ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2018) 15 10.6 | DOI: 10.1530/ey.15.10.6

ESPEYB15 10 Type 1 Diabetes Mellitus Continuous glucose monitoring, insulin pumps and artificial pancreas (7 abstracts)

10.6 Reduction in hypoglycemia with the predictive low-glucose management system: a long-term randomized controlled trial in adolescents with T1DM

Abraham MB , Nicholas JA , Smith GJ , Fairchild JM , King BR , Ambler GR , Cameron FJ , Davis EA & Jones TW; PLGM Study Group


Children’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia


To read the full abstract: Diabetes Care. 2018;41:303-310

One of the major short term complications of T1DM is the imminent risk of hypoglycemia during insulin treatment. In addition and importantly, long term complications of diabetes include those induced by frequent hypoglycemia, namely neurologic and developmental impairment upon frequent hypoglycemic episodes at a young age. In addition, it is debated of whether or not reduction of hypoglycemia may lead to deterioration of metabolic control as measured by HbA1c levels.

In this study from Australia, the Medtronic MiniMed 640G pump with Suspend before low (predictive low-glucose management [PLGM]) was compared with sensor-augmented pump therapy (SAPT) alone. The primary outcome, percentage time in hypoglycemia with sensor glucose (SG) <3.5 mmol/L (63 mg/dL), was significantly reduced in the trial arm when the prediction device was in place. Most importantly, during the six months study protocol the reduction of hypoglycemia did not lead to impaired metabolic control. This study clearly shows that (1) good metabolic control can be achieved with a low rate of hypoglycemia, (2) predictive-low-glucose management using insulin pump therapy can substantially and significantly reduce the time in hypoglycemia and (3) reduction of hypoglycemia using SAPT occurred both during the day and the night and also severe hypoglycemia could successfully be prevented.