Incremental Value of Continuous Glucose Monitoring When Starting Pump Therapy in Patients With Poorly Controlled Type 1 Diabetes
| Autor: | Yves Reznik, Eric Renard, V. Sulmont, Nathalie Jeandidier, Marc Nicolino, Hélène Hanaire, Denis Raccah, Bruno Guerci |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Blood Glucose Male Insulin pump medicine.medical_specialty endocrine system diseases Adolescent Emerging Treatments and Technologies Endocrinology Diabetes and Metabolism medicine.medical_treatment Monitoring Ambulatory Hypoglycemia Body Mass Index Insulin Infusion Systems Blood Glucose Self-Monitoring Diabetes mellitus Internal Medicine medicine Humans Hypoglycemic Agents Insulin Age of Onset Child Original Research Glycemic Glycated Hemoglobin Advanced and Specialized Nursing Type 1 diabetes Dose-Response Relationship Drug business.industry nutritional and metabolic diseases medicine.disease Surgery Diabetes Mellitus Type 1 Anesthesia Female Minimed Paradigm business |
| Zdroj: | Diabetes Care |
| ISSN: | 1935-5548 0149-5992 |
| DOI: | 10.2337/dc09-0750 |
| Popis: | OBJECTIVE To compare the improvements in glycemic control associated with transitioning to insulin pump therapy in patients using continuous glucose monitoring versus standard blood glucose self-monitoring. RESEARCH DESIGN AND METHODS The RealTrend study was a 6-month, randomized, parallel-group, two-arm, open-label study of 132 adults and children with uncontrolled type 1 diabetes (A1C ≥8%) being treated with multiple daily injections. One group was fitted with the Medtronic MiniMed Paradigm REAL-Time system (PRT group), an insulin pump with integrated continuous subcutaneous glucose monitoring (CGM) capability, with instructions to wear CGM sensors at least 70% of the time. Conventional insulin pump therapy was initiated in the other group (continuous subcutaneous insulin infusion [CSII] group). Outcome measures included A1C and glycemic variability. RESULTS A total of 115 patients completed the study. Between baseline and trial end, A1C improved significantly in both groups (PRT group −0.81 ± 1.09%, P < 0.001; CSII group −0.57 ± 0.94%, P < 0.001), with no significant difference between groups. When the 91 patients who were fully protocol-compliant (including CGM sensor wear ≥70% of the time) were considered, A1C improvement was significantly greater in the PRT group (P = 0.004) (PRT group −0.96 ± 0.93%, P < 0.001; CSII group −0.55 ± 0.93%, P < 0.001). Hyperglycemia parameters decreased in line with improvements in A1C with no impact on hypoglycemia. CONCLUSIONS CGM-enabled insulin pump therapy improves glycemia more than conventional pump therapy during the first 6 months of pump use in patients who wear CGM sensors at least 70% of the time. |
| Databáze: | OpenAIRE |
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