 vaccinations and the changes in glycemic control remains debatable. We report a case of a patient with type 1 diabetes mellitus (DM) with previously well-controlled glucose on a hybrid closed-loop insulin pump who developed significant glucose variation, new onset Raynaud phenomenon, and liver dysfunction after the vaccination. Case Report: A 33-year-old man with type 1 DM since the age of 5 years was on an insulin pump for 17 years. He had a reasonable controlled glucose level with a hemoglobin A1c level of 6.8% (51 mmol/mol). Three days after he received the COVID-19 vaccination, his glucose level started to fluctuate in the range of 46 to 378 mg/dL with 3.5 times higher total daily insulin requirement. The patient developed white-pale cold hands, weight gain, fatigue, and liver dysfunction. Computed tomography of the abdomen revealed mild hepatomegaly, and laboratory workup was negative for hepatitis. One month later, his glucose level became better controlled, and his liver function improved. Continuous glucose monitoring revealed that his glucose profile returned to baseline after 6 weeks. Discussion: COVID-19 vaccination resulted in significant glucose variation and fluctuations in this patient. It could be explained by the vaccine-induced immune response causing an increase in insulin resistance, such as in adipose tissue and muscle cells. Immune stimulation could have also caused the abnormal liver function and explain his new onset Raynaud phenomenon. Conclusion: We described, for the first time, the long-term continuous glucose monitoring glucose profile with a hybrid closed-loop system in type 1 DM after COVID-19 vaccination. Clinicians need to keep alert to glycemic excursion and side effects after immunization in type 1 DM.

"I HAVE A LOT OF CONTROL OVER MY TREATMENT": THE ROLE OF DIABETES TECHNOLOGY ON ADOLESCENTs' SELF-EFFICACY DURING COVID-19

Background and Aims: For adolescents with type 1 diabetes (T1D), self-efficacy in diabetes management is associated with better glycemic levels and improved health outcomes. We examined the impact of the COVID-19 pandemic on self-efficacy and diabetes management among adolescents with T1D. Method(s): We conducted semi-structured interviews with adolescents with T1D who were participating in an ongoing clinical trial. Adolescents (n = 24;mean age = 13.8 +/- 2.1 years;42% female;mean HbA1c = 8.7 +/- 1.7%;95% CGM users) described their confidence in their ability to manage diabetes during the pandemic. Interviews were transcribed and coded, establishing inter-reliability (kappa = .78). Adolescents' diabetes device use and HbA1c were extracted from medical records. Result(s): Most adolescents (63%) reported increased confidence over the course of the pandemic. Over half (53%) of these adolescents were already using an insulin pump, while 33% updated their method of insulin delivery over the pandemic. Many participants cited diabetes technology as an important factor in their self-management confidence. They described the additional information about blood glucose trends the technology provided as being beneficial during the pandemic, allowing them to make necessary adjustments on their own, at a time when seeing providers was inconsistent. Several participants also reported that the technology helped them adhere to recommendations regarding insulin dosing and glucose monitoring during quarantine, leading to improvements in blood glucose levels and an overall increase in self-efficacy. Conclusion(s): Findings illustrate the role of diabetes technology in the daily lives of adolescents with T1D, as well as their potential benefits during the particularly unique time of COVID-19.

In-Person Versus Virtual Insulin Pump Training Experiences among People with Diabetes in 6 European Countries

Background and Aims: While insulin pump training has historically been conducted in person, the COVID-19 pandemic has necessitated a rise in virtual alternatives. The present study aims to examine the perceived effectiveness of in-person versus online pump training among people with diabetes in Europe. Method(s): From April-May 2022, 2,457 people with type 1 diabetes in France, Germany, Italy, Netherlands, Sweden, and UK took an online survey in which they indicated their use of pump therapy. Respondents who started using a new pump model in the last year indicated their pump training method (n = 366) and those who received training reported their confidence in pump use after training (n = 356). Confidence scores were calculated as the proportion of users selecting 9 or 10 on a 10-point scale. Result(s): The majority of pump users trained in person with an HCP or pump company representative (76%). One quarter of pump users trained virtually with a professional (24%), and 12% completed a self-guided training tutorial online. Those who completed a self-guided tutorial were significantly less confident using their pump than those who trained with a professional in person (34% vs. 51%, p = 0.021) or virtually (34% vs. 55%, p = 0.006). No differences in confidence were observed between those who trained with a professional in person or virtually (51% vs. 55%). Conclusion(s): These findings suggest that virtual training may be an effective alternative to in-person methods, though professional guidance is critical to building confidence in pump use. Further research is needed to identify improvements to online, self-led trainings to increase proficiency among new pump users.

