title: Prevention of hypoglycemia by using low glucose suspend function in sensor-augmented pump therapy.
abstract: BACKGROUND
  Severe hypoglycemic episodes are a barrier for achieving optimal glycemic control. Sensor-augmented pump (SAP) therapy with insulin in combination with a novel mechanism of automatic insulin shutoff (low glucose suspend [LGS]) can be used to prevent and reduce hypoglycemia. In a prospective study, we investigated the effect of the LGS algorithm on the frequency of hypoglycemia in children and adolescents with type 1 diabetes under real-life conditions.
  
  
  METHODS
  Twenty-one patients with type 1 diabetes (10.8±3.8 years old, duration of diabetes 5.9±3.0 years, pump therapy for 3.7±1.7 years, glycated hemoglobin level 7.8±1.1%) from three pediatric centers used the Paradigm(®) Veo(™) system (Medtronic Minimed, Northridge, CA) during two subseqent time periods: SAP without LGS for 2 weeks and then SAP with LGS enabled for 6 weeks. The primary objective was to assess the frequency of hypoglycemic episodes when using the LGS feature with an insulin delivery shutoff of a maximum of 2 h at a sensor glucose level below 70 mg/dL (3.9 mmol/L).
  
  
  RESULTS
  In total, 1,298 LGS alerts occurred (853 shorter than 5 min). Forty-two percent of LGS activations (>5 min) lasted less than 30 min, whereas 24% had a duration of 2 h. The number of hypoglycemic excursions (average/day) was reduced during SAP+LGS (<70 mg/L, 1.27±0.75 vs. 0.95±0.49, P=0.010; ≤40 mg/dL, 0.28±0.18 vs. 0.13±0.14, P=0.005) as was the time spent in hypoglycemia (average minutes/day, 101±68 vs. 58±33, P=0.002) without significant difference in the mean glucose level (145±23 vs. 148±19 mg/dL). No episodes of severe hyperglycemia or diabetic ketoacidosis were observed following LGS activation.
  
  
  CONCLUSIONS
  The present investigation provides evidence that SAP with LGS reduces the frequency of hypoglycemia without compromising safety.
authors.affiliation: Children's Hospital on the Bult, Hannover, Germany. danne@hka.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Danne
authors.forename: Olga
authors.initials: O
authors.lastname: Kordonouri
authors.forename: Martin
authors.initials: M
authors.lastname: Holder
authors.forename: Holger
authors.initials: H
authors.lastname: Haberland
authors.forename: Sven
authors.initials: S
authors.lastname: Golembowski
authors.forename: Kerstin
authors.initials: K
authors.lastname: Remus
authors.forename: Sara
authors.initials: S
authors.lastname: Bläsig
authors.forename: Tanja
authors.initials: T
authors.lastname: Wadien
authors.forename: Susanne
authors.initials: S
authors.lastname: Zierow
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hartmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000517:prevention & control; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D008297:Male; D017060:Patient Satisfaction; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin