Landelijk Diabetes Congres 2016

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1 Landelijk Diabetes Congres 2016 Insuline Pompen, zelfcontrole en sensoren, need to know Thomas van Bemmel, Internist Gelre Ziekenhuis Apeldoorn

2 Disclosures (potentiële) belangenverstrengeling zie hieronder Voor bijeenkomst mogelijk relevante relaties met bedrijven Speakers fee, adviesraad Novo Nordisk Medtronic Astra MSD

3 Insuline Pompen, zelfcontrole en sensoren, need to know

4 Pompen en sensoren, need to know Bloedglucose metingen Self Monitoring Blood Glucose Flash Glucose Monitoring Continuous Glucose Monitoring Continuous Subcutaneous Insulin Infusion Artifical Pancreas

5 Eerste insuline pomp 1960

6 Quiz vraag 1 Flash Glucose Monitoring systeem vermindert aantal hypoglycaemieen Ja Nee

7 Quiz vraag 2 Subcutane insulinepomp heeft alleen voordeel voor mensen met diabetes mellitus type 1. Ja Nee

8 Quiz vraag 3 CGM (Continuous Glucose Monitoring) heeft geen effect op het HbA1c Ja Nee

9 Quiz vraag 4 CGM (Continuous Glucose Monitoring) resulteert in minder hypoglycaemieen Ja Nee

10 Self Monitoring Blood Glucose voor wie en waarom? Bij basaal bolus insuline regime Instellen langwerkende insuline Bij instellen mix insuline Kortdurend, bij bijvoorbeeld gebruik van prednison en gebruik van snel werkende insuline Bij alleen orale glucose verlagende middelen?

11 Relatie HbA1c met glucose meting

12 Relatie HbA1c met glucose meting

13 Is self-monitoring of blood glucose effective in improving glycaemic control in type 2 diabetes without insulin treatment: a meta-analysis of randomised controlled trials Zhu H, et al BMJ Open 2016

14 Is self-monitoring of blood glucose effective in improving glycaemic control in type 2 diabetes without insulin treatment: a meta-analysis of randomised controlled trials Zhu H, et al BMJ Open 2016 Conclusions Use of SMBG by patients with non-insulin-treated T2D led to a significant reduction in HbA1c levels 0.33% (95% CI 0.45 to 0.22; p=3.0730e-8; n=18)

15 Flash Glucose Monitoring Hoe werkt het?

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18 Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial J Bolinder et al, September 12, 2016 Lancet

19 Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial J Bolinder et al, September 12, 2016 Lancet

20 Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial J Bolinder et al, September 12, 2016 Lancet

21 Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial J Bolinder et al, September 12, 2016 Lancet Conclusions Flash glucose testing reduced the time adults with well controlled type 1 diabetes spent in hypoglycaemia.

22 Quiz vraag 1 Flash Glucose Monitoring systeem vermindert aantal hypoglycaemieen Ja

23 Continuous Glucose Monitoring Hoe werkt het?

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25 Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data JC Pickup, BMJ 2011 Two step approach meta-analysis using individual patient data for difference in HbA1c percentage between continuous glucose monitoring and self monitoring of blood glucose using random effects model. Overall mean difference for all six trials was 0.30% (3 mmol/mol), favouring continuous glucose monitoring

26 Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data JC Pickup, BMJ 2011 Model estimated difference in HbA1c using continuous glucose monitoring compared with self monitoring of blood glucose according to baseline HbA1c percentage and sensor usage

27 Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data JC Pickup, BMJ 2011 Conclusions CGM was associated with a significant reduction in HbA1c percentage, which was greatest in those with the highest HbA1c at baseline and who most frequently used the sensors. Exposure to hypoglycaemia was slighty reduced during continuous glucose monitoring.

28 Quiz vraag 3 CGM (Continuous Glucose Monitoring) heeft geen effect op het HbA1c Nee

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30 Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial Van Beers et al, Lancet Diabetes Endocrinology sept 2016

31 Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial Van Beers et al, Lancet Diabetes Endocrinology sept 2016

32 Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial Van Beers et al, Lancet Diabetes Endocrinology sept 2016

33 Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial Van Beers et al, Lancet Diabetes Endocrinology sept 2016 Conclusions CGM significantly improved time that the patients spent in a normoglycaemic state, with less time spent in hypo- glycaemia and hyperglycaemia, compared with SMBG. CGM decreased the frequency of severe hypoglycaemic events in this high-risk population, and produced less glucose variability, but without a change in HbA1c.

34 Quiz vraag 4 CGM (Continuous Glucose Monitoring) resulteert in minder hypoglycaemieen Ja

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36 Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial Y Reznik et al. Lancet 2014

37 Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial Y Reznik et al. Lancet 2014 The difference between the two groups was 0 7% (95% CI 0 9 to 0 4, adjusted15 p<0 0001)

38 Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial Y Reznik et al. Lancet 2014

39 Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial Y Reznik et al. Lancet 2014 Conclusions Treatment with an insulin pump reduced glycated haemoglobin more than multiple daily injections in patients with type 2 diabetes. Masked continuous glucose monitoring showed clinically significant reductions in the time spent in hyperglycaemia while using pump treatment, without an increase in the time spent in hypoglycaemia.

40 Quiz vraag 2 Subcutane insulinepomp heeft alleen voordeel voor mensen met diabetes mellitus type 1. Nee

41 Artificial Pancreas nice to have, need to have?

42 2 month evening and night closed-loop glucose control in patients with type 1 diabetes under free-living conditions: a randomised crossover trial Kropff et al. Lancet Diabetes Endocrinol 2015; 3:

43 2 month evening and night closed-loop glucose control in patients with type 1 diabetes under free-living conditions: a randomised crossover trial Kropff et al. Lancet Diabetes Endocrinol 2015; 3:

44 2 month evening and night closed-loop glucose control in patients with type 1 diabetes under free-living conditions: a randomised crossover trial Kropff et al. Lancet Diabetes Endocrinol 2015; 3: Conclusions Use of an AP at home is a safe and effective method for closed-loop insulin delivery. Use of an AP results in a reduction of percentage time spent in hypoglycaemia and hyperglycaemia.

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