Abstract Details

Session title: Living with diabetes Session type: Poster - Living with Diabetes Track: Living with Diabetes

Presentation number: P-1218

Abstract title:

Novel user friendly Libre Pro continuous glucose monitoring [CGM]: exclusive India initial experiences and learnings.

Presenting author: Manjunath M

Background

Continuous glucose monitoring provides information about the direction, magnitude, duration, frequency, and causes of fluctuations in blood glucose levels. Compared with conventional intensified glucose monitoring, defined as three to four blood glucose measurements per day, continuous monitoring provides much greater insight into glucose levels throughout the day. Continuous glucose readings that supply trend information can help identify and prevent unwanted periods of hypo- and hyperglycemia.

Aim

Initial experiences and learnings from new Libre Pro[first-of-its-kind revolutionary diabetes technology], currently exclusively launched [early 2015] in India.

Method

Current systems for CGM and Ambulatory Glucose Profiles [AGP] are cumbersome and require regular finger-pricking to ensure they are calibrated correctly for accuracy. Abbott FreeStyle® Libre Pro Flash Glucose Monitoring System appears to be transformative. The superiority of this system includes tremendous ease of use, 13 day memory, and non-requirement of calibrations with finger stick glucose.

Results

Following Ethics Committee approval and Informed Consent, we adapted the Professional ['Pro"] version, into Personal mode[122 subjects; 561 sensor 13 day cycles; continuous/ intermittent use; local, national and international-USA, Australia, Asia- subjects - telemedicine; parallel finger prick BG once daily and biweekly 7 point profiles].

Indications:
1.	T1DM on pump / MDI;
2.	T2DM on OHA / insulin;
3.	Gestational / Pregestational diabetes;
4.     Prepregnancy counselling;
5.	Educational/ motivational tool;
6.	Abnormal difficult to manage diurnal glycemic profiles [eg: renal, liver dysfunction];
7.	Challenging clinical scenarios [hypoglycemia unawareness, nocturnal hypoglycemia, dawn- anticipated and unanticipated, artificial reproduction technologies];
8.	Special life situations [high altitude mountain climbing; underwater sports; recreational/ religious vacations];
9.	Spontaneous hypoglycemia - in people without diabetes.

Complications: mal-insertion[1], bleeding during sensor insertion[2], premature disconnection of sensor[4]; true sensor malfunction[Nil].

Benefits: HbA1c improvements, decreased hypoglycemia, improved/ flexible lifestyles, better accuracy at high altitudes, improved motivation and very high patient satisfaction/ happiness [no finger pricks!].

Special learnings: a. Ability to rapidly [few days/weeks] identify responders [complete/ partial] vs non¬responders to new therapy additions [GLP-1, gliptins, bromocriptine, AGI etc]; b. Scientifically and rationally match/ tailor /personalize pharmacotherapy to unique patient specific pathophysiology and corresponding diurnal glycemic profile variations [predominant fasting, pre-prandial vs post-prandial hyperglycemia; variable insulin: carb ratios and insulin sensitivity at different parts of day]. Currently Libre Pro is approved by Health Authority of India only for people above 18 years of age, thus depriving its immense benefits to children and adolescents with diabetes.

Discussion

With further continued technology improvements and decreasing costs, Libre Professional, and more importantly Personal CGM, could foster 'universal" and 'affordable" CGM use..We strongly urge that Libre Pro be approved for pediatric diabetes population also in India. Currently this has been approved for people above 18 years of age. Increasingly refined diabetes management guidelines will accrue [rich data and actionable insights], both to people with diabetes and health care providers.- dream 'Glucose Watch".

Novel user friendly continuous glucose monitoring [CGM]: exclusive India initial experiences and learnings