ESPE 2018 SATELLITE SYMPOSIUM MEETING REPORT

7 MEETING REPORT – ESPE 2018 SATELLITE SYMPOSIUM Insulin Treatment & Advanced Technology in the Management of Children with Diabetes Another intervention for improving time in range is an insulin pump augmented with a function that suspends insulin delivery for when the patient’s blood glucose falls below a predetermined threshold, or even when blood glucose is predicted to fall below a certain level. As demonstrated in the ASPIRE and PROLOG trials, for instance, this reduces hypoglycaemia and consequently increases time in range . 7, 8 So CGM is becoming the standard of care, said Battelino, because of its important benefits even when used standalone, in patients using multiple daily injections. Other benefits include improvements in hypoglycaemia awareness and improved quality of life related to a reduced frequency of hyperglycaemic events. Moreover, the CONCEPTT study showed that CGM use by pregnant women with type 1 diabetes improved their time in range and resulted in a significant reduction in the proportion of babies born large for their gestational age . 9 Battelino noted the recent arrival of sensors that are implanted subcutaneously, can last for 6 months and have a mean absolute relative difference (MARD; between monitor readings and actual capillary blood glucose) below 10%, predicting that the diabetes technology “landscape will be considerably changed” as a result. And although these technologies are more expensive than conventional means of blood glucose monitoring, Battelino cited an analysis of the RESCUE trial , 10 which suggested CGM may be cost-saving at a national level due to reductions in diabetes- related hospital admissions and work absences. The first closed-loop system, also known as the artificial pancreas, was approved in the USA in 2016, and several other companies have systems undergoing development and testing. In clinical trials, the amount of time patients spend in auto (ie, closed- loop) mode correlates with the amount of time they spend in range. Closed-loop systems have been tested in pregnant women, children and during exercise . 11, 12 But the long developmental process of these devices has resulted in patients creating their own versions, using already available pumps and CGM devices, controlled by open-source algorithms. “I am not sure how safe this is, but it shows the imminent need people with diabetes have to reduce the burden of their condition”, said Battelino. Finally, noting that CGM produces a vast amount of data that can be difficult and time- consuming to interpret, he introduced the concept of advisor apps. One example is the DreaMed Advisor Pro, an app with which Battelino is personally involved * , which gives insulin dose advice based on CGM readings. When the team tested it against multiple experienced clinicians, the decisions of the app differed from that of the clinicians by no more than the clinicians’ decisions differed from each other . 13 Battelino says that for doctors without immediate access to a diabetes specialist, “you simply click the button and within less than a second you have your suggestion”, on how an expert might advise the patient to adjust their treatment. The advisor is currently the subject of a multicentre clinical trial, he said.