With Hybrid Closed-Loop System Dblg1, the Clinical Improvement Obtained Is All the More Important as the Initial Clinical Situation Was More Deteriorated

Background and Aims: Does automatised insulin administration in closed-loop (CL) with DBLG1 system improve TIR (time in range 70-180mg/dl) and TBR (time below range <70) in all adult patients affected by Type 1 diabetes (APT1D) ? Methods: 140 APT1D, HbA1c > 8%, 43,3 +/- 13,0 years, treated with Dana insulin pump were randomised to either receive after 2 weeks in open loop (OL), CL treatment with the DBLG1 algorithm, or continue in OL, with a 4 CL/1 OL ratio. COVID health crisis prematurely terminated the study. Nonetheless, 99 patients received at least 14 days of treatment with CGM data >=75% of the time (88CL, 11 OL). Result(s): After adjusting on baseline HbA1c and centers, patients in CL versus OL, spent 12min less per 24h in hypoglycemia <70 mg/dl (p < 0.01), 3h12 more in target 70-180 (p < 0.001), 3h less in hyperglycemia >180 mg/dl (p < 0.0007). These improvements were primarily nocturnal. Significative (p < 0.0001) linear correlations were observed between: 1 - TIR baseline/ Delta-TIR: patients with the lowest TIR at T0 are the ones who increase it the most. 2 - TBR baseline/Delta-TBR: patients with the highest TIR at T0 are the ones who lower it the most. The patients who were initially the most hyperglycemic, and therefore had the least hypoglycemias, are the ones who gained the most in TIR, without deteriorating their TBR. Conclusion(s): The DBLG1 system is likely to benefit the entire spectrum of metabolic disorders in Type 1 diabetes, either by improving TIR70-180 or decreasing TBR70, depending on the situation at initiation.

Telemedicine in pediatric diabetology.

Since the coronavirus disease 2019 (COVID-19) pandemic, telemedicine in pediatric diabetology has become part of care of children and adolescents with type 1 diabetes (T1D) and their families, especially video consultations. An improvement in glycemic control as well as in therapy satisfaction could be achieved. Different requirements are necessary for implementation in the technical, organizational, and regulatory sense. For implementation, it is important to adapt the work-flow and to create an adequate workplace for video consultation with specific infrastructure. For the actual video consultation with the patient, all digital data should be used, e.g., from blood glucose meters and continuous glucose monitoring (CGM) devices as well as insulin pumps or digital pens, and the upload of these data by the patient beforehand is obligatory. The discussion of the data in a patient-centered manner with the use of graphs and figures derived from the ambulatory glucose profile (AGP) or similar methods should be done as in face-to-face consultations. Another possibility of telemedicine is video education. Here, it is not sufficient just to use known educational material, but this has to be adapted or, if necessary, some parts need to be newly developed. Reimbursement is still insufficient and needs to be improved to make telemedicine economically reasonable for the provider.Copyright © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Smartphone Built-in Features: Do They Help Our Diabetic Patients?

