MMPAD Milan Meeting Report

20 European Roadshow - Milan, 29 June 2018 MEETING REPORT The ambulatory glucose profile (AGP) is an advanced application that summarises statistically standardised data on blood glucose, collected over a number of days, and displays them graphically. It has not seen a great deal of paediatric use. Forlenza et a l 26 have used the software to process the data of the JDRF study, conducted in three age groups (8-14, 15-25, > 25 years) with HbA1c above and below the range, to analyse 1100 tracks from 393 patients. It was found that average blood sugar is different in different age groups, but always gets better in older subjects, while low blood glucose concentrations are lower in younger children and glycaemic variability is directly related to HbA1c levels. The CGM remains the most important tool in the management of diabetes and in the future will be the basis for the automatic release of insulin (AID) . Cost effectiveness becomes favourable for two SMBG per day. It has been shown to reduce hypoglycaemia and HbA1c. It is indicated in all children under 6 years, in all patients with CSII, in those with low blood glucose concentrations or those who play sports that require remote monitoring. The REPLACE-BG trial has shown that CGM alone equals BGM + CGM, that there are no differences according to age, level of education or experience with CGM, and risks in terms of insulin dosage do not increase; the JMC has enabled a reduction of 52% in BGM, although BGM was still allowed for high risk situations . 27 In summary, the sensors are very helpful in reducing HbA1c and insulin without degrading the quality of life of patients, they can be used to correct insulin therapy, but must be worn for at least 70% of the time and, in children, require further studies. The PGLS (Predictive Low Glucose Suspend) is currently the most important technology for automatic prevention of hypoglycaemia . Combined with SAP, it is really important in patients with many hypoglycemic episodes, not on target and where it is important to reduce the HbA1c by reducing the hypoglycaemia; it is favourably cost effective. The artificial pancreas hybrid, already on the US market for about 1 year, will probably soon arrive in Europe. Many studies have been conducted and it has been used by many patients, demonstrating, in a meta-analysis, that it reduces blood glucose by an average of 10 mg/dL, reducing hypoglycaemia and increasing the time in range (TIR) . 28 Pancreas islet transplantation is also a reality and it has proved able to cure diabetes, representing the 4a line of treatment of T1D. An extract from Dr. Bonfanti‘s presentation is available here