Technological advances in the treatment of type 1 diabetes have been significant in recent years and have considerably improved the management of the disease.
Continuous glucose monitoring has radically changed the management of type 1 diabetes by empowering patients to self-manage and adjust their insulin therapy. Glucose monitoring methods have evolved considerably over the last few decades: from urine tests before the 1980s, to capillary blood glucose self-monitoring with a portable blood glucose meter introduced in 1978, to continuous glucose monitoring (CGM) methods that emerged in 1999.
Recently, CGMs have replaced capillary blood glucose meters. CGMs include sensors and transmitters that send blood glucose readings to a receiving system such as a meter, smartphone, or smartwatch, and potentially to a cloud service.
Currently in France, all diabetic patients on multi-injection or continuous insulin pump administration are eligible for reimbursement of a continuous glucose monitoring system allowing the measurement of interstitial glucose by wearing an interstitial glucose sensor. This study aims to evaluate blood glucose readings collected by two devices:
* Abbott FreeStyle Libre (FSL) is a flash interstitial glucose monitoring system where glucose is continuously monitored via intermittent scanning (ISGS). It is a standalone interstitial glucose sensor that collects glucose data by scanning the sensor.
* Dexcom is a real-time continuous glucose monitoring (RTGS) system. The reader provides a blood glucose reading every 5 minutes, along with a trend arrow and data collection over several hours (up to 24 hours).
These continuous glucose monitoring (CGM) methods allow blood glucose readings to be transmitted to an online platform that healthcare professionals can access. They can then analyze these readings remotely. This data analysis is assisted by algorithms that identify the time spent within, above, or below the target blood glucose level. Following the assessment by the healthcare professional, the patient can be contacted directly via the platform's instant messaging service.
In recent years, a link has been observed between type 1 diabetes (T1D) and eating disorders (EDs). Indeed, patients with T1D are at higher risk of developing an ED than the general population. This is partly explained by the fact that particular attention is paid to the dietary and nutritional management of T1D patients from the moment of their diabetes diagnosis, in order to allow for better glycemic control. Eating disorders in patients with type 1 diabetes (T1D) can lead to potentially serious complications. In the short term, they increase the likelihood of diabetic ketoacidosis resulting from hyperglycemia not corrected by adequate insulin administration. Hospitalization rates and length of stay are also significantly higher in patients with both T1D and an eating disorder. In the long term, they can lead to a higher prevalence of microvascular complications such as diabetic retinopathy (with a 2.5-fold increased risk), microalbuminuria, and diabetic neuropathy. Higher mortality has also been demonstrated in these patients: a mortality rate of 4.06% for patients with T1D, 8.86% for patients with anorexia nervosa, and 14.5% for patients with both conditions.
Few studies have investigated the association between T1D and eating disorders. These studies are older, have small sample sizes, and focus on only one type of eating disorder. Within the framework of this project, the SCOFF questionnaire will be used to screen for restrictive (anorexia nervosa) and compulsive (bulimia) eating disorders. Glycemic control will be assessed through the analysis of CGM data. No study has used this innovative tool to evaluate the impact of eating disorders on type 1 diabetes.
The aim is also to change healthcare professionals' approach to eating disorders by screening for them regularly and early to prevent chronicity and short- and medium-term complications. These results could contribute to establishing specific recommendations regarding the screening for eating disorders in the management of patients with type 1 diabetes, and for appropriate multidisciplinary care.
