المؤلفون: TALEB, NADINE¹ (AUTHOR), MESSIER, VIRGINIE¹ (AUTHOR), PARENT, VALERIE¹ (AUTHOR), BOVAN, DANIJELA¹ (AUTHOR), BRAZEAU, ANNE-SOPHIE¹ (AUTHOR), RABASA-LHORET, RÉMI¹ (AUTHOR)

المصدر: Diabetes. 2019 Supplement, Vol. 68, pN.PAG-N.PAG. 1p.

مستخلص: Background: For nonsevere hypoglycemia (NS-H), treatment guidelines recommend 15-20g of rapidly absorbed carbohydrates (CHO) and repeat intake at 15 min until recovery (glucose above 70 mg/dL). The adequacy of this one size fits all approach is questioned. Our group reported an average intake of 32 ± 24g CHO in a type 1 diabetes (T1D) outpatient study. We aim to validate N-SH treatment guidelines in the context of modern therapies. Methods: Randomized four way cross-over trial to assess treatment with 16g vs. 32 g CHO (glucose tablets) for fasting subcutaneous insulin induced NS-H at two glucose thresholds: a) below 54 mg/dL and b) between 54 to 63 mg/dL. Plasma glucose is measured every 5 min till recovery then at 15-30 min intervals. Results: Preliminary data was collected for 12 of 33 subjects (53.2 ± 16.8 years old, 58.3% females, HbA1c 56 ± 7.7 mmol/mol, diabetes duration 31.9 ± 15.8 years). Comparison of 16 vs. 32g CHO for each threshold revealed the following change in glucose 15 min post treatment (primary outcome): a) below 54 mg/dL: 12.0 ± 21.8 vs. 17.6± 28.4 mg/dL, p=0.4; b) between 54 to 63 mg/dL: -1.6 ± 19.7 vs. 12 ± 22.7 mg/dL, p=0.06; time needed to recovery (above70 mg/dL): a) below 54 mg/dL: 30 ± 13.6 vs. 29.6 ±14.4 min, p= 0.9; b) between 54 to 63 mg/dL: 37.5 ±14.4 vs. 28.7 ± 17.2 min, p= 0.1 and time needed for disappearance of symptoms: a) below 54 mg/dL: 27.8± 22.3 vs. 22.8 ± 9.5 min, p=0.8; b) between 54 to 63 mg/dL: 24.2 ± 10.7 vs. 16.7± 11.5 min, p=0.5. Regression analysis will be conducted to study response predictors (plasma insulin and catecholamines levels, body composition, etc.) Conclusion: The response to nonsevere hypoglycemia treatment is extremely variable. A one size fits all recommendation is unlikely to be appropriate. Data of this trial will add to the knowledge of hypoglycemia treatment in T1D. Disclosure: N. Taleb: None. V. Messier: Other Relationship; Self; Eli Lilly and Company. V. Parent: None. D. Bovan: None. A. Brazeau: None. R. Rabasa-Lhoret: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk A/S. Funding: Canadian Institutes of Health Research (354024); JDRF (4-SRA-2018-651-Q-R) [ABSTRACT FROM AUTHOR]

