Impact in real-world of intermittent-scanned continuous glucose monitoring with alarms on hypoglycemia and its recognition in type 1 diabetes.

BACKGROUND: Recent studies have demonstrated that real-time CGM use reduce the incidence severe hypoglycemic events and impaired awareness of hypoglycemia (IAH) However, there are few real-world studies evaluating the effect of intermittently scanned continuous glucose monitoring (isCGM) on hypoglycemic episodes and hypoglycemia unawareness (IAH). The present study was designed to cover this research-practice gap. METHODS: This is a real-world, observational, prospective cohort study with 2 years of follow-up in which 60 subjects with T1D who experienced frequent hypoglycemic events were included. All the patients were invited to use isCGM type Abbott FreeStyle Libre 2® on a continuous basis for 2 years. Glucometric parameters were obtained during the initial 2 weeks using isCGM and compared with data collected for the same period at 1 year and at the end of follow-up. The IAH was evaluated using the Clarke questionnaire, and to assess psychological aspects related to hypoglycemia the Hypoglycemia Fear Survey (HFS) was used. RESULTS: After 2-years of follow-up using isCGM, we observed a decrease in glucose variability (40.3 ±â€¯0.8 % vs. 37.1 ±â€¯0.9 %, p = 0.003), time in low glucose range (54-69 mg/dL) (5.2 ±â€¯0.4 % vs. 3.6 ±â€¯0.3 %, p = 0.001), time in very low glucose range (<54 mg/dL) (3.2 ±â€¯0.5 % vs. 0.8 ±â€¯0.2 %, p < 0.001), less events related to low glucose levels (10.6 ±â€¯1.1 vs 8.0 ±â€¯1.0, p = 0.042) and a short duration of hypoglycemia episodes (106.1 ±â€¯5.9 min vs. 85.7 ±â€¯5.7 min, p = 0.008). In addition, participants presented a reduction of 47 % in the frequency of IAH, assessed by the Clarke questionnaire scores (24.6 % vs. 11.6 %, p = 0.034), as well as hypoglycemia fear (77.8 ±â€¯2.4 vs 68.2 ±â€¯2.1, p < 0.001). Furthermore, a reduction in total insulin dose was also observed (0.64 ±â€¯0.30 UI/Kg/day vs 0.56 ±â€¯0.11 UI/Kg/day, p = 0.018). CONCLUSIONS: In the real-world, long-term use of isCGM could reduce both hypoglycemic episodes and IAH in people with T1D.

Retinal sensitivity and gaze fixation evaluated by microperimetry in subjects with type 2 diabetes: two independent parameters that explore different neuronal circuits.

BACKGROUND AND AIMS: Retinal sensitivity (RS) and gaze fixation (GF) assessed by retinal microperimetry are useful and complementary tools for identifying mild cognitive impairment (MCI) in patients with type 2 diabetes (T2D). The hypothesis is that RS and GF examine different neural circuits: RS depends only on the visual pathway while GF reflects white matter complex connectivity networks. The aim of the study is to shed light to this issue by examining the relationship of these two parameters with visual evoked potentials (VEP), the current gold standard to examine the visual pathway. MATERIALS AND METHODS: Consecutive T2D patients > 65 years were recruited from the outpatient clinic. Retinal microperimetry (MAIA 3rd generation) and visual evoked potentials (VEP) (Nicolet Viking ED). RS (dB), GF (BCEA63%, BCEA95%) (MAIA) and VEP (Latency P100ms, Amplitude75-100 uV) were analyzed. RESULTS: Thirty three patients (45% women, 72.1 ± 4.6 years) were included. VEP parameters significantly correlated with RS but not with GF. CONCLUSIONS: These results confirm that RS but not GF depends on the visual pathway, reinforcing the concept that they are complementary diagnostic tools. Used together can further increase the value of microperimetry as screening test for identifying T2D population with cognitive impairment.