Automonitorização contínua com sensor de sistema flash em pacientes portadores de diabetes mellitus tipo 1: adesão, controle glicêmico estimado e hipoglicemias

Abstract

Introduction: Patients with type 1 diabetes mellitus (T1DM), due to their high glycemic lability, require more frequent glycemic self-monitoring, most often performed by digital puncture. Our objective was to evaluate adherence by T1DM patients who used to self-monitor 3 to 5 times daily to a Continuous Glucose Monitoring System (CGMS), as well as to observe whether there was an improvement in estimated glycemic control and hypoglycemia rates. Methods: Prospective cohort study with 35 patients with T1DM (mostly female, 62.8%, 31.7 ± 10.3 years, 60.9 ± 13.6 kg, 1.6 ± 0.08 m, BMI 23.4 ± 5.04, T1DM time of 11.71 ± 8.81 years) decompensated using exclusively capillary glycemic self-monitoring (AMGC). These patients used FreeStyle® Libre (FSL), a subcutaneous CGMS sensor, which was changed every 15 days by the medical team for 3 months. The following sensor information was evaluated: number of daily screenings (RD), percentage of data captured (DC), estimated glycated hemoglobin (A1c E), mean glycemia (MG), hypoglycemic indicators [percentage (PH), number of events (EH), duration (DH)]. Sensor data over the 3 months were evaluated by Friedman test and the Connover's post test was applied to variables with significant difference. All data were analyzed using SPSS version 20 software, considering significant p < 0.05. Results: There was a significant increase in RD, which went from 3 to 5 capillary checks to an average of 13.1 ± 10.6 times per day with FSL. The patients used the sensor properly since the average percentage of CD was 88.5% ± 8.1. We found no differences over time in the estimated glycemic control as well as in the hypoglycemic indicators, which had a mean percentage > 8.4%, higher than the ADA recommended value of 4%. Conclusions: The replacement of AMGC by FSL allowed patients to considerably increase their number of measurements and their diabetes knowledge. Despite good sensor adherence, they did not improve the estimated glycemic control and hypoglycemia indicators, the latter remaining higher than the values indicated for good glycemic control.