Speaker Biography

Vary Coulic
Biography:

Abstract:

Introduction. Up to now hypoglycaemia episodes and yo-yo events remain a problem during insulin therapy in diabetic patient /1/. Last year at this meeting and at WCDT-2016 we have shown that an Apparatus for Diabetes Diagnosis coupled with Complex for Insulin Therapy (ADD-CIT), using differential temperature (Dt) evaluation dynamics as feedback for pump insulin delivery, could be useful in the treatment of acute life threatening alterations of the glucose metabolism due to type 1 diabetes /2, 3/. We hypothesized that Dt, representing energy production and utilization, thus reflecting glucose metabolism, could be a valuable complement to blood glucose measure for monitoring insulin therapy.

 

Objective. If this hypothesis is true, ADD-CIT use could be useful in any glucose metabolism disorders. The aim of the present work was to verify this assertion.

 

Methods. Three groups of patients were considered studied: with type 1 diabetes (DM-1 - 83); with type 2 diabetes (DM-2 – 45); and patients without known diabetes (DM-0 - 66) but presenting a severe pathology causing acute hyperglycaemia difficult to control. The evolution of Dt was also investigated in a group of 10 healthy volunteers

Part of these patients were treated according usual schemas, the other part was treated by ADD-CIT (Tab.1)

Table 1: Patients cohort

Series

DM 1

DM 2

DM 0

Healthy control

ADD-CIT treated

64 (including 50 with kidney insufficiency)

36 (including 18 with heart pathology)

27 (with heart pathology)

10 (observation only)

usual schema

19

9

39 (24 ARCA, 15 with heart pathology)

0

Total

83

45

66

10

After informed consent, the main inclusion criterion was the presence of hyperglycaemia > 11.1 mmol/l (200 mg/dl) at admission (mean values in different groups - 15±3,5mmol/l). Age, sex, BW were comparable. Observation or session duration was up to 8 hours. Usual clinical investigations were provided including glucose blood level measurement every hours (Acutrends strips or gasometer apparatus ADL-90 Flex).

Results. In the ADD-CIT group of patients a glycaemia decrease of 30-40% from its initial value was observed within 2-4 hours and a stable mean glucose level equal or inferior to 11.1 mmol/l was obtained. Rare episodes of hypoglycaemia (< 4,3 mmol/l) and no yo-yo phenomena were observed. In the control groups monitored only by glycaemia evaluation, this result was attained only after 5-7 hours with frequent yo-yo phenomena. Hypoglycaemia events were also present. No correlation was noted between Dt and glycaemia. Dt values were negative mainly in decompensated DM 1 patients. Dt decreased during the sessions in DM 2 patients but rarely reached negative levels. Dt increased at the end of any successful session approaching values observed in healthy controls. This increase was an indication for stopping the session. In some cases Dt abnormally felt at the end of a session whereas glycaemia remained stable: then a caution glucose injection corrected the situation without glycaemia modification.

Discussion and conclusion. Though our series were are small and not fully matched, the results of the ADD-CIT groups of patients in terms of glycaemia decrease and stabilization were convincingly better than in patients treated using the usual procedure based only on glycaemia measurements. This confirms the usefulness of Dt evolution evaluation as a complementary feedback for insulin delivery not only in DM 1 patients but also in DM 2 and any other patients with acute severe glucose metabolism disorders.