Issue 156 Item 5 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.