Coppini, D.

Dave, J.

Dubey, Venketesh N.

Bournemouth University Research Online

Diabetologia (2021) 64 (Suppl 1):S1–S380Diabetes Register.Supported by: DU, UU, Swe. Diab. Found., SHH Found., Fam. ErnforsFund, AstraZeneca, MSD, Novo Nordisk, ALFDisclosure:M. Svedbo Engström: None.540Effect of WhatsApp messaging based intervention on insulin adher-ence and treatment effectiveness in diabetic patients in central IndiaS. Saboo, B. Saboo;Diabetology, Prayas Diabetes Center, Indore, India.Background and aims: Low adherence to pharmacological therapy andmonitoring by patients with diabetes mellitus is very common and repre-sents a challenge. Technological Help has came to a rescue in connectingwith patients during this covid-19 period by enhancing communicationand the reach for the healthcare. WhatsApp is a very commonly usedsocial media app and its available with most of the patients. This studyexamined the effect of an intervention using WhatsApp® messaging oninsulin adherence and treatment effectiveness in patients with diabetesMaterials and methods:A randomized clinical trial was performed with573 patients who had diabetes and/or hypertension and who had enrolledin a diabetes clinic. The patients were randomly assigned to either theintervention group (n = 296), which received usual care plus WhatsAppmessages-based dose titration for insulin with an emphasis on medicationadherence, or the control group. The control group (n = 277) onlyreceived usual care. Medication adherence, as measured by theMorisky-Green Test, was compared after 32 weeksResults: After the follow-up period (8 months), 78.5% of the patients inthe intervention group were adherent versus 57.2% in the control group.Also, the number of patients achieving target hba1c <7% were more inintervention group 73 % as compared to control group 52 %.Conclusion: Diabetes is a progressive disease, and the treatmentshould be continuous. Technological aids using WhatsApp couldbe useful as a reinforcement to increase adherence to medicationand achieving target levels of optimum health. This approach is wellaccepted by patients and easily accessible to them and it maintainsconnection between patient and caregivers during and after covid-19period. If used judiciously it can reduce the burden on ourhealthcare system and yield better outcomes in terms of better treat-ment adherence and treatment outcomes.Disclosure: S. Saboo: None.541Long-term HbA1c outcomes with and without intermittent CGM usein adults with type 2 diabetes participating in the Onduo ProgramJ.E. Layne1, R.M. Bergenstal2, N.A. Barleen1, R.F. Dixon3, H. Zisser4;1Onduo LLC, Newton, 2International Diabetes Center at Park Nicollet,Minneapolis, 3Remedy, Needham, 4Verily Life Sciences, South SanFrancisco, USA.Background and aims: The Onduo Virtual Diabetes Clinic (VDC) forpeople with type 2 diabetes (T2D) combines a mobile app, remote life-style coaching and video consultations with board-certified endocrinolo-gists for medication management and prescription of real-time (rt)CGMdevices for intermittent use in high risk participants. This analysis exam-ined change in HbA1c at 6 months and 1 year in VDC participants withand without intermittent rtCGM use.Materials and methods: Adults ≥18 years of age with T2D who enrolledin the VDC program from February 2018 through April 2019 with baselineand follow-up HbA1c values at 1 year were included. The CGMgroup wasrequired to have used CGM ≥30 days prior to the follow-up HbA1cmeasurement. Outcomes included within group change in mean HbA1cwith and without CGM use. Subgroup analysis was performed for partici-pants with 6-month and 1-year data. Between group comparisons forchange in HbA1c stratified by baseline categories of >9.0%, 8.0 to 9.0%,7.0 to <8.0%, <7.0% and by <8.0% and ≥8.0% were evaluated by a two-sample t-test for equivalence of mean change in HbA1c between groups.Results: Of the cohort (n=772), 45.9% (n=354) used CGM and 54.1%(n=418) did not use CGM. At baseline the CGM group was significantlyyounger (mean±SD): 53.3±8.6 vs 55.1±9.4 years, had higher HbA1c:7.9%±1.8 vs 7.6%±1.7, and greater insulin use: 36.2% vs 28.5%.Change in HbA1c at 1 year is presented in the Table. The increase inparticipants meeting the Health Effectiveness Data and Information Set(HEDIS) target of HbA1c <8.0% was greater in the CGM group, 55.1%to 78.3%, vs no CGM, 60.8% to 74.0% (p=0.002). Subgroup analysis(n=468, 60.6%) revealed significant improvement in HbA1c at 6 monthsand 1 year for both the CGM and no CGM groups with a baseline HbA1c>8.0% (p<0.001). On average participants meeting the AmericanDiabetes Association (ADA) treatment target of HbA1c <7.0% at base-line remained at target at 6 months and 1 year.Conclusion: Participation in the Onduo VDC was associated with asignificant reduction in HbA1c at 1 year in those not meeting treatmenttargets, with approximately 2-fold greater improvement with CGM use.These results suggest that improvement in HbA1c observed at 6 monthswas maintained at 1 year.Disclosure: J.E. Layne: Employment/Consultancy; Employee ofOnduo, LLC, the study Sponsor.542Development of a new device for screening for peripheral diabeticneuropathyD. Coppini1,2, J. Dave3, V. Dubey3;1Poole Hospital, Poole, UK, 2Mater Dei Hospital, Msida,Malta, 3Bournemouth University, Bournemouth, UK.Background and aims:We developed a new tool called 'Vibrascan' thatutilises a vibratory plate for the screening of peripheral diabetic neurop-athy. Its design was based on the mechanics of the Neurothesiometer, butis intended as a more intuitive, operator- independent