Pre-bed blood glucose is independently
associated with imminent nocturnal
hypoglycaemia observed on continuous
glucose monitoring (CGM) in Type 1
TTL Pang, J Taylor, A AGHA, H Siddique and A
Diabetes and Endocrine Unit, Dudley Group of Hospitals NHS Foundation
Trust, Dudley, UK
Aims: We asked whether daytime glucose indices are associated
with imminent CGM-detected nocturnal hypoglycaemia in patients
with Type 1 diabetes receiving intensive insulin therapy.
Method: We included the most recent 115 consecutive studies,
each of at least 72h duration on Medtronic iPro2, from our clinical
service. Each patient calibrated their sensor using capillary blood
glucose (CBG) at least three times per day and always at bedtime
(22:00 to 0:00). We deﬁned CGM-detected nocturnal hypogly-
caemia as <3.5mmol for at least 30min between 0:00 and 06:00.
Data are expressed as mean Æ SD; hazard ratio at 95% conﬁdence
interval. We entered signiﬁcant risk factors into logistic regression
model by backward elimination.
Results: We studied 89 subjects with Type 1 diabetes, mean age
36 Æ 16, 72% female and 43% pregnant. Sixteen per cent were on
insulin pump and mean HbA1c was 66 Æ 20 mmol/mol. There
were 64 episodes of nocturnal hypoglycaemia observed in 42% of
patients. These patients are of younger age (30.5 Æ 10.0 years vs
40.0 Æ 18.7 years, p < 0.01) and had lower HbA1c
(59 Æ 15 mmol/mol vs 72 Æ 21 mmol/mol, p < 0.01), after
adjustment for confounding. Reviewing daytime CGM parameters
and CBG readings, mean glucose from 6:00 to 0:00, area under
curve <4mmol, peak CGM glucose and pre-bed CBG, were
signiﬁcantly associated with nocturnal hypoglycaemia. After
adjustments, the association persisted only with pre-bed CBG.
Hazard ratios for nocturnal hypoglycaemia at pre-bed CBG
thresholds were: <7mmol, 10.7 (5.6 to 20.4); <8mmol, 8.1 (4.2
to 15.7); <9mmol, 4.7 (2.4 to 9.5); <10mmol, 4.8 (1.9 to 12.4).
Conclusion: We have stratiﬁed risk of imminent nocturnal
hypoglycaemia according to bedtime CBG. These data can aid
glucose target setting.
Clinical care and other categories posters: Incretin
Evaluation of the long-term cost-
effectiveness of treatment switching from
sitagliptin to liraglutide in subjects with
Type 2 diabetes in the United Kingdom
, G Subramanian
, S Arnoldini
, B Hunt
Institute of Metabolism and Systems Research, University of Birmingham,
Heart of England NHS Foundation Trust, Birmingham, UK,
Novo Nordisk Ltd., Gatwick, UK,
Ossian Health Economics and
Communications, Basel, Switzerland
Objectives: The recent LIRA-SWITCH trial showed that treat-
ment switching from sitagliptin 100mg to liraglutide 1.8mg led to
statistically signiﬁcant and clinically relevant improvements in
HbA1c and body mass index. The aim of this study was to assess
the long-term cost-effectiveness of treatment switching from
sitagliptin to liraglutide 1.8mg in patients with Type 2 diabetes
in the United Kingdom.
Methods: The QuintilesIMS CORE Diabetes Model Version 8.5+
(QuintilesIMS Health, Basel, Switzerland) was used to project costs
and clinical outcomes over patients’ lifetimes. Baseline cohort
characteristics and treatment effects were based on the randomised
controlled LIRA-SWITCH trial. Both future costs and clinical
beneﬁts were discounted at 3.5% per annum. Costs were accounted
in pounds sterling (GBP [£]) and expressed in 2016 values.
Results: Model projections showed improved quality-adjusted life
expectancy for patients with poor glycaemic control (HbA1c 7.5%
to 9.5%) on sitagliptin changing treatment to liraglutide 1.8mg
compared with those continuing on sitagliptin (9.18 vs 9.02
quality-adjusted life years [QALYs]). Treatment switching was
associated with increased overall costs (£24,737 vs £22,362) due to
higher pharmacy costs. Costs associated with diabetes-related
complications were lower in patients changing to liraglutide
(£14,593 vs £15,191). Switching to liraglutide was associated with
an incremental cost-effectiveness ratio of £15,423 per QALY
gained vs continuing sitagliptin treatment.
Conclusions: Treatment switching from sitagliptin 100mg to
liraglutide 1.8mg in patients with poor glycaemic control is likely
to be considered cost-effective in the UK setting.
Observational prospective analysis of real-
world experience of glucagon-like peptide-1
receptor agonist dulaglutide in patients
with Type 2 diabetes in Clyde
S PACITTI, C Smith and J Deosaran
Department of Diabetes, Royal Alexandra Hospital, Paisley, UK
Aim: Observational study of clinical effects of dulaglutide in real-
world patients and comparison with published study data.
Methods: Patients with Type 2 diabetes registered at diabetes
clinics in Clyde were identiﬁed from Sci-Diabetes. The pharmacy
department provided which patient had been prescribed dulaglu-
tide until July 2017. Data on HbA1c, weight and concurrent
therapies were obtained from Sci-Diabetes and Clinical Portal.
Results: In all, 182 patients were eligible for review; 53% female.
Median age was 59 (26 to 85). Of these, 42.3% were on insulin.
Dulaglutide was a monotherapy in 3.85%. Mean starting HbA1c
was 86.83mmol/mol with a mean reduction of 14.29mmol/mol
(95% CI 11.02 to 17.56, p < 0.0001) at three months and
13.68mmol/mol (95% CI 10.52 to 16.85, p < 0.0001) at six
months. Mean starting weight was 100.01kg with a reduction of
2.06kg (95% CI 1.08 to 3.04, p < 0.0001) at three months and
3.46kg (95% CI 2.01 to 4.81, p < 0.0001) at six months. Of
patients, 14% stopped dulaglutide due to side effects or poor
ª 2018 The Authors, presented at the Diabetes UK Professional Conference ª 2018 Diabetes UK. 35 (Suppl. 1), 36–205
Abstracts of the Diabetes UK Professional Conference, 14-16 March 2018 DIABETICMedicine