REACHING CONTINUOUS GLUCOSE MONITORING TARGETS WITH SENSOR-AUGMENTED PUMP: A CASE REPORT

Abstract

Background and Aims Sensor-augmented pumps with predictive low-glucose suspend (SAP with PLGS) can be a good therapy option in countries where hybrid closed loop systems are not available. We present a case of a 25 year old patient with history of uncontrolled diabetes achieving CGM targets using SAP with PLGS (Medtronic Minimed 640G, Guardian Sensor 3). Methods Female patient diagnosed with type 1 diabetes at the age of 8, had a history of uncontrolled diabetes with MDI therapy. Despite optimizing parameters of flexible MDI her A1C during the last 6 years has been between 9.0-9.7%. Intermittent use of professional CGM confirmed high glucose variation and high average sensor glucose. Before initiating SAP her TDD was 54 units (0.8 u/kg), ICR 6 grams/U, ISF 2.0 mmol/L/U and glucose target 6.5mmol/l. After 5 days of 2 hours education SAP was initiated. CGM analysis was performed regularly on day 1, 3, 7 the first week of initiation and every 2 weeks thereafter using Medtronic CarelinkTM System Software. Fine tuning of settings was made during the online visits according to CGM parameters and weight reduction leading to TDD of 32U (0.6U/kg). In person visits were performed the 1st and 3rd month. Results After 90 consecutive days of sensor wear we achieved the following CGM metrics: 78% Time In Range, 3+1 % Time Below Range, 16+2 % Time Above Range, Average Sensor Glucose 7.8 mmol/l, Glucose Management Indicator of 6.7% and Coefficient of Variation 32%. Conclusions SAP with PLGS can be a helpful tool to achieving good glycemic control in selected patients.