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Ariel Omiunu, Ashley Ooms, Supreet Singh, Ben Szirth, Albert S Khouri; Influence of Insulin Pump Use and Continuous Glucose Monitors in Type 1 Diabetes Mellitus. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5306. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The American Academy of Ophthalmology recommends a full ocular screening at age 15 or 5 years after diagnosis of Type 1 Diabetes Mellitus (T1DM), a life-long autoimmune disorder. T1DM leads to uncontrolled Blood Glucose (BG) levels, which may lead to ocular complications, such as diabetic retinopathy and macular edema. Dexcom (San Diego, CA) Continuous Glucose Monitoring Systems (CGMS) provide subjects with continuous glucometer readings with awareness of normal BG levels (90 to 105). CGMs can be used in tandem with Insulin Pumps (IPs) to help automate insulin delivery and maintain a normal BG. Overuse of IPs by increasing output of insulin to match unhealthy lifestyle choices may result in an unregulated glycemic control over long-term use, resulting in weight gain and end organ damage. We evaluated the changes in BG levels, BMI, and intra-ocular pressure (IOP) within a cohort of patients using CGMS with IPs, and made comparisons to patients without IP use.
Data was collected from 82 subjects with known T1DM between ages of 13 and 28. Data obtained from each subject included age, duration of T1DM, BG data, IOPs, and BMI (Table 1). Subjects were further divided into groups based on duration of diabetes (Table 2). IOP measurements were obtained using a non-contact puff tonometer, and a retinal camera was used to evaluate the incidence of retinopathy. Sample t-tests and analysis of variance test were used for statistical analysis.
Mean age of subjects was 17.85 ± 4.51 years, with average 9.76 ± 5.37 years with T1DM. 66 of 82 subjects (52.87% male) reported use of CGMS with IPs, of which the mean duration IP use was 7.21 ± 4.66 years. Results (Table 1) showed no significant changes in IOPs, BMI, or BG levels between patients within this cohort who used CGMS with IPs and patients who used CGMS alone. A higher incidence of dot hemorrhages was observed in patients with IPs.
While our findings do not indicate a negative risk for using CGMS with IPs in this cohort, subjects with T1DM have deranged control early in the disease process, and should still undergo a baseline exam at the time they initiate use of CGMS and IPs, as well as yearly screenings including retinal imaging and IOPs. Further studies with subjects using CGMS and IPs for a longer time period will be performed.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Table 1. Results of patients using CGMS with and without IPs.
Table 2. Results based on duration of T1DM.
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