OBJECTIVE -This randomized controlled trial assesses the effect on glycemic control of continuous glucose monitoring system (CGMS)-guided insulin therapy adjustment in young people with type 1 diabetes on intensive diabetes treatment regimens with continuous subcutaneous insulin infusion (CSII) or glargine.RESEARCH DESIGN AND METHODS -Pediatric subjects were recruited if they had an HbA 1c (A1C) Ͻ10% and had been on CSII or glargine for at least 3 months. Thirty-six subjects were randomized to insulin adjustment on the basis of 72 h of CGMS every 3 weeks or intermittent self-monitoring of blood glucose (SMBG) for 3 months. A1C and fructosamine were measured at baseline and 6 and 12 weeks. Follow-up A1C was measured at 6 months. Mean baseline A1C was 8.2% (n ϭ 19) in the CGMS group and 7.9% (n ϭ 17) in the control group.RESULTS -There was a significant improvement in A1C from baseline values in both groups, but there was no difference in the degree of improvement in A1C at 12 weeks between the CGMS (Ϫ0.4% [95% CI Ϫ0.7 to Ϫ0.1]) and the control group (Ϫ0.4% [Ϫ0.8 to 0.2]). In the CGMS group, improved A1C was at the cost of increased duration of hypoglycemia.CONCLUSIONS -CGMS is no more useful than intermittent fingerstick SMBG and frequent review in improving diabetes control in reasonably well-controlled patients on nearphysiological insulin regimens when used in an outpatient clinic setting.
Aims: To determine the outcome of children with neuromuscular disease (NMD) following admission to a tertiary referral paediatric intensive care (PICU). Methods: All children with chronic NMD whose first PICU admission was between July 1986 and June 2001 were followed up from their first PICU admission to time of study. The outcomes recorded were death in or outside of PICU, duration of PICU admission, artificial ventilation during admission and following discharge from PICU, and readmission to PICU. Results: Over 15 years, 28 children were admitted on 69 occasions. Sixteen (57%) children had more than one admission. The median duration of PICU admission was 4 days (range 0.5-42). Twenty three per cent of unplanned admissions resulted in the commencement of respiratory support that was continued after discharge from the PICU. Severity of functional impairment was not associated with longer duration of stay or higher PRISM scores. Ten children (36%) died, with four (14%) deaths in the PICU. A higher proportion of children with severe limitation of function were among children that died compared to survivors. Conclusion: Most children with NMD admitted to the PICU recover and are discharged without the need for prolonged invasive ventilation. However, in this group of children, the use of non-invasive home based ventilation is common and they are likely to require further PICU admission.A cute respiratory insufficiency is a common complication of chronic neuromuscular disorders (NMD) such as Duchenne muscular dystrophy (DMD) or spinal muscular atrophy (SMA). A common fear is that once intubated for an acute illness, children with NMD will not recover to be weaned from ventilation.1 In a UK study, 27% of all PICU admissions requiring ventilation for more than 28 days after an acute illness had an underlying neuromuscular disorder, and 45% of this group died.
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