Thank you very much Professor Bergen style for this excellent overview that really shows that C. G. M. Is in the center of diabetes care nowadays. And please allow me to discuss a little bit the engagement and satisfaction with sensor based glucose monitoring among people with diabetes, discuss a little bit the preferences and views of people with diabetes. Those are my disclosures for you to review. And the important thing is that people with diabetes should start with optimal control immediately after the disease is discovered. This data from john McCain and David natan are on type one diabetes. And what they showed is if a person with diabetes a has 1st 10 years a mean glucose a one C 7% in the 2nd 10 years. The ming glucose expressed by a one C. 9% versus a person that had exactly the opposite 1st 10 years, 9% and then the next 10 years 7% on average over the 20 years they look the same same day. Simic exposure. But there is a striking difference. If the 1st 10 years are better. There is a 33% reduction in the risk for cardiovascular disease and more than 50% reduction in the G. F. R. So early intervention is very important for a greater reduction in cardiovascular and kidney complications. The same is true for type two diabetes and we know this already from the, from the U. K. P. D. S. Study, this is the A one C. Drop initially when the south Korea's and insulin combination was introduced and there was a reduction in microvascular disease. If this was early on in the therapy in myocardial infarction as well as in death from any cause. So with knowing this and knowing that we have hard time to achieve ming glucose when we look at it retrospectively by located hemoglobin. It is we really believe time to move on to the time in range centered diabetes care because timing range captures also variation, highs and lows and of course tells us about hypoglycemia and postprandial elevations. There's a mounting evidence that C. G. M. Or intermittently scanned C. G. M. Also in individuals with Type two diabetes is not only efficient but we want to say very efficient in daily care. This is a retrospective real world analysis. As you can see there is a United States cohort and the Canadian cohort combined the two together. The baseline A one C is high for this population. Just another prove that we do not have optimal outcomes in Type two diabetes. So 9.4% in the US cohort of 9.2 in the combined And here you see that the located hemoglobin, the mean the surrogate for a mean glucose decreased by 1.1%, which is those of us that follow up these studies for some time. A really impressive decrease from baseline of 9.28 .1 still not optimal but a huge improvement. And this interestingly was actually true in throughout the observation period. So it was actually a prolonged effect, not just an initial and what's important is that from this french relief study, we actually were able to see from the data on the National Insurance system, 74,000 individuals with Type one or Type two diabetes. That what's important is acute acute complications, decrease acute complications, decrease both 12 months prior lifestyle When observations started compared to 12 months following the intermittently scanned C. G. M. As you can see in Type One, a total decrease of almost 50% in an n type two diabetes of almost 40% decrease in acute complications. And this of course reflects not only in the well being of these people but of course also in the cost. Importantly a recent follow up of this. Same study demonstrated that also after two years of observation intermittently scam. See GM was associated with a decreased hospitalization of again, almost 50% now, both in Type one and type two diabetes driven by reductions in diabetic ketoacidosis and 88% of all individuals persisted with the system, Which means that an in consumption of the glucose strips decreased of course by more than 80% because we know it is actually a replacement for finger prick glucose measurement. So this can effectually be a reduction in cost both because of reduced acute complications and admissions to the hospital as well as less use of strips. There are several calculations on predicted budget impacts with the increasing proportion of people that are using intermittently scanned C. G. M. This is type one diabetes as you can see here costs year one, year two and year three. And then basically the calculations for the local health economy and it is interesting to see that the cost effectiveness actually is immediate. So if you decrease acute complications then of course you don't need to wait for a long time to see the benefits of reduced acute admissions acute er And of course DK and this is just money here you have an eye super quality of our smb G of 3600 the likelihood of cost effectiveness with a threshold of 20,000 is 70.8. As you see very much in favor of cost effectiveness. This is another study that was published online late last year from U. K. And here interestingly, as you can see here you have a UK willingness to pay threshold of £30,000 as you can see. However you calculate the costs. They are all well below this threshold. Approximately one half or two thirds of this threshold depends with study which data you use, which horizon you use. You have a here a 60 year time horizon, 10 year time horizon, five years or even shorter term. Still well beyond the UK willingness to pay threshold. And this is either by a one C benefit and again as you can see of course the higher the initial a one C The higher the reduction in a one C. Of course the better also the outcome on the on the ice er and the british pounds quality which of course is expected. But it's quite surprising that the price effect is actually so pronounced. Here is the other side of this coin. So money that is of course important for the entire society for the health care budgets, particularly in systems where this is a managed budget like in all the european union and elsewhere where they use the same system. But then the other side of the coin, of course is what people with diabetes think This is a survey, an initial survey and people with type one diabetes thought that the first most important thing was for the food choice. But then the second already was time in range. Almost 60% replied. So in type two diabetes on insulin again, food was the first and then time in range together with a once he was on the second place. And interestingly people with no insulin in their therapy also put time in range already on the second place. The most recent analysis actually showed that with one year difference or one year more recent, that type one type two diabetes population actually showed even not an insulin that it is really important to have your glucose numbers on target, which means the time in range in another world, the most recent one. This is a survey of one. more than 1000 people with type one diabetes. 