Objective: To evaluate the pre-set features of smartphones and the inclusion of ADCES7 guidelines for Diabetes self-care during the COVID-19 era. Method(s): The pre-loaded applications of the iPhone 13 and Samsung S22 Ultra were tested with the ADCES7 parameters: 1) Healthy eating, 2) Being Active, 3) Monitoring, 4) Taking Medication, 5) Problem Solving, 6 )Healthy coping, 7) Reducing Risks. We evaluated the smartphones for the following subcategorties of the ADCES7 parameters: 1a) Nutrition, 1b) Calorie-counting;2a) Step-counting, 2b) Calorie-burning, 3a): Blood pressure, 3b) Blood glucose, 3c) HbA1c, 3d) Weight, 3e) Push notification, 4a) Med Log, 5a) Contact healthcare team, 5b) Contact family;6a) Mental health outreach, 7a) Goal-Setting, 7b) Graph analysis. We added additional categories 8) Insulin pumps and 9) Language. Result(s): 1. Nutrition facts= Apple(Yes), Samsung(No);2. Calorie counting= Apple(Yes), Samsung(Yes);3. Step counting= Apple(Yes), Samsung(Yes);4. Calorie Burning= Apple(No), Samsung(Yes);5. Monitoring BP= Apple(No). Samsung(Yes);6. Monitoring Blood Glucose= Apple(No), Samsung(Yes);7. Monitoring HbA1c= Apple(No), Samsung(Yes);8. Weight Monitoring= Apple(Yes), Samsung(Yes);9. Push Notifications and Med Reminders= Apple(Yes), Samsung(Yes);10. Goal setting= Apple(No), Samsung(Yes);11. Med Log= Apple(No), Samsung(Yes);12. Facetime, Samsung Video Call= Apple(Yes), Samsung(Yes);13. Healthy Coping= Apple(No), Samsung(No);14. Goal Setting for Steps= Apple(No), Samsung(Yes);15. Graph Analysis= Apple(Yes), Samsung(Yes);16. Insulin pumps= Apple(No), Samsung(No);17. Foreign languages= Apple(46), Samsung(187) Samsung provides more ADCES7 parameters and more language options than Apple. Conclusion(s): The smartphones have internal resources for patients to self-manage their Diabetes Mellitus. As MDs, we can continue to partner with our patients for diabetes management during COVID-19 and beyond.

Emerging Technologies For Diabetes Management: Application And Challenges

For the last few years, technology has had its impact in laboratory affairs, and this has been given an urgent impetus by the COVID-19 pandemic. As a general rule, laboratories have become 'smarter'. The 'intelligent' lab today uses more of automation, software, artificial intelligence, and changes are grossly evident at the manufacturer level. Flexibility is the key for Industry 4.0 (and Lab 4.0) and the faster one adapts, better will be the ability to survive in the global market. Technological developments are an essential part of medical profession in research and patient care. The development of technologies goes hand-in-hand with improvement in healthcare delivery standards. However, technological developments have also met with significant challenges. Many of the advances in the recent years have not found a role in actual clinical care, even today. For example, continuous subcutaneous insulin infusion (CSII) pump and continuous glucose monitoring ( CG M) devices offered a lot of promise in the management of Type I Diabetes Mellitus, especially in young patients;however, they have found limited actual clinical utility. Similarly, many novel computational tools have also come up in the self-management of diabetes mellitus. These include, but are not limited to wearables ' sensors and apps. Practical issues, health-economic challenges, and ethics need to be considered before emerging technologies find a place in routine use.

Health inequalities and diabetes

Inequalities in health care exist in many countries in the world. In 2008 the then UK Secretary of State for Health commissioned the Marmot review, ‘Fair Society, Healthy Lives', to propose strategies to address health inequalities in the UK. Most of Marmot's proposals were not acted upon and in 2020, 10 years after the initial recommendations were published, Marmot found that there had been no improvement and some things were worse. In diabetes care inequalities are widespread, impacting on prevention, treatment, access to technology, screening for complications, risk of complications, morbidity and mortality. Ethnicity is a major risk factor, starkly demonstrated by the increased COVID-19 related mortality in people from minority ethnic groups with diabetes. Disadvantaged groups include, but are not limited to, those with social deprivation, intellectual and physical disabilities and severe mental illness. The decision to shelve the long-awaited white paper on tackling health inequalities, taken recently by the last Secretary of State for Health amid protests from a coalition of medical organisations, makes it unlikely that the government will take the actions proposed by Marmot. In the absence of a national strategy, responsibility to recognise and address inequalities in diabetes care falls on health care professionals, in teams and as individuals. Copyright © 2023 John Wiley & Sons.

Managing Diabetes in Pregnancy Before, During, and After COVID-19.

