In preschool children with type 1 diabetes, twice-daily insulin injections fail to provide adequate glycemic control, with frequent and prolonged episodes of either hypo- or hyperglycemia.
The study also suggests that use of a continuous glucose monitoring system (CGMS) reveals daily glucose trends missed by self-monitoring of blood glucose (SMBG) and is well tolerated by patients and their families.
Dr. George S. Jeha, from Texas Children’s Hospital in Houston, and colleagues used the Medtronic MiniMed CGMS to evaluate the degree of metabolic control in 10 children younger than age 6 with type 1 diabetes that was considered "well controlled" based on SMBG and HbA1c. All of the children underwent two 72-hour periods of CGMS monitoring separated by 1 month. All of the children were on lispro insulin.
Dr. Jeha stated that, "most of children spent a significant amount of time (6% of a 24-hour period) with hypoglycemia. Each child on average had at least one hypoglycemia episode per day lasting close to 1 hour." These hypoglycemic episodes occurred mainly over night when the children were asleep and therefore went undetected.
Equally concerning, Dr. Jeha said, is that when those children are not hypoglycemic they were typically running high glucose values. "Almost 50% of a 24-hour period is spent with values greater than 200 mg/dL with the normal range being 80-120 mg/dL" he said, with postprandial hyperglycemia an almost universal finding.
"The third important finding is that all of these kids have an acceptable HbA1c for age and are considered well controlled," Dr. Jeha emphasized.
This study shows that HbA1c "is not a very reliable predictor of good control and only reflects the average of extreme high and extreme low glucose values thus giving a false reassurance that the patient is doing well when in fact he or she is not," Dr. Jeha said.
He believes that the management of young children with type 1 diabetes needs to change to improve the control of their disease. He said that his team has just completed a study showing that insulin pump therapy significantly improves metabolic control and lifestyle in diabetic children.
Diabetes Care 2004;27:2881-2886
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