Continuous glucose monitoring added to a standardised insulin protocol following total pancreatectomy

INTRODUCTION: After total pancreatectomy (TP), patients are at high risk of hypoglycaemia regardless of insulin treatment modality. Information on treatment targets and modalities of insulin treatment following TP is sparse. This descriptive study presented experiences with a standardised insulin protocol and examined how the addition of intermittently scanned continuous glucose monitoring (isCGM) influenced the treatment of diabetes following TP. METHODS: Results from two retrospective cohorts of patients who had undergone total pancreatectomy were collected, 30 patients not using isCGM served as references (operated in 2018-2019, mean age 65.4 years) for 40 patients using isCGM (operated in 2020-2021, mean age 63.3 years). An identical insulin treatment protocol was used for both cohorts. HbA1c, insulin doses, weight and episodes with severe hypoglycaemia were recorded at three, six, nine and 12 months after TP. Percentage of time below range (TBR), time in range (TIR) and time above range (TAR) were collected for isCGM users. RESULTS: HbA1c and insulin doses were similar in the two groups during the first year following TP. In isCGM users, TBR was 0%, TIR 43-48% and TAR 52-57%. Episodes of severe hypoglycaemia were numerically but not significantly lower in isCGM users (zero versus four, p = 0.21). The same applied to days of readmittance 4.0 ± 7.7 days versus 15.5 ± 40 (p = 0.13) per patient/year. CONCLUSIONS: In the first year following TP, the use of isCGM was not associated with better glycaemic control. A non-significant trend towards less severe cases of hypoglycaemia and a nonsignificant numerical reduction in days of hospitalisation were observed in isCGM users. FUNDING: None. TRIAL REGISTRATION: Not relevant.