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Purpose To compare the efficacy and safety of early versus later ab interno gelatin microstent placement with mitomycin C. Design Canada-wide, multicenter, retrospective propensity score-matched cohort study. Participants Two hundred seventy eyes (135 early cases and 135 later cases) with no prior incisional surgery. Methods Surgeons’ first 20 patients (early cases group), from 6 glaucoma surgeons across 4 Canadian sites, were matched 1:1 to patients with the closest propensity score from the later (21+) patients (later cases group). Main Outcome Measures Primary outcome was hazard ratio (HR) of failure of the early versus later cases groups, with failure defined as IOP of less than 6 mmHg with more than 2 lines of vision loss or more than 17 mmHg with no medications (complete success) on 2 consecutive visits despite in-clinic maneuvers (including needling) more than 1 month after surgery. Secondary outcomes were HRs for failure, defined as IOP outside the range of 6 to 14 mmHg and 6 to 21 mmHg with and without allowing for medications (qualified success), interventions, complications, and reoperations. Results Hazard ratio of failure for early versus later cases groups was 1.38 (95% confidence interval [CI], 0.97–1.96) for the IOP range of 6 to 17 mmHg, 1.29 (95% CI, 0.90–1.84) for 6 to 14 mmHg, and 1.48 (95% CI, 1.03–2.13) for 6 to 21 mmHg without medication and 0.95 (95% CI, 0.55–1.64), 0.95 (95% CI, 0.61–1.48), and 0.95 (95% CI, 0.52–1.75) for the same IOP ranges allowing for medications. Needling rates were 43.0% (early cases group) and 41.5% (later cases group). Complication rates after 1 month occurred in 9.6% (early cases group) and 11.1% (later cases group; P = 0.69). Reoperation rates were 14.8% (early cases group) and 8.1% (later cases group; P = 0.08). Conclusions There is some evidence for improved success in the later cases group. Similar needling rates, similar complication rates, and a slightly higher reoperation rate were found for the early cases group. The results suggest that this procedure can be adopted by existing surgeons with current training regimens, although they may see an improvement in their success outcomes over time.

Background: Type 2 diabetes poses an economic burden to healthcare systems. For individuals with non-intensively treated T2DM, it is unclear whether the use of CGM would add health-economic value. The aim of this study was to compare the costs of SMBG compared to CGM in non-intensively treated T2DM. Methods: A retrospective cost-analysis using the IBM® MarketScan® Databases was conducted. T2DM patients aged ≥18 years who were using SMBG or initiated CGM between Jan 2018 and March 20were eligible for inclusion. Inclusion criteria included two consecutive claims for T2DM or one claim for T2DM and a claim for glucose lowering therapy, at least one pharmacy claim for SMBG strips or CGM sensors and continuous enrollment for 1-year before and after the index date. Individuals with CGM in pre-index period, pregnancy, rapid-acting insulin, glucagon, T1DM, gestational or secondary diabetes were excluded. SMBG and CGM patients were matched using a propensity score and all cause costs during a one-year follow-up period were compared. Results: A total of 3,498 patients were included in each matched cohort. For CGM patients, 77% used flash monitoring and 23% a real-time CGM. 35% of SMBG and 37% of CGM users were on basal insulin. Considering median values, SMBG total healthcare costs per person/year were $1,934 less vs. CGM users (p < 0.05) . SMBG patients had significantly lower pharmacy cost (-$2,257, p Conclusion: This analysis shows that SMBG is less costly than CGM in non-intensively treated T2DM patients and is associated with lower pharmacy costs, including glucose-lowering medications. Furthermore, no significant differences in the number of emergency room visits or hospitalizations are seen in SMBG and CGM users. Disclosure D. Kerr: Advisory Panel; Abbott Diabetes, Novo Nordisk A/S, Sanofi. Consultant; Evidation Health. Research Support; Novo Nordisk A/S. Stock/Shareholder; Glooko, Inc., Hi.Health. I. Duncan: Consultant; Onduo LLC. F. Giorgino: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk. Consultant; Lilly Diabetes, Sanofi. Research Support; Lilly Diabetes, Roche Diabetes Care, Takeda Pharmaceutical Company Limited. E. Repetto: Employee; Roche Diabetes Care. C. Perkins: Employee; Roche Diagnostics USA. R. Maroun: Employee; Amgen Inc., Roche Diagnostics. M. Rivers: Employee; Roche Diabetes Care. A. Wu: None.

Background: To maintain glucose control in T1DM is especially difficult in children that have unpredictable amounts of physical activity and broad eating patterns. Advances in diabetes technology include Continuous Subcutaneous Insulin Infusion (CSII) and patch/tubeless micropumps are newer options available. Patch pumps are free of tubing, small and lightweight. We aimed to report the initial clinical effect of an insulin micropump therapy in a cohort of children with T1DM. Method: We studied pediatric patients (5-years old) , converting from multiple daily injections of insulin (MDI) to Roche Accu-chek Solo tubeless micropump system. Nine children (5 female/4 male) were followed during 1 and 3 months. All patients used Continuous Glucose Monitoring (CGM) and data was collected to learn time spent in hypoglycemia, normoglycemia and hyperglycemia, as well the glucose variability. Results: Data from this small cohort showed that basal insulin infusion rates at baseline and 3 months were similar (7.7U to 7.6U) and insulin bolus requirements reduced from 14.3U to 12.7U, respectively. Based on CGM analysis the table below shows the % of time spent at different glycemia values (mean/SD) , as well its variability. HbA1c was 7.3% at baseline and 7.4% after 3 months, and there were no emergency room admissions due to severe hypoglycemia. Conclusion: The initial results of this new insulin micropump therapy in children showed an improvement on glucose control and variability, without increasing hypoglycemia. Additional studies are necessary to demonstrate the medium and long-term effect of this new device in this population. Disclosure L. Rista: Advisory Panel; Roche Diabetes Care. Speaker's Bureau; AstraZeneca, Novo Nordisk. A. Flores: Speaker's Bureau; Novo Nordisk, Roche Diabetes Care, Sanofi. M. Rivers: Employee; Roche Diabetes Care. C. Vulcano: Employee; Roche Diabetes Care. E. Repetto: Employee; Roche Diabetes Care.