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Master Thesis

Transition d'un système de mesure en continu du glucose de type FGM à un système rtCGM : améliore-ton vraiment les paramètres d'évaluation de l'équilibre glycémique et de qualité de vie chez une cohorte de patients diabétiques de type 1

Abstract : Introduction: Glycemic monitoring has undergone a revolution in recent years with the arrival of the CGM (Continuous Glucose Monitoring) system based on the continuous measurement of glucose in the interstitial fluid. In 2019, 2 devices are reimbursed in France in the DT1 patient; Free Freestyle (FSL) and Dexcom G4 (DG4). The DG4 differs from FSL by the presence of audible alarms warning the patient of hypo- or hyperglycemia, and therefore seems more suitable for patients with hypoglycemic problems and / or significant glycemic variability. If through large randomized studies these two devices have proven their effectiveness on glycemic control and the quality of life of T1D patients, so far comparative or switch data are limited. We wanted to study the evolution of the glycemic balance and the quality of life after a sensor change (from FSL to DG4) over a period of 3 months. Methods: We performed a single-center retrospective study of 10 T1D patients included in a educative program realised in the department of Pr D.RACCAH. Data from AGP and responses to standardized questionnaires assessing quality of life (ADDQoL), satisfaction with the device (DTSQs) and feeling and fear of hypoglycemia (Gold score, Clarke score, HFS) were collected at M0 and M3. Results: In total, the 10 patients included in our study have 25.5 years evolution time of T1D, a Hba1c dosed at 8.47%, treated in 90% of cases by external insulin pump. 3 patients experienced a severe episode of hypoglycaemia over the past year, and 50% of patients have a hypoglycemia unawareness. First, there was a significant increase in TIR (+ 11.77%, p=0.01), decrease in the time spent in hypoglycemia <70 mg/dl (-4.66%, p=0.027), hypoglycaemia fequency (-24.9 events, p=0.039) and % coefficient of variation (-5.67%, p=0.008). While objective parameters for reducing hypoglycemia exposure are improved, the same is not true for the Gold (Clarke) and Hypersensitivity (HFS) scores for hypoglycaemia. Secondly, quality of life and satisfaction scores are not improved after 3 months wearing DG4 compared to FSL (ADDQoL, DTSQs). Conclusion: Our pilot study reports that the transition from a FGM to a rtCGM device is accompanied by an improvement in glycemic control parameters over a number of 10 T1D patients followed over 3 months. The educational approach to the initiation of DG4 and during regular reassessments could be a major reason for this improvement in blood sugar control. The lack of improvement in satisfaction and quality of life could be explained by a short duration of study. These results need to be confirmed by studies based on a similar methodology in order to provide new data allowing the clinician to be better placed in the initial choice or reevaluation of a CGM device, centered on the patient's profile (metabolic, quality of life, patients choice and autonomy).
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https://dumas.ccsd.cnrs.fr/dumas-02395734
Contributor : Faculté de Médecine Amu <>
Submitted on : Thursday, December 5, 2019 - 4:22:12 PM
Last modification on : Thursday, September 3, 2020 - 11:45:15 AM
Long-term archiving on: : Friday, March 6, 2020 - 6:35:44 PM

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Yannis Preau. Transition d'un système de mesure en continu du glucose de type FGM à un système rtCGM : améliore-ton vraiment les paramètres d'évaluation de l'équilibre glycémique et de qualité de vie chez une cohorte de patients diabétiques de type 1. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02395734⟩

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