MMPAD Munich Meeting Report

MEETING REPORT 16 European Roadshow - Friday 25 th May, 2018 Munich, Germany ADVANCES IN TECHNOLOGY FOR DIABETES TREATMENT Presented by Professor Thomas Danne - Diabetes Center for Children and Adolescents AUF DER BULT Thomas Danne introduced innovative technologies for intermittent scanning (flash) glucose monitoring (FGM) and continuous glucose monitoring (CGM) of blood sugar levels. He was convinced that within the next 5 years conventional blood sugar assessment will no longer exist. He emphasised that new technologies will gain ever more significance, which was further confirmed by a survey among the participants of the European Roadshow in Munich showing that 44% of attendees said that more than half of their patients used such modern technologies. In December 2017, an international consensus paper urging healthcare practices to implement CGM was published . 18 Danne also explained how to interpret acquired data to optimise blood sugar control of patients. Nonetheless, severe hypoglycaemia may still occur despite most modern technologies. Time in range is more important than HbA1c level The speaker reminded the audience of the many consequences should blood sugar levels be outside the target range. However, what is more meaningful, HbA1c value or the duration of blood sugar concentration within the range (time in range [TIR])? HbA1c values do not reveal anything about the hypoglycaemic risk of the individual patient, Danne said. He demonstrated his point through graphs (Figure 5) . An HbA1c value of 6.7 or 6.8 mg/dL does not reveal how often a patient has experienced hypoglycaemia, but the TIR does. He explained that patients with a highly variable blood sugar level do not necessarily have worse HbA1c values. Innovative measuring devices display on a screen when hypoglycaemic episodes have occurred. They also show upcoming trends in blood sugar concentrations. According to Danne, TIR is much more important than HbA1c values for patients. Thus, TIR might complement HbA1c values as a parameter to assess blood sugar control in the near future. In modern devices, the pre-set target range is 70–180 mg/dL, but can be further limited on an individual basis (eg, 70–140 mg/dL). Depending on age, comorbidities and adherence, one can choose values that are closer to the physiological range. Can hypoglycaemia lead to the death of my child? Parents are often terrified that they could find their child with type 1 diabetes dead in bed one morning. Danne explained that the risk of sudden cardiac arrest is only increased between 11 and 12 years of age. In scientific literature, a case of a 7-year-old has been published , 19 but Danne believes this was a one-off occurence. This phenomenon occurs more often in boys, Caucasians, and those with higher HbA1c values, higher daily insulin dosages, a lower body mass index, instabilities in glycaemic control and severe hypoglycaemic episodes . 20 It is assumed that arrhythmias during hypoglycaemia are ultimately responsible for the dead-in-bed syndrome. In young children this "system has not yet matured and thus is not so vulnerable", Danne explained. An extract from Professor Danne's presentation is available here