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Real-Time Continuous Glucose Monitoring Improves Glycemic Control

Use of real-time continuous glucose monitoring helps to improve glycemic control in patients with poorly controlled type 1 diabetes, according to new published findings. "Intensive self-management with frequent self-monitoring of blood glucose (SMBG) is important in type 1 diabetes to achieve good metabolic control," Dr. Jan Bolinder, of Karolinska University Hospital Huddinge, Stockholm, Sweden, and colleagues write. "Nevertheless, many patients still experience episodes of unrecognized hypo- and hyperglycemia."

The researchers examined the effect of a new real-time glucose monitor (Guardian RT) on glycemic control in poorly controlled type 1 diabetes. The device allows users to see interstitial glucose readings (calibrated to SMBG reference values) and to set low and high glucose alarms. In addition, the monitor provides trend information on changing glucose values.

The study included 81 children (median age 14.4 years) and 81 adults (age 39.1 years). All of the subjects had adhered to intensified insulin treatment, but had HbA1c levels of 8.1% or more.

The patients were randomly assigned for 3 months to use the Guardian RT continuously (arm 1) or for 3-day periods every 2 weeks (arm 2), or to continue conventional SMBG (control).

If hypo- or hyperglycemic alarms or symptoms occurred, the subjects were asked to perform confirmatory SMBG measurements prior to corrective actions.

Overall, 156 patients completed the study. Mean baseline A1c values were 9.5%, 9.6%, and 9.7% in arms 1, 2 and control, respectively.

An association was seen between real-time CGM and reductions from baseline in A1c in arm 1 versus control at 1 month (0.6% versus 0.2%, p = 0.008) and 3 months (1.0% versus 0.4%, p = .003). No significant differences were found for arm 2 versus control or arm 1.

"At 3 months, 50% of the patients in arm 1 had A1c reductions of at least 1% (37% in arm 2 and 15% in control arm) and 26% had reductions of at least 2% (9% in arm 2 and 4% in control arm)," Dr. Bolinder and colleagues report.

The team notes that this is "the first randomized controlled trial to demonstrate a clinically meaningful reduction in A1c using real-time continuous glucose monitoring in type 1 diabetic patients."

Diabetes Care 2006;29:2730-2732.

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