ORIGINAL ARTICLE   

Minerva Endocrinologica 2017 September;42(3):195-202

DOI: 10.23736/S0391-1977.16.02326-9

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

Continuous glucose monitoring and hypoglycemia unawareness in type 1 diabetes: a pilot study

Mohamed ZALZALI ¹ ✉, Valérie HOUDELET-GUERINOT ¹, Eric SOCQUARD ², Aurore THIERRY ³, Brigitte DELEMER ¹, Céline LUKAS-CROISIER ¹

¹ Department of Endocrinology, Diabetology and Nutrition, University Hospital Reims, Reims, France; ² Endocrinology Clinic, Troyes, France; ³ Methological Assistance Unit, University Hospital Reims, Reims, France

BACKGROUND: Looking for strict normoglycemia in type 1 diabetes increases the risk of hypoglycemia, exposing to hypoglycemia unawareness. It has been shown that the early correction of hypoglycemia can help recovering the perception of hypoglycemia. The purpose of this prospective study was to assess the value of sensor-augmented insulin-pump therapy to treat hypoglycemia unawareness.
METHODS: Eleven patients with type 1 diabetes and partial or total hypoglycemia unawareness received sensor-augmented insulin-pump therapy combined to the low blood glucose-suspend feature (Paradigm® Veo™ pump and Enlite® sensors) for three months.
RESULTS: Eighty per cent of the patients improved their hypoglycemia unawareness with an increase in the hypoglycemia perception threshold of 31 mg/dL as evaluated by blinded continuous glucose monitoring. These results were correlated to a self-assessment quiz evaluation. Results were sustained at six months (three months after patients stopped using the system). Sensitive neuropathy, untreated hypoglycemia and the area under the curve for hypoglycemia events were associated with less chance of recovery. These devices were globally considered by the patients as simple to use, with no major disadvantages and only a single withdrawal occurred.
CONCLUSIONS: Sensor-augmented insulin-pump therapy should be considered as a possible treatment of hypoglycemia unawareness.

KEY WORDS: Diabetes Mellitus, Type 1 - Hypoglycemia - Insulin infusion systems - Blood glucose self-monitoring