Background: Pregnant women with diabetes are identified as being more vulnerable to the severe effects of COVID-19 and advised to stringently follow social distancing measures. Here, we review the management of diabetes in pregnancy before and during the lockdown. Methods: Majority of antenatal diabetes and obstetric visits are provided remotely, with pregnant women attending hospital clinics only for essential ultrasound scans and labor and delivery. Online resources for supporting women planning pregnancy and for self-management of pregnant women with type 1 diabetes (T1D) using intermittent or continuous glucose monitoring are provided. Retinal screening procedures, intrapartum care, and the varying impact of lockdown on maternal glycemic control are considered. Alternative screening procedures for diagnosing hyperglycemia during pregnancy and gestational diabetes mellitus (GDM) are discussed. Case histories describe the remote initiation of insulin pump therapy and automated insulin delivery in T1D pregnancy. Results: Initial feedback suggests that video consultations are well received and that the patient experiences for women requiring face-to-face visits are greatly improved. As the pandemic eases, formal evaluation of remote models of diabetes education and technology implementation, including women's views, will be important. Conclusions: Research and audit activities will resume and we will find new ways for supporting pregnant women with diabetes to choose their preferred glucose monitoring and insulin delivery.

48th Annual ISPAD Conference

The proceedings contain 335 papers. The topics discussed include: CGM initiation in youth with public insurance results in improvements in A1c and increased transition to hybrid closed loop systems;disengagement from advanced diabetes technologies during the covid-19 pandemic associates with worse short-term outcomes in the US T1D exchange quality improvement collaborative;the impact of daily mean air temperature on time in hypoglycemia in 1642 children and adolescents with type 1 diabetesclinically relevant?;the economic impact and cost saving following providing technology in the management of type 1 diabetes in a pediatric population in Saudi Arabia: what we learn?;postprandial glycemic excursion and optimal insulin pump dosing strategy following high-protein meals among children and adolescents with type 1 diabetes: a randomized cross-over study;safety of user-initiated intensification of insulin delivery using the Cambridge hybrid closed-loop algorithm;and association of time in range targets achievement with treatment modality in youths with type 1 diabetes: realworld data from the International SWEET Registry.

Therapeutic delivery: industry update covering January 2022

This industry update covers the period from January 1 through January 31, 2022, and is based on information sourced from company press releases, scientific literature, patents and news websites. January 2022 saw Janssen and Midatech expand their collaboration on bioresorbable polymer microsphere technology for drug delivery. Takeda announced its plans to acquire UK-based Adaptate Biotherapeutics and Gandeeva raised further investment funds to support its drug discovery and development platform focused on the evaluation of protein-drug interactions. Biogen announced that it will sell its stake in a biosimilars joint venture and ABL Bio and Sanofi announced a collaboration around a novel treatment for Parkinson's disease. New regulatory announcements this month included US FDA approvals of a new insomnia treatment for Idorsia and a treatment for atopic dermatitis developed by Pfizer. Insulet gained FDA clearance for a closed-loop insulin pump and Ascendis Pharma followed up its United States approval last year for a once-weekly treatment for growth hormone deficiency with European approval. Pfizer and Ionis announced the discontinuation of the clinical development of a novel cardiovascular drug. In terms of collaborations, Novartis and Alnylam announced they will work together to explore targeted therapies to restore liver function;Scorpion Therapeutics partnered with AstraZeneca to develop novel cancer treatments and Nutriband Inc. and Kindeva Drug Delivery will work together to develop a transdermal fentanyl patch. Collaborations were also announced between Century Therapeutics and Bristol Myers Squibb and Lilly and Entos Pharmaceuticals in the areas of stem cell therapies for cancer treatment and neurology, respectively. A team from the Massachusetts Institute of Technology reported progress in developing oral mRNA treatments and West Pharmaceutical Services published a blog describing the development of a proof-of-principle system for a closed-loop feedback system targeting opioid overdose. A report on the BBC website highlighted the benefits of more sustainable inhalers.

