MD Conference Express - (Page 12)
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F E A T U R E
Real-Time Continuous Glucose Monitoring and Diabetes Treatment
Written by Heather Q. Sinclair
Real-time continuous glucose monitoring (RT-CGM) provides valuable information about glucose trends and patterns in diabetic patients. This method of glycemic management offers the potential to improve bolus dosing and overnight control of insulin therapy among children and adults with type 1 diabetes mellitus (T1DM) through the use of hyper/ hypoglycemia alarms and retrospective data that may assist clinicians in optimizing insulinto-carbohydrate ratios and overnight basal rates. Recent trial data may provide evidence that supports the widespread use of RT-CGM in patients with T1DM. William Tamborlane, MD, Yale University School of Medicine, New Haven, CT, presented findings from recent landmark CGM studies and discussed the clinical implications of these findings. In 2006, the GuardControl study revealed that CGM resulted in lower HbA1C levels and incremental improvement in diabetes control (from very poor to poor). However, the study was relatively small (n=162 patients) and evaluated outcomes over a short period of time (12 weeks) [Deiss D et al. Diabetes Care 2006]. Recently, the Juvenile Diabetes Research Foundation CGM study explored the safety and efficacy of CGM in patients with T1DM and HbA1C levels of ≥7.0% and <7.0%. The study involved two trial arms. In the first part of the study, patients were stratified according to age group (age 8 to <15 years, 15 to <25 years, and ≥25 years) and randomized to receive either RT-CGM or standard self-monitoring of blood glucose. There were approximately 110 patients in each age group. The primary outcome was difference in HbA1C from baseline to 6 months. The second arm of the study included 129 patients with baseline HbA1C of <7.0%. Approximately 50% of patients in this cohort were <25 years old. All patients wore blinded CGM devices at baseline, and patients in the control group wore blinded CGM devices at Weeks 13 and 26. The primary outcome was the difference in frequency of sensor glucose levels <70 mg/dL. At 6 months, patients with baseline HbA1C levels > 7.0% who received RT-CGM within the ≥25 years age group demonstrated more favorable improvement in HbA1C levels compared with control, and this improvement was sustained for 12 months. There was no difference between RT-CGM and control in patients under the age of 25 years. Change in HbA1C correlated with the frequency of CGM use. In well-controlled patients with baseline HbA1C levels <7.0%, sensor glucose levels of ≤70 mg/dL occurred more often in the control group than in the CGM group (p=0.05 for Weeks 13 and 26). At 26 weeks, 88% of patients in the RT-GCM group were able to maintain optimal A1C levels (<7.0%) versus 63% in the control group (p<0.001). The closed loop CGM, often termed the “artificial pancreas,” consists of a continuous glucose monitor, insulin infusion pump, and a control algorithm that delivers insulin according to real-time glucose readings. This closed loop control system includes a self-correcting feedback loop (Figure 1). Roman Hovorka, PhD, University of Cambridge, Cambridge, United Kingdom, discussed the progress that is being made concerning the overnight closed-loop approach. Postprandial glucose control remains a challenge, and 55% to 75% of severe hypoglycemia episodes occur at night [DCCT Research Group. Am J Med 1991; Davis et al. Diabetes Care 1997]. Therefore, studies have been designed to evaluate the effect overnight closed loop devices on the incidence of nocturnal hypoglycemia and euglycemic achievement in patients with T1DM.
Highlights from the
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August 2010
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Table of Contents for the Digital Edition of MD Conference Express
MD Conference Express
Contents
Real-Time Continuous Glucose Monitoring and Diabetes Treatment
The Globalization of Diabetes
Treat the Individual, Tend to the Population
Microvascular Outcomes from the ACCORD Trial
Diabetic Retinopathy in the ACCORD Trial
Results from the STAR 3 Study
Findings from HELP PD
Insights from the BARI 2D Trial
Effect of Atorvastatin on Beta Cell Function
Caffeine Supplementation Reduces Exercise Induced Hypoglycemia
Cardiometabolic Risk
Point of Care Devides
Newer Insulins
Diabetes, Glycemia and Cardiovascular Disease: Is it Time to Rethink the Regulatory Approach?
Diabetes and Cancer: ADA Consensus Statement
The Diabetic Foot Wound
HEALTHY Study - Middle School-Based Intervention to Reduce Diabetes Risk
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