المؤلفون: TAGOUGUI, SEMAH, TALEB, NADINE, SUPPERE, CORINNE, BOUKABOUS, INÈS, MESSIER, VIRGINIE, RABASA-LHORET, RÉMI

المصدر: Diabetes; 2019 Supplement, Vol. 68, pN.PAG-N.PAG, 1p

مستخلص: Background: Exercise-induced hypoglycemia is a major barrier for physical activity practice. Compared to conventional insulin therapy, closed-loop (CL) insulin delivery reduces hypoglycemic risk during post-absorptive exercise but has not been studied during postprandial exercise. Methods: Randomized crossover trial comparing 3 strategies for a postprandial (PP) exercise (90 min after breakfast) at 60% of VO2peak for 60min: 1) Unannounced exercise (Unann); 2) Announced exercise with reduced insulin bolus (Ann+RB): increased glucose target combined with a 33% meal bolus reduction); 3) Announced exercise with full bolus (Ann+FB): increased glucose target combined with usual meal bolus in 37 adults with type 1 diabetes. Results: Median percentage time spent in hypoglycemia (<70 mg/dl) was reduced with Ann+RB compared to Unann (Primary outcome; 0[0-0]% vs. 0[0-26]%; p<0.05). The drop in plasma glucose during exercise was smaller with Ann+RB (-5.5 ± 50.5 than with Ann+FB (-46.8 ± 52.2) and Unann (-43.2 ± 48.6) strategies (p <0.05). Accordingly, hypoglycemic events were reduced with Ann+RB (n=2) compared to Ann+FB (n=3) and Unann (n=9). However, Ann+BR strategy was associated with increased time in hyperglycemia (> 250mg/dl). Conclusion: Announcement of postprandial exercise to the closed-loop algorithm combined with meal bolus reduction reduced hypoglycemic risk, yet at the expense of mild increase in hyperglycemia. Disclosure: S. Tagougui: None. N. Taleb: None. C. Suppere: None. I. Boukabous: None. V. Messier: Other Relationship; Self; Eli Lilly and Company. R. Rabasa-Lhoret: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk A/S. [ABSTRACT FROM AUTHOR]

: Copyright of Diabetes is the property of American Diabetes Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: ARDILOUZE, JEAN-LUC, GOBEIL JR., FERNAND, MENARD, JULIE, BOVAN, DANIJELA, MESSIER, VIRGINIE, SAVARD, MARTIN, BAILLARGEON, JEAN-PATRICE, RABASA-LHORET, RÉMI

المصدر: Diabetes; 2019 Supplement, Vol. 68, pN.PAG-N.PAG, 1p

مستخلص: Recommendation to insulin pump users is to change catheters every 3 days. Convergent data point to inflammation for catheter-related insertion site problems. Objective: to explore if adding a tiny amount of non-steroidal anti-inflammatory drug (NSAID) into insulin solution increases catheter wearing time compare to insulin alone. Methods: Double-blinded randomized study in insulin pump users with type 1 diabetes. Participants were instructed to keep catheters as long as glycemic control was acceptable and insertion site remained comfortable. Subjects performed 4 experiments: 2 testing lispro and 2 testing the mixed solution (lispro: 90 units/ml + ketorolac: 3 mg/ml), each experimental period separated by a 1-week washout. Safety parameters were measured at entry vs. end of study (including plasma ketorolac concentration). We defined responders as participants wearing catheter ≥ 1 day using lispro+ketorolac vs. lispro. Results: Fourteen subjects completed the study (males: 7, age: 43.5±18.0 years, diabetes duration: 29.6±13.9 years, pump therapy: 9.0±4.5 years, A1c: 7.1±0.6%). There was no catheter wearing time difference (lispro+ketorolac: 7.45±2.99 vs. lispro: 7.82±2.64 days). The daily doses of insulin and ketorolac were respectively 46.44±12.39 units and 1.55±0.41 mg. Ketorolac plasmatic concentration was at 19.7±17.6 ng/ml (1000 times lower than after clinically indicated doses). From entry vs. end of study, creatinine increased (70±17 vs. 81±19 µmol/L, p=0.018) and glomerular filtration rate declined (119±33 vs. 109±34 ml/min/1.73m², p=0.028). Wearing time improved in responders (n=7, 50%): 6.04±1.38 vs. 7.97±1.68 days (p=0.018). Conclusions: While no difference was observed overall, a large sub-group of patients could be responders to the addition of some NSAID to insulin. Due to the small sample size, the true magnitude of kidney function deterioration is unknown and might not be clinically significant. Disclosure: J. Ardilouze: None. F. Gobeil: None. J. Menard: None. D. Bovan: None. V. Messier: Other Relationship; Self; Eli Lilly and Company. M. Savard: None. J. Baillargeon: None. R. Rabasa-Lhoret: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk A/S. Funding: JDRF [ABSTRACT FROM AUTHOR]

: Copyright of Diabetes is the property of American Diabetes Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: ARDILOUZE, JEAN-LUC, GOBEIL JR., FERNAND, MENARD, JULIE, BOVAN, DANIJELA, MESSIER, VIRGINIE, SAVARD, MARTIN, BAILLARGEON, JEAN-PATRICE, RABASA-LHORET, RÉMI