1001 141 with type two diabetes and then 1002 166 or type two without insulin. In this survey, timing range was already very well in the first place in all three groups, which I thought even to me was kind of a slight surprise. But of course people understand what's good for them. This is a treatment satisfaction study very recent that is presented this year at the A. T. T. D. Please join this presentation by huang and nada. The background is the assessment of diabetes treatment satisfaction using freestyle libra. 14 days of course for its sensor in people with Type one and type two diabetes. It's a post approval of course prospective multi center non randomized adult study from the United States, six months of baseline period where participants used blood glucose monitoring and then six months follow up the study enrolled almost 1000 people. So 935 people. The intermittently scan C. G. M. Was associated with use was associated with a significant increase in diabetes treatment satisfaction in individuals with Type one diabetes, as you will see and also in individuals with Type two diabetes. And this was highly significant. In addition, the perceived frequency of hypoglycemia among individuals with type two diabetes was significantly lower and again very significant difference compared to blood glucose monitoring. Finally, daily scam frequency was correlated with a decrease in mean glucose, which of course was shown in many other studies and was anticipated. And the study concludes that using crystal liberal is associated with a significant improvement in diabetes treatment satisfaction of course, as well as as with the effectiveness of this. This is the the graphic. So up is the blood glucose monitoring. So first six months followed by freestyle libra. And this is the mean score total treatment satisfaction as you can see in Type one and type two diabetes below a very striking and of course highly significant difference and this is a little bit nuanced. So sub scores as you can see one after the other. Actually, there is almost a third difference in scores is when you when you when you compare the two and as you can also see. But the last two all are highly significant, perceived frequency of hyperglycemia was not significant and perceived frequency of hypo was not significant in type one diabetes, but it was in Type two diabetes. And so the the elderly individuals with type two diabetes, which is a very, very important group in many ways. And this study included 267 elderly adults with Type two diabetes. And here the definition of elderly was perhaps a little bit surprising to many of us. It's above 65 years. So perhaps not so old, but in many ways the most important population with usually many comorbidities and perhaps more fragile. And here as you can see the priest, a liberal usage was associated with a significant increase in treatment satisfaction. Again, very significant and perceived frequency of hypoglycemia also significantly lower in this population. When you compare freestyle, liberal with glucose monitoring. Furthermore, dailies, clan frequency was again correlated with surrogate marker of ming glucose and each additional scan was associated with a reduction of point 036% in a one c. So graphical this is population above 65 years with type two diabetes. As you can see a very significant improvement in treatment satisfaction where the intermittent dis can see GM the freestyle deep breath was used and again, this will be presented at this at bat here in Berlin. A more nuanced three presentation. As you can see here a side of the hyperglycemia. All other measured outcomes in this quality of life assessment satisfaction assessment were significantly better when a intermittently scanned C. G. M. The freestyle libra was used and here actually is another way to look at the the benefit of use of C. G. M. Here we can actually calculate the complications. 10 year cumulative incidence of the developing diabetes relate complications when we improve the time in range. As seen from several studies. So, if in fact one diabetes, if time in range is 58% the risk for myocardial infarction is around 3.3 and when this is around 80% of course it goes down to 22.5 to 2.7 and this is even more pronounced for type two diabetes. So it is a visible representation that timing range improvement is associated with the with the reduction of cumulative incidence of chronic complications related to diabetes. This of course is associated with cost reduction. Again, this is a United States prediction study that a a use of timing range center diabetes care with an improvement of timing range could save billions in type one and even more so of course because it's more, so many more people in Type two diabetes. So a 10% increase actually would save several billions in Type one and even more so in type two diabetes. Here again, a more nuanced approach with several different view. So cost reduction. A 10% hypoglycemic events, 20% hypoglycemic events, 30% hypoglycemic events and so on. Again. Each 10% of reduction of acute complications here hypoglycemia saves billions of money in this particular society. Let us focus a little bit on the new standards of care for diabetes. We all know it. It's a very welcome publications supplement number one each year from diabetes care and here the general device principles recommendations are when prescribing the device, ensure that people with diabetes receive initial and ongoing education. So this of course is very important. We have to empower people to use it the right way. It's also important to say that these devices that measure time in range are intuitive. So people with diabetes have much less trouble to understand and of course to use it prospective lee and and efficiently for type two diabetes. The applications are getting broader and broader. I think for very good reasons here you see physical activity or medication change diabetes management with multiple daily injections on continuous subcutaneous insulin infusion of course for diabetes management on basal insulin who are capable of using the device safely. So more and more groups are added to the continuous glucose monitoring recommendations in this. In this A. D. A. Standards of care applicability to use with type one or type two diabetes of course, you know that the youth has little trouble to use technology and they're very keen to to engage with this. So the success is very, very likely. Please allow me to invite you in the end to our next year 80 td. So we are already thinking about the next year. It is a very pleasant time of the year. March 6 to 9 next year in Florence where the spring will be in full blow in this old Rennes Sun City. I do hope we will meet there next year again. And with this, I would like to thank you very much for your attention. This is my team. They have to work while I speak and I'll be very happy to discuss with you these issues after our meeting. Thank you
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