Glycaemic Control Assessment of Paediatric T1dm Patients Throughout the Covid-19 Pandemic between 2019 and 2021 in a District General Hospital

Aims Our aim is to assess whether Covid-19 had an overall impact on diabetic control within the paediatric type 1 diabetic population who attend Causeway Hospital. We retrospectively compared baseline HbA1cs of patients between the years 2019 - 2021 to assess for change in the mean HbA1c throughout all paediatric T1DM patients as well as to compare patients with and without an insulin pump. We planned to retrospectively assess the percentage of newly diagnosed diabetic patients who were in DKA on initial presentation. Finally, we wanted to assess HbA1c control of patients with a libre 2 sensor to assess whether patients who scanned more frequently have better overall HbA1c and/or time in target glucose range. Methods NIECR, TWINKLE and LIBREVIEW systems were used to collect data from all Causeway diabetic patients from 2019-2021 to compare HbA1c, number of libre scans and data including whether patients presented in DKA. For data collected on patients with a libre sensor - this was analysed using an unpaired t-test and a p-value subsequently calculated to assess statistical significance. Results In total data was collected from 92 patients throughout the years 2019 - 2021. The median HbA1c of all T1DM patients increased from 65.2 in 2019 to 65.7 in 2020 then improved in 2021 to 64.07mmol/mol. In 2020, there were fewer overall patients with a new diagnosis of T1DM (n=8) compared with 2019 (n=11) and 2021 (n=11). In 2020 37.5% of newly diagnosed patients were in DKA on initial presentation compared with 18% in 2019 and 27% in 2021. Total number of T1DM patients with an HbA1c <48 was 5.6% in 2019, 3.8% in 2020 and 11.8% in 2021. Mean HbA1c from all T1DM patients increased from 65.24mmol/mol in 2019 to 65.72mmol/mol in 2020 and improved to 64.08mmol/mol in 2021. Mean HbA1c in T1DM patients with an insulin pump also increased from 57.76mmol/ mol in 2019 to 59.63mmol/mol in 2020 and improved to 57.56mmol/mol in 2021. In patients with a libre 2 sensor, percentage time within target glucose range (3.9-10mmol/L) increased from 31.25% in those who scanned <4 times/day(n=12) to 59.44% in those who scanned >12 times/day(n=18) resulting in a pvalue of 0.0001. In patients with a libre 2 sensor, mean HbA1c values in those who scanned <4 times per day was 76.5 compared to 55mmol/mol for patients who scanned >12/day resulting in a p-value of 0.0003. Conclusion Throughout all T1DM paediatric patients, we noted an increased HbA1c in 2020 and an improvement in 2021. There was also an increase in incidence of DKA at presentation in newly diagnosed patients who presented in 2020 compared to 2019/2021. Our patients with an insulin pump had better overall HbA1c control than those who self-inject. Patients with a libre 2 sensor who scan more frequently are more likely to have an increased amount of time within the target glucose range of 3.9-10mmol/L and are more likely to have a lower HbA1c.

Evaluating Availability of Glucose Data During In-person versus Telemedicine Visits in an Endocrinology Specialty Clinic

Introduction: Blood glucose (BG) data are essential for diabetes management. Before Coronavirus Disease 2019 (COVID-19) pandemic, BG data would be obtained as patient fingerstick BG logs, or insulin pump and/or continuous glucose monitor (CGM) data downloaded from patients' devices during in-person visits. Transition to telemedicine during the pandemic altered clinic workflow and challenged access to BG data. This study compares availability and sources of BG data in telemedicine versus in-person endocrinology visits. Research Question or Hypothesis: Hypotheses: 1) BG data availability was higher for in-person versus telemedicine visits. 2) More fingerstick BG logs were available for in-person visits. 3) Availability of pump and/or CGM data was higher during in-person versus in-person visits. Study Design: This was an observational retrospective study conducted via chart review. Methods: We randomly screened adult diabetes management clinic visits at Banner 'University Medicine Endocrinology Clinic from 6/1/2019 to 12/13/2019 (in-person, Group A) and 6/1/2020 to 12/31/2020 (telemedicine, Group B). Incomplete visits were excluded. Chi-square test was used for between group comparison. Results: Out of the 766 screened visits, 200 were included in Group A and 199 in Group B. Overall, availability of BG data (from all noted sources) was higher for Group A (79%) than Group B (46.2%), P<0.001. More fingerstick BG logs were available for Group A (78.5%) than Group B (21.5%), P<0.001. Availability of insulin pump and/or CGM data was not statistically significant between the two groups (54.1% vs 45.9%, P=0.210). Conclusion: The higher overall BG data availability for in-person visits was driven by that of fingerstick BG logs. Pump and CGM data availability did not differ between groups suggesting that those data were successfully shared with the clinic for telemedicine visits. Enhancing ability to share fingerstick BG data for telemedicine visits should be considered. Future studies are needed to assess availability of clinically relevant data.

