Review wetenschappelijk congres American Diabetes Association
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Review wetenschappelijk congres American Diabetes Association 12-16 JUNI 2020
Het 80e jaarcongres van de American Diabetes Association (ADA) vond dit jaar, virtueel, plaats van 12 tot en met 16
juni. Een verslag hiervan kun u lezen op de volgende pagina’s.
1. Sustained Intensive Treatment and Long-Term Effects on A1C Reduction (SILVER Study) by CGM in Persons with T1D Treated with MDI Marcus Lind, Arndis F. Olafsdottir, Irl B. Hirsch, Jan Bolinder, Sofia Dahlqvist, Aldina Pivodic, Jarl Hellman, Magnus O. Wijkman, Erik Schwarcz, Henrik Lbrektsson, Tim Heise, William Polonsky Seattle (USA), Stockholm (Sweden), Uddevalla (Sweden), Gothenburg (Sweden), Uppsala (Sweden), Boston (USA), Örebro (Sweden), Neuss (Germany), San Diego (USA) BACKGROUND
CGM reduces A1c and time in hypoglycemia in persons with T1D treated with MDI evaluated over short time periods. It’s unclear to what extent CGM improves glucose control, treatment satisfaction, hypoglycemia fear and diabetes-related QoL long term. METHODS
The GOLD trial was a 16 month randomized crossover trial of CGM use in persons with T1D treated with MDI. The SILVER study is an extension in which patients continued CGM use (Dexcom G4/G5) for 1 year with clinical visits every 3 months.
SMBG in GOLD until end of SILVER study/1.0-1.5 years), showed decreased A1c of 0.35% (95% CI 0.19-0.50), p < 0.001. TIR increased by 8.6% (95% CI 5.1-12.0, p < 0.001), from 43.0-51.0%. Time in hypoglycemia < 54 and < 70 mg/ dl decreased from 2.1-0.6%, p < 0.001 and from 5.4-2.9%, p < 0.001, respectively. From randomization and screening in GOLD, A1c decreased by 0.45% (p < 0.001) and 0.68% (p < 0.001) after 2.5 years, respectively. Wellbeing WHO-5, p < 0.001, treatment satisfaction DTSQ, p < 0.001 and hypoglycemia confidence, p < 0.001 increased. Diabetes-distress decreased PAID, p = 0.006 over the time period (Figure 1). CONCLUSION
RESULTS
The primary endpoint, A1c change during long-term CGM use compared with SMBG during GOLD (from end of
The SILVER study supports beneficial long-term effects by CGM use on A1c, TIR, hypoglycemia, treatment satisfaction, wellbeing, hypoglycemia confidence and diabetes dis-
GOLD Study 9.2
SILVER Study
Run-in
SMBG period
Wash out
CGM period
Extension
Run-in
CGM period
Wash out
SMBG period
Extension
9.0
HbA1c (NGSP, %)
8.8 8.6 8.4 8.2 8.0 7.8 7.6 7.4 CGM/SMBG 47 47 47 SMBG/CGM 56 55 55
-1.5 0
47 55
47 54
45 46 56 53
3
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10
46 55
47 56
44 52
45 54
43 51
44 53
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Month
j a a r g a n g 1 8 | n r. 3 | a u g u s t u s 2 0 2 0
Figure 1. Comparison GOLD study and SILVER study.
nederlands tijdschri voor diabetologie
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A B S T R AC T S A N N U A L M E E T I N G
tress in persons with T1D treated with MDI. Funding: Dexcom, Inc. COMMENTAAR
Toevoegen van CGM aan CSII zorgt voor een betere glykemische regulatie en kwaliteit van leven. Voor het combineren van CGM en multipele dagelijkse injecties (MDI) met insuline is er, zeker op de (middel)lange termijn, minder bewijskracht. Doel van de SILVER-studie was om d
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