SAT-644 A Case of the Use of the Eversense Continuous Glucose Monitor with Repeated Same-Pocket Insertion

Introduction:The Eversense continuous glucose monitoring (ECGM) system is a 90-day implantable, subcutaneous device approved for patients with diabetes. The manufacturer recommends alternating arms for each subsequent insertion site to allow for appropriate healing. To date, there is few data describing use of the same subcutaneous pocket for all subsequent ECGM devices. We present the experience of a patient’ s first year use of ECGM with 4 out of 5 device placements within the same subcutaneous pocket. The patient uses an insulin pump and is a concomitant user of Dexcom G5 continuous glucose monitor, allowing us to compare data from his two CGM systems. Clinical Case:42-year-old male with a 14-year history of type 1 diabetes, user of the ECGM from July 2018 to date. The first device was placed in his right arm; his second ECGM was placed in his left arm with all subsequent implant replacements in the same pocket, a total of 5 devices, four in the same pocket. Patient baseline glucometric data obtained from his first ECGM device (period 1 [P1]) indicated an estimated HbA1c (A1c [%]) of 7.06, average glucose (AG [mg/dL]) 156±61, coefficient of variation (CV) 39.1, time in range (TIR [%]) 66.73, time below range (TBR [%]) 2.59, time in serious low (SH [%]) 0.41, time above 180 mg/dL (TA180 [%]) 21.38, and time in serious high, above 250 mg/dL (TA250 [%]) 8.72. Data obtained from subsequent device insertions is described by periods of data time: period 2, 3 and 4 (P2, P3, P4). Glucometric data was as follows for the 3 time periods. A1c was 6.9, 6.9 and 7.1; AG 152±65, 153±64, 157±68; CV 42.7, 41.8, 43.3; TIR 65.7, 65.72, 64; TBR 3.81, 4.13, 3.68; SH 0.93, 0.7, 0.92; TA180 20.1, 20.2, 20.2; TA250 9.3, 9.1, 10.7 respectively for P2, P3 and P4. All four ECGM devices were replaced successfully within the same subcutaneous pocket with minimal bleeding and discomfort. There were no complications, and all devices functioned well, with excellent and constant transmitter signal and longevity. A 1-month overlapping Dexcom CGM data at the end of P2, start of P3 demonstrated A1c of 6.8; AG 144±64; TIR 67.2; TBR 7.5; SH 1.9;TA180 25.3 and TA250 8.2. ECGM data of the same time frame showed A1c of 7.3, TIR of 59.5, TBR 3.6, SH 1.09, TA180 22.1, and TA250 13.5. Conclusions:Our experience with the ECGM over repeated insertions within the same pocket shows that using this technique is a feasible method for subsequent device implantation. We present one of our patients, user of ECGM, with the longest use of same insertion pocket, demonstrating adequate and constant signal and no complications. The ECGM procedure itself has minimal risk for bleeding, pain, and infection. The use of the same pocket further decreases this risk, by decreasing the number of punctures and procedure time. Consideration for same pocket insertion is proposed to be discussed with the patient, limiting the same pocket insertion to a maximum of one year, based on our clinical experience.