FLASH GLUCOSE MONITORING WITH THE FREESTYLE LIBRE 2: RESULTS FROM THE FLASH-UK RANDOMISED CONTROLLED TRIAL (ON BEHALF OF THE STUDY GROUP)

Objectives To evaluate whether intermittently scanned continuous glucose monitoring (isCGM) with optional alarms (FreeStyle Libre 2) improves glycaemia as measured by HbA1c and sensor-based gluco-metrics, patient reported outcome measures (PROMS) and cost-effectiveness compared with selfmonitoring of blood glucose (SMBG). Design Flash UK is a multicenter, open-label, two arm, parallel, randomised controlled trial delivered in 7 specialist hospital diabetes clinics and 1 primary care centre. Participants 156 people with Type 1 diabetes, age 16 years and over treated with either multiple daily insulin injections or insulin pump therapy with HbA1c 7.5%-11% were randomised. Interventions Participants were randomised (1:1) to the FreeStyle Libre 2 (n = 72) or standard care with SMBG (n = 69). Participants were reviewed at 4, 12 and 24 weeks post-randomisation. Education and treatment optimisation was provided to both groups at randomisation, 4 and 12 weeks. Participants in the SMBG arm wore blinded glucose sensor (Freestyle Libre Pro) during the last 2 weeks of the study;all participants wore a 2-week blinded sensor prior to randomisation. All study visits were conducted either inperson or virtually owing to the COVID-19 pandemic. Main outcome measures The primary outcome was HbA1c at 24 weeks, analysed by intention to treat. Secondary outcomes included glucose time in range (3.9 to 10mmol/l), time below and above range and glucose variability. PROMS included EQ-5DL-5L, Type 1 Diabetes Distress Scale, Diabetes fear of injecting and self-testing, Diabetes Eating Problem Survey, Diabetes Treatment Satisfaction, Patient Health Questionnaire and The Glucose Monitoring Satisfaction Survey. Economic evaluation included healthcare resource use, insulin usage and Freestyle Libre 2 utilisation. Results & Conclusion Results and conclusions will be presented during the 15th International Conference on Advanced Technologies & Treatments for Diabetes, April 27 to 30th Barcelona, Spain and Online.

EFFECT OF THE COVID-19 PANDEMIC ON METABOLIC CONTROL IN INSULIN PUMP USERS IN A DIABETES CENTER IN COLOMBIA

Background and Aims: The COVID-19 pandemic has led to changes in the management of insulin pump patients, requiring the use of telemedicine as a follow-up strategy. This study aimed to describe the metabolic control before and during the pandemic following the implementation of a teleconsultation program. Methods: Observational study of a cohort of insulin pump users at the Diabetes Center, Fundación Santa Fe de Bogotá from January 2020 to July 2021. Changes in HbA1c, time in range, episodes of hypoglycemia in both, pre-pandemic ( January to April 2020). and the pandemic (April to July 2021) period were evaluated. Results: During the study period, 44 patients were included, 22 males (50%), with a mean age of 41 years and time of diabetes 20.9 years. Micro-infusion systems incluided paradigm754 (11%), veo640 (72%), and veo670 (15%). No significant changes in metabolic control or time in the range were observed in the patients under follow-up (Table 1). Table 1 Conclusions: The implementation of a telemedicine program for follow-up of patients on insulin pumps provided maintenance of metabolic control.

