MON-563 - Continuous Glucose Monitoring (CGM) Metrics in Type 1 Diabetes with Add-on Acarbose Therapy

Glycemic variability (GV) contributes to long-term complications in Type 1 diabetes (T1DM), and postprandial glucose spikes remain a major driver of GV despite optimised insulin therapy. Acarbose delays intestinal carbohydrate absorption and may reduce glucose fluctuations. However, data evaluating standardized CGM-derived GV indices in T1DM is limited.
Aim and

Objective:


Aim: To evaluate the impact of acarbose on insulin requirements and glycemic variability in individuals with Type 1 diabetes using continuous glucose monitoring (CGM).


Objective: To analyse the effect of acarbose as an add-on therapy to insulin on CGM-derived glycaemic variability.
Materials and

Methods:
A formal sample size calculation was not conducted since this study is exploratory. Instead, a sample size of 20 participants was chosen based on feasibility, availability of CGM devices, and anticipated patient compliance with acarbose therapy and follow-up. Of 20 participants, six discontinued after baseline investigations; the remaining 14 completed the study. FreeStyle Libre 2 CGM was used for this study. The CGM data was collected at the baseline and subsequently after usage of acarbose for 3 months. CGM data from this Post-intervention Phase were compared with baseline data to evaluate the effect of acarbose as an add-on to insulin therapy on glycemic variability and insulin requirement. The readings of CGM were analysed using the eGlu software, The parameters were exported and further statistically analysed using SPSS version 24.0. Based on the Shapiro-Wilk test results, the paired t-test was used to compare pre- and post-intervention values. A p-value of less than 0.05 was considered to be statistically significant.

Results:
Acarbose add-on therapy resulted in significant improvements in glycemic variability and hyperglycemia metrics, with decreased hypoglycaemia risk. Overall Glycemia: Mean glucose decreased from 192.25 ± 29.74 to 161.62 ± 27.69 mg/dL (p < 0.01), reaching statistical significance. GMI improved from 7.91 ± 0.83% to 7.18 ± 0.76% (p = 0.056). Glycaemic Variability: MAGE decreased from 175.32 ± 33.11 to 153.39 ± 28.74 mg/dL (p = 0.004). The glycaemic variability (GV) decreased but was not statistically significant.Time-in-Range Metrics: The mean Time in Range improved from 37.98 ± 15.41% at baseline to 46.42 ± 22.32% after 12 weeks of acarbose therapy.
Discussion and

Conclusion:
Our study evaluated the impact of acarbose on glycemic and CGM parameters. The small size and duration were the main limiting factors; despite this, we observed meaningful changes in MAGE and ADRR. Although statistically not significant, a positive trend in HbA1c reduction, TIR, GMI, and mean glucose was observed. TAR decreased modestly while TBR remained unchanged, confirming safety regarding hypoglycaemia.
Keywords: Acarbose, Glycaemic Variability, MAGE, ADRR, CGM, Type 1 Diabetes.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*