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Diabetes patient profiles
Adults

ADULT PATIENTS WITH TYPE 1 DIABETES
CASE STUDY

Profile 1

DIABETES PATIENT WITH ELEVATED HBA1C

PROFILE

 

  • Shaun
  • 40 year-old male
  • Type 1 diabetes for 28 years
  • Currently on MDI
  • HbA1c of 9.1% (76mmol/mol), higher than his 7% (53mmol/mol) HbA1c target

 

CHALLENGE

 

The patient has been unable to control his blood glucose levels despite multiple daily injections and carbohydrate counting. He is frustrated because he is still not reaching his target and he is well aware that due to his elevated HbA1c he is at greater risk of developing diabetes-related complications.

 

GOAL

 

The goal for the patient is to reach his target of 7% (53mmol/mol) HbA1c.

TREATMENT CONSIDERATION

Continuous subcutaneous insulin infusion (CSII) can be a treatment option for adults with type 1 diabetes, if attempts to reach HbA1c target have failed with multiple daily injections (MDI).

Profile 2

Diabetes patient with Dawn phenomenon (hyperglycaemia)

PROFILE

 

  • Susan
  • 50 year-old Female
  • Type 1 Diabetes for 35 years
  • HbA1c 7.8% (61.mmol/mol)
  • MDI – long acting insulin once daily in the morning and rapid acting before meals

 

CHALLENGE

 

The patient reports experiencing high overnight fasting blood glucose levels on a regular basis and is becoming frustrated. Her early morning high BG reading makes her feel as though her day is ruined before it's begun. She would like greater control over her high blood glucose level because she is aware of the increased risk of long-term diabetes complications (Retinopathy, Nephropathy, Neuropathy etc).

 

GOAL

 

The patient's goal is to obtain better control over her morning hyperglycaemia.

TREATMENT CONSIDERATION

CSII is recommended for patients showing one of the following criteria: HbA1c ≥ 7% (53mmol/mol), recurring hypoglycaemia, repeated occurrence of the Dawn phenomenon, with overnight fasting blood glucose levels frequently exceeding 9mmol/L or history of severe glycaemic excursions4,5,6.

Profile 3

Diabetes patient with frequent hypoglycaemia

PROFILE

 

  • Richard
  • 32-year old male
  • Type 1 diabetes for 23 years
  • MDI – one injection of long acting insulin in morning and rapid acting insulin before meals
  • HbA1c 7.0% (53mmol/mol)

 

CHALLENGE

 

The patient experiences frequent hypoglycaemia during the day at least 3 times a week. The hypoglycaemia events usually occur after exercise. He has experienced severe low blood glucose level events, requiring third party assistance twice in the past 6 months.

 

GOAL

 

The goal is to reduce the frequency of his hypoglycaemia and allow him to engage in sport more frequently - while obtaining good glycaemic control.

Treatment considerations

CSII is indicated in case of hypoglycaemia, or fear of low blood glucose level. Fear of hypoglycaemia, especially during the night, may compromise quality of life (QOL) for the family and jeopardize efforts to achieve optimal metabolic control5,7-11.

Profile 4

Diabetes patient with lifestyle changes

PROFILE

  • Maria
  • 34 year-old female
  • Type 1 diabetes for 18 years
  • HbA1c of 7.5% (58mmol/mol)
  • Currently on MDI
  • The patient started a new job 3 months ago. Half of her time will involve travelling across various time zones

 

CHALLENGE

 

The patient is concerned about maintaining blood glucose level when she travels. She is worried that she won’t be able to manage the frequent time zone changes and longer days combined with meal time disruption are also causing concern.

 

GOAL

 

The patient’s goal is to achieve HbA1c control despite leading an unpredictable lifestyle.

TREATMENT CONSIDERATION

CSII can benefit patients seeking a more flexible lifestyle, and improve the patient’s wellbeing11,14.

References

1Lauritzen T, Pramming S, Deckert T, Binder C. Pharmacokinetics of continuous subcutaneous insulin infusion. Diabetologia 1983; 24:326-9.

2Battelino T et al, Conget I, Olsen B, Schütz-Fuhrmann I, Hommel E, Hoogma R, Schierloh U, Sulli N, Bolinder J; SWITCH Study Group. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia. 2012 Dec;55(12):3155-62.

3Weiss R et al , Garg SK, Bode BW, Bailey TS, Ahmann AJ, Schultz KA, Welsh JB, Shin JJ. Hypoglycemia Reduction and Changes in Hemoglobin A1c in the ASPIRE In-Home Study. Diabetes Technol Ther. 2015 Aug;17(8):542-7.

4National Diabetes Services Scheme (NDSS) Diabetes Australia. Insulin Pump Consumables: Eligible Criteria. Available at http://www.ndss.com.au/ Products--Outlets/Insulin-pump-consumables/Eligibility-Criteria/. Accessed Jun 18, 2012.

5AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocrin Pract. 2007;13(suppl 1):3-68.

6Koivisto VA, Yki-Järvinen H, Helve E, et al. Pathogenesis and prevention of the dawn phenomenon in diabetic patients treated with CSII. Diabetes.1986;35:78-82.

7J. C. Pickup & A. J. Sutton Severe hypoglycaemia and glycemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous Diabetic Medicine 2008 :25, 765–774.

8Bulsara MK et al. The impact of a decade of changing treatment on rates of severe hypoglycemia in a population based cohort of children with type 1 diabetes. Diabetes Care 2004;27(10):2293-8.

9Phillip M, Battelino T, Rodriguez H, Danne T, Kaufman F. Use of insulin pump therapy in the pediatric age-group: consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2007;30:1653-1662.

10Hoogma RP, Hammond PJ, Gomist R, et al. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycemic control and quality of life: results of the 5-nations trial. Diabetes Med. 2006;23:141-147.

11Karagianni P et al. Continuous subcutaneous insulin infusion versus multiple daily injections. Hippokratia 2009;13(2):93-96.

12Bergenstal RM, Klonoff DC, Garg SK. et al. Threshold-Based Insulin-Pump Interruption for Reduction of Hypoglycemia, N Engl J Med. June 22, 2013DOI: 10.1056 / NEJMoa1303576.

13Ly TT et al. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial. JAMA. 2013 Sep 25;310(12):1240-7

14Misso ML et al. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus (Review).The Cochrane Collaboration. The Cochrane Library 2010, Issue 1.

15Slover RH et al. Effectiveness of sensor-augmented pump therapy in children and adolescents with type 1 diabetes in the STAR 3 study. Pediatr Diabetes. 2012 Feb;13(1):6-11.

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