NEWER CONTINUOUS GLUCOSE MONITORING SYSTEMS

“Newer Continuous Glucose Monitoring Systems” Satish K. Garg, MD Professor of Medicine and Pediatrics, Director of adult Diabetes program, University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, Colorado. Over the past decade there have been many advances in diabetes technologies, such as Continuous Glucose Monitoring devices/systems (CGMs), insulin-delivery devices, and hybrid closed-loop systems. There have been significant advances in CGMs in the past decade. In fact, ten years ago very few people use to believe in the use of CGMs, even though they had been available for the past two decades. Many providers used to question who, why, and when will patients ever use CGMs similar to the questions asked about Self-Monitoring of Blood Glucose (SMBG) about four decades ago. At the time of this writing, more than five million people world-wide are using a CGM for their diabetes management, especially those who require insulin (all patients with Type 1 diabetes (T1D) and about 20% of patients with Type 2 diabetes (T2D)). Total sales of all CGMs now exceeds more than $7 billion and the use of SMBG is going down every day. Most of the CGMs have improved their accuracy significantly in the past two decades. I still remember doing studies on the GlucoWatch and earlier versions of Dexcom STS where mean absolute relative difference (MARD) used to be in the range of 15-26%. Now most of the CGMs (Guardian by Medtronic, G6 by Dexcom, and Libre 2 by Abbott) have single-digit MARD. In addition, the majority of the new CGMs do not require calibrations and the newer CGMs last for 10-14 days. An implantable CGM by Senseonics (Eversense®) is approved in the USA for 3 months and a different version is approved in Europe for 6 months. FDA has still not approved the 6-month version of Eversense® implantable sensor in the USA, which also has single-digit accuracy. The newer CGMs that are likely to be launched in the next 3-6 months;hopefully around the ATTD Conference, include 10.5-day Dexcom G7 (60% smaller than the existing G6), 7-day Medtronic Guardian 4, 14-day Libre 3, and 6-month Eversense®. Most of the newer CGM data can be viewed on Android or iOS/iPhone smart devices, and in many instances they have several features like predictive alarms and alerts, easy insertion, automatic initialization (in some instances down to 27 mins, Dexcom G7) with single-digit MARDs. It has also been noticed that arm insertion site might have better accuracy than abdomen or other sites like the buttock for kids. Lag time between YSI and different sensors have been reported differently, sometimes it's down to 2-3 mins;however, in many instances, it's still 15-20 mins. Diabetes effects communities of color disproportionately higher. For example, the highest prevalence of diabetes in the USA is amongst Native Americans (14.7%), which is nearly two times higher than Caucasians. African Americans and Hispanics also have higher prevalence of diabetes in the USA. It's also known that LatinX, African Americans, and Native Americans are much less likely to be offered new technologies like continuous subcutaneous insulin infusion (CSII/insulin pumps) and CGMs. Use of technology, especially CGMs, is expected to remove many of the social barriers and disparities in care for people with diabetes. A large database during the COVID-19 pandemic recently reported better Time-in-Range (TIR) in patients with diabetes irrespective of their ethnic background. However, the baseline TIR was significantly lower for minorities as compared to Caucasians. I believe the future will bring a larger increase in the use of CGMs for people with insulin-requiring diabetes (estimated at more than 100 million people globally) and those with T2D on non-insulin therapies (estimated at more than 400 million people globally). I also envision an increase in the number of pre-diabetes patients (estimated at more than 200 million people globally) using CGMs so that early medical intervention for diabetes management can be entertained. The intermittent or continuou use of CGM would depend upon the clinical needs. Needless to say, healthy individuals without diabetes (who can afford CGMs) might even use these technologies for self-evaluation of their glucose profiles after meals.

THE DBLG1 SYSTEM CAN IMPROVE BLOOD SUGAR CONTROL IN PEOPLE WITH POORLY CONTROLLED TYPE 1 DIABETES, ESPECIALLY WHEN THE INITIAL IMBALANCE IS HIGH