testing instrument.Materials and methods: Twenty healthy subjects were tested using bothNeurothesiometer and VibraScan. For using the Neurothesiometer, aS283Diabetologia (2021) 64 (Suppl 1):S1–S380single operator measured VPT (vibration perception thresholds in Volts(V). VibraScan can be operated independently by the subject in the sittingposition and placing both feet on the vibrating plate. The range of vibra-tion used is the same for both devices (i.e. from 0V to 50V). The frequen-cy and amplitude of VibraScan is completely programmable such thatseverity level can be interpreted automatically by the device. VPTmeasurements by both devices were correlated using the Bland -Altman method in order to measure the agreement between both devices.Results: Mean VPT measured for left and right foot using Neurothesiometerwas 4.53 ± 0.65 Vand 4.97 ± 0.57 V, and 4.76 ± 0.60 Vand 5.22 ± 0.67 V forleft and right foot using VibraScan. There was very good correlation betweenindividual values for each device (r = 0.893, p < 0.01 for right foot and r =0.816, p < 0.01 for left foot). Despite the differences in operation technique,there was very little difference in VPT measurements between devices. whenusing the using Bland-Altman method.Conclusion: The intuitive, quick and essentially observer independentnature of VibraScan enables an important new normal method of screen-ing for the at risk foot in diabetic individuals. Further studies on diabeticsubjects with varying severity of neuropathy are planned to help strength-en its possible role for screening patients in tandem with their annual eyescreening visit, a much awaited unified approach in the modern manage-ment of diabetes.Disclosure: D. Coppini: None.SO 40 CGM543High treatment satisfaction and less severe hypoglycaemia after 24-month use of intermittently scanned continuous glucose monitoringS. Charleer1, C. De Block2, L. Van Huffel3, E. Dirinck2, F. Nobels3, C.Mathieu1, P. Gillard1,4;1University Hospitals Leuven - KU Leuven, Leuven, 2UniversityHospital Antwerp, Edegem, 3OLV Hospital Aalst, Aalst, 4ResearchFoundation Flanders (FWO), Brussels, Belgium.Background and aims: Nationwide reimbursement of intermittentlyscanned continuous glucose monitoring (isCGM) was introduced inBelgium in 2016. This prospective observational multicentre real-worldtrial (FUTURE) studies the impact of isCGM on quality of life (QOL)and glycaemic control of people with type 1 diabetes (T1D) in 3 diabetescentres. Here, we report the 24-month data of the FUTURE trial.Materials and methods: Between July 2016 and July 2018, 1906 T1Dadults were consecutively recruited. Demographic, metabolic, glucose,and QOL (SF-36, Problem Areas In Diabetes-Short Form,Hypoglycaemia Fear Survey, Diabetes Treatment SatisfactionQuestionnaire [DTSQ]) data were collected at start, 6, 12, and 24 monthsof standard follow-up. Primary endpoint was evolution of QOL.Secondary endpoints were change in HbA1c, self-reported severehypoglycaemia and diabetes-related work absence, and number of peoplewho reach clinical CGM consensus targets. Data are mean±SD, least-square mean (95% CI), or n (%).Results: Of 1906 people who started isCGM, 1577 (83%) used isCGMfor at least 24 months. Twelve percent (n=237) discontinued isCGM dueto switching to real-time CGM (n=75; 32%), skin irritation or allergy(n=39; 17%), and frequent sensor loss (n=26; 11%). People were 46±15years old, had T1D for 23±14 years, 22% were using an insulin pump,16% (n=299) were hypoglycaemia unaware, with HbA1c of 7.8±1.2%.QOL scores were high at baseline and remained stable. DTSQ satisfactionimproved from 28.0 (26.1-29.8) to 30.4 (28.6-32.2) (p<0.0001), withhigh self-reported treatment satisfaction (8.5±1.4 on a scale of 10).HbA1c did not change over 24 months. Compared to 6 months beforeisCGM initiation, fewer people experienced severe hypoglycaemic eventsneeding help from others (17.7% [n=314] vs 9.5% [n=150]; p<0.0001)and hypoglycaemic comas (3.8% [n=67] vs 1.1% [n=18]; p<0.0001) inthe 6 months prior to the 24-month time point. The same evolution wasobserved in number of severe hypoglycaemic events needing help fromothers (83.1 vs 44.5 events/100 patient-years; p=0.003) andhypoglycaemic comas (9.5 vs 3.0 events/100 patient-years; p=0.009).Additionally, fewer people were absent from work (7.7% [n=134] vs2.5% [n=39]; p<0.0001) and missed fewer days of work (80.8 vs 35.1days/100 patient-years; p=0.009). From the first twoweeks of isCGM useup to 24months, more people reached the targets of <4% of time <70mg/dL (24.0% [n=331] vs 29.5% [n=367]; p<0.0001), >70% of time 70-180mg/dL (10.4% [n=143] vs 12.0% [n=148]; p=0.046), <25% of time >180mg/dL (18.5% [n=256] vs 20.1% [n=249]; p=0.025), and <5% of time>250 mg/dL (15.4% [n=212] vs 20.6% [n=254]; p<0.0001). Results arecomparable when omitting drop-outs from analyses.Conclusion: isCGM use over 24 months in a large T1D populationincreases treatment satisfaction while maintaining other aspects ofQOL and HbA1c. The lower prevalence of people who experiencesevere hypoglycaemia and who miss work, together with morepeople who achieve the consensus targets for hypoglycaemia andhyperglycaemia indicate that isCGM can be beneficial in long-term diabetes care.Clinical Trial Registration Number: NCT02898714Disclosure: S. Charleer: None.S284

Development of a new device for screening for peripheral diabetic neuropathy

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Development of a new device for screening for peripheral diabetic neuropathy

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