MMPAD Munich Meeting Report

MEETING REPORT 17 European Roadshow - Friday 25 th May, 2018 Munich, Germany Figure 5 : Different times in range (TIR) with similar HbA1c values. The patient’s data to the left reveal better metabolic control (slide: Danne). Change of paradigm In Germany, there is a paradigm shift concerning insulin treatment in paediatric patients, with younger patients being increasingly offered insulin pumps. Combined treatment with CGM or FGM has also become very popular. Whilst half of children with diabetes are using insulin pumps, "adults are far behind," Danne said. There are regional differences within Germany – in the South, people are more reluctant to use pumps in paediatric patients. The use of an insulin pump can reduce the risk of hypoglycaemic episodes and DKA, Danne explained. He showed a study by Karges and colleague s 21 which demonstrated that during pump therapy, fewer DKAs occurred compared with injection therapy. The pump was also associated with the lowest risk of hypoglycaemic episodes. The patients who may benefit are those with a high hypoglycaemic risk, and those who have hypoglycaemic episodes at night and high glycaemic variability, the need for flexible regular insulin dosages because of physical activity or working shifts and an irregular daily routine. Individualised therapy also suits patients with dawn phenomena as regular insulin, tailored to the circadian rhythm, will be released. Carbohydrate ratio and correction factors can be programmed and calculated depending on the blood sugar levels and time of day. Trust the algorithms! In sensor-guided pump therapy, the basal rate can be turned off to prevent hypoglycaemic events. Danne's experience revealed, however, that experienced patients particularly do not trust the algorithms and would rather eat even when the pump is turned off, because they are afraid of a hypoglycaemic episode. The consequences are elevated HbA1c values, Danne said. Therefore, expert s 22 advise patients with low-glucose pumps not to get nervous and to trust the algorithms.