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Holiday LADA case study

A fifty year-old male with latent autoimmune diabetes in adulthood presented to my clinic in mid December for help with his diabetes management. His current therapy includes a Minimed 670G insulin pump and CGM. He reports to a sedentary lifestyle and diet high in processed carbs. Up until his initial visit, he had not seen an endocrinologist in over two years.

When he was first diagnosed with LADA, he was informed that he did not need to cover snacks containing <15 grams of carbohydrates (a very old way of practicing). He continues to follow these recommendations. Additionally, he was bolusing either immediately before or after his meals due to fear of hypoglycemia. This led to significant postprandial hyperglycemia.

An analysis of his CGM and pump download showed a time in range (TIR) or time spent between 70-180mg/dl of 37% (>70% recommended). There was no detected hypoglycemia and >50% of his time was spent >250mg/dl. His download also showed frequent auto mode exits due to high sensor glucose, likely due to his poor bolusing habits.

The patient and I had a LONG discussion on bolusing habits. We talked about the importance of covering any and all carbohydrates. We also reviewed the importance of bolusing 15-20 min before his meals and snacks. He seemed motivated to make changes and was excited to finally get some education. I made NO changes to his pump settings that day. All of the changes that we made in office were behavior based.

One week later, he presented with significant improvements. In fact, his time in range had improved from 37% to 57%; a 20% improvement with behavior changes alone! We were both thrilled and I was so impressed with his commitment. I see this happen a lot. Simply taking the time to educate can make the world of difference to people.

This 20% improvement is not just a number. For every 4% increase in TIR the patient spends one additional hour between 70-180mg/dl. A 20% improvement in TIR means that he was spending approximately 6.5 more hours a day between 70-180mg/dl. No wonder he was feeling so much better!

We also know from a TIR study published in 2019 in Diabetes Care (Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials) that for every 10% drop in TIR, risk of retinopathy increases by 60% and nephropathy by 40%. This patient is doing amazing things for his health.

Our goal for the next visit in two weeks is to meet the standard outcomes measures goal of TIR >70%. The best part is, HE was the one to set this goal. Self-motivation is AWESOME. I’m so proud, and we are just getting started! Success stories are the best holiday gifts!

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