المصدر: Diabetes; 2019 Supplement, Vol. 68, pN.PAG-N.PAG, 1p

مستخلص: Background and Objectives: Current recommendation is to change insulin pump catheters every 3 days. The rational supporting this recommendation is weak, mostly historical or anecdotical, and based on habits. Our objective was to determine catheter length of wearing under day-to-day condition. Methods: Participants with type 1 diabetes (T1D) worn their usual catheter during 2 periods as long as glycemic control was acceptable and insertion site remained comfortable. Data are presented as means ± standard deviations. Hypoglycemia (≤ 3.5 mmol/L) and hyperglycemia (≥ 13.8 mmol/L) were recorded via self-monitoring of blood glucose or continuous glucose monitoring. Each experimental period was separated by a 1-week washout, consisting of the usual catheter management. Results: Participants (n=22, 12 males, age: 47.1±16.2 years, BMI: 26.6±4.1 kg/m², duration of T1D: 27.5±14.3 years, pump therapy: 8.8±6.2 years, 14 using Medtronic, 8 using Animas, usual catheter wearing: 3.5±0.5 days, insulin: 51.7±15.5 units/day, A1c: 7.4±0.8%) completed 41/44 periods (348.7 experimental days; one subject quitted, 2 catheters accidentally ripped-out). Catheters were worn 8.18±2.93 days, the shortest and the longest periods were respectively 3.81 and 15.61 days. Reasons for removal were uncontrolled glycemia despite bolusing (73%), discomfort (15%), or both (12%). Number of hypoglycemia and hyperglycemia per day were 0.18±0.17 and 0.90±0.56, respectively. No severe hypoglycemia, nor hyperglycemia ≥ 20 mmol/L or ketosis were observed over the study. Conclusions: Catheters might be worn beyond 3 days, up to 8 days and possibly more, significantly reducing patients and financial burden. Longer-term data are required to ensure that longer catheter wearing is not associated with impact on glucose control or lipohypertrophy. Disclosure: J. Ardilouze: None. F. Gobeil: None. J. Menard: None. D. Bovan: None. V. Messier: Other Relationship; Self; Eli Lilly and Company. M. Savard: None. J. Baillargeon: None. R. Rabasa-Lhoret: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk A/S. Funding: JDRF [ABSTRACT FROM AUTHOR]

: Copyright of Diabetes is the property of American Diabetes Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Roy-Fleming, Amélie, Taleb, Nadine, Messier, Virginie, Suppère, Corinne, Cameli, Charlotte, Elbekri, Saad, Smaoui, Mohamed R., Ladouceur, Martin, Legault, Laurent, Rabasa-Lhoret, Rémi

المصدر: Canadian Journal of Diabetes; Oct2018:Supplement, Vol. 42, pS52-S52, 1p

المؤلفون: Goulet-Gélinas, Lucas, Saade, Marie-Béatrice, Suppère, Corinne, Tagougui, Sémah, Messier, Virginie, Fortin, Andréanne, Rabasa-Lhoret, Rémi

المصدر: Canadian Journal of Diabetes; Oct2018:Supplement, Vol. 42, pS51-S51, 1p

المؤلفون: Haidar, Ahmad, Messier, Virginie, Legault, Laurent, Ladouceur, Martin, Rabasa-Lhoret, Rémi

المصدر: Canadian Journal of Diabetes; Oct2016 Supplement, Vol. 40, pS11-S11, 1p

المؤلفون: Taleb, Nadine, Suppère, Corinne, Emami, Ali, Messier, Virginie, Legault, Laurent, Ladouceur, Martin, Chiasson, Jean-Louis, Haidar, Ahmad, Rabasa-Lhoret, Rémi

المصدر: Canadian Journal of Diabetes; Oct2016 Supplement, Vol. 40, pS10-S10, 1p

المؤلفون: Rabasa-Lhoret, Rémi, Abitbol, Alexander, Messier, Virginie, Legault, Laurent, Smaoui, Mohamed, Ladouceur, Martin, Haidar, Ahmad

المصدر: Canadian Journal of Diabetes; Oct2016 Supplement, Vol. 40, pS11-S11, 1p

المؤلفون: Gingras, Véronique, Cameli, Charlotte, Haidar, Ahmad, Messier, Virginie, Legault, Laurent, Rabasa-Lhoret, Rémi

المصدر: Canadian Journal of Diabetes; Oct2016 Supplement, Vol. 40, pS49-S49, 1p