CGM
Aids Glycemic Control in Young Diabetics
A
continuous subcutaneous glucose monitoring system
improves metabolic control in pediatric patients
with type 1 diabetes.
Swedish researchers reported in the May issue
of Pediatrics.
The continuity is particularly important, said
lead investigator Dr. Johnny Ludvigsson. "When
patients see the continuous blood glucose profiles
they may finally understand what they never understood
from sporadic values." This is "the
connection between meals, insulin, exercise and
how blood glucose fluctuates."
Drs. Ludvigsson and Ragnar Hanas of Linkoping
and Central Hospital, Uddevalla, studied 27 type
1 diabetes patients ranging in age from 5 to 19
years. All were being treated with intensive insulin
therapy. They were randomized to open or blind
study arms. Those in both groups wore the glucose
sensor for 3 days every 2 weeks, and the groups
crossed over at 3 months.
Glucose profiles obtained from the system were
used to adjust insulin therapy in the open arm
at follow-up visits every 6 weeks. However, in
the blind arm, neither the team nor the patients
were aware of these profiles and adjustment was
based solely on 7-point glucose readings obtained
weekly by the patients.
Although both the investigators and their patients
initially had problems with the unfamiliar devices,
in the open study arm, hemoglobin A1C values decreased
from 7.70% to 7.31%, a significant difference.
No such difference was seen in the blind arm.
Another "surprising and perhaps even scary
finding," say the researchers, was that all
patients had at least one nocturnal episode of
low subcutaneous glucose and all but one had such
experiences during the day.
Overall, the investigators conclude that the system
is a useful tool for education and improvement
of metabolic control. As Dr. Ludvigsson pointed
out, "insight and increasing motivation often
mean a lot." Pediatrics 2003;111:933-938.