Background and Aims: In type 1 diabetes (T1DM), despite technological advances, results on glycaemic control or quality of life remain poor. Improvements could be achieved with system that automatically calculates doses and controls the pump such as DBLG1-system which is evaluated in our study. Methods: 140 T1D patients treated with insulin pumps and poorly balanced (HbA1c >8%) were recruited in early 2020 in 9 French diabetes centres. They were randomised to receive three months of automated insulin delivery by the DBLG1 system and a Dana pump (CL) or to continue their usual treatment (OL), with a randomisation ratio of 4 DBLG1/1 conventional treatment. The COVID crisis prematurely terminated the study. We present the results of the 99 patients treated for at least 14 days with CGM data for at least 75% of the time (88 CL/11 OL). Results: After adjustment for initial HBA1c and centres, patients treated with CL spent on average 12 min less per 24h in hypoglycaemia <70 mg/dl than patients treated with OL (p < 0.01). They spent 13.6% more time in the 70-180 target range (p < 0.001) per 24 hours, i.e. almost 3.5 hours, and 3 hours less in hyperglycaemia >180 mg/dl (p < 0.0007). The benefit was mainly nocturnal. There was a linear relationship between the time in hypo- or normoglycaemic targets at baseline and the amount of improvement achieved by the system (p < 0.001). Conclusions: In T1DM patients poorly controlled by insulin pumps, the DBLG1 system significantly improves the time spent in hypo- and normoglycaemia. The greater the initial imbalance, the greater the improvement.

TRAINING, INITIATION AND ONE-YEAR FOLLOWUP OF INSULIN PUMP THERAPY BY TELEMEDICINE

Background and Aims: During the recent COVID-19 pandemic, telemedicine has been used in type 1 diabetic patients to monitor and check metabolic balance, through specific platforms for downloading data. Aim of our study is to describe the experience of remote training, initiation and one-year follow-up of insulin pump therapy and continuous glycemic monitoring in four poorly controlled type 1 diabetic patients, presenting several hypoglycemic episodes. Methods: In April 2020 four patients were determined to be CSII therapy candidates, primarily to reduce hypoglycemic episodes. The remote training consisted of 3 or 4 sessions focused on self-management of advanced insulin therapy and technical aspects of pumps. They occurred in patients' homes using Skype™ for synchronous teleconferencing. After the training, two patients transitioned to the MiniMed 670G system, one to Omnipod and one to Accu-Chek Solo. Insulin pump informations and CGM data were remotely downloaded, and follow-up telemedicine visits were scheduled. Results: As early as two weeks after the insulin pump has been implanted, a hypoglycemic episode reset was recorded in all patients and the time in range (TIR) was greater than 90% in three of the four patients. During one-year remote follow-up, all patients maintained a satisfactory %TIR and glycemic variability, with a limited number of hypoglycemic events. One patient had COVID-19 disease and one became pregnant: these conditions were well managed by telemedicine service. Conclusions: These findings support the effectiveness of telemedicine for remote training, initiation, and follow-up of insulin pump therapy, ensuring a positive control of glycometabolic outcomes.

TELEMEDICIN DURING COVID-19 PANDEMIC, EXPERIENCE FROM A PORTUGUESE CENTER

Background and Aims: During the COVID 19 pandemic and due to lockdown periods there was a need to adapt diabetes consultations and organize health professionals in order to provide the best response to people with diabetes. Methods: In order to assess the patient's satisfaction with teleconsultations an on-line user satisfaction questionnaire was sent to all patients of the pediatric and Insulin pump Departments of APDP, who had consultation from March 16th to June 1st 2020. Results: The questionnaire was sent to 971 persons. The average age was 36.4±19.1 years, mostly female (53.1%), with higher education degree (46.9%). The results for medical consultations showed that 69.1% of the participants totally agree that the doctor was able to correctly interpret the current needs in diabetes management, and 49.5% totally agree and 35.6% agrees that the therapeutic adjustment was as efficient as if it had been performed in a face-to-face consultation. Regarding nursing consultations 56,7% completely agree or agree that it was possible to maintain adequate monitoring of diabetes. In relationship with nutrition 58,5% completely agree or agree that it was possible to clarify aspects related to food, carbohydrate counting or exercise efficiently. Conclusions: The results reveal that the majority of the patients felt supported in managing their diabetes and agree that teleconsultation with the multidisciplinary team was an adequate substitute for face-to-face consultation, it was possible to raise and clarify doubts about the management of diabetes and COVID-19 and that this model could complement face-to-face consultations.