Improved Glycemic Control through Continuous Glucose Sensor-Augmented Insulin Pump Therapy: Prospective Results from a Community and Academic Practice Patient Registry

Cohen, Ohad; Körner, Anna; Chlup, Rudolf; Zoupas, Christos; Ragozin, A K; Wudi, Krisztina; Bartášková, Dagmar; Pappas, Aggelos; Niederland, Tamás; Zoltán, Taybani; Barák, L; Vazeou, Andriani

doi:10.1177/193229680900300429

Cited by 23 publications

(27 citation statements)

References 23 publications

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“…The results of this pilot study are in accordance with the recent state of the art of development of closed loop systems using CGMS-augmented insulin pumps 9,11,19,20 . Example 1 a) Plasma glucose concentration is 3.5 mmol/L, ie.…”

Section: Discussionsupporting

confidence: 75%

“…This overcomes the limitations of traditional monitoring by producing glucose profiles instead of distinct measurements, real-time glucose values, glucose trends and warnings when glucose values approach dangerously low or high concentrations. In this way, frequent use of CGM systems and careful pattern analysis can improve glycaemic control [7][8][9][10] . On the other hand, evaluation of the prolific data provided by CGMS often makes the implementation of CGMS in practice, difficult.…”

Section: Introductionmentioning

confidence: 99%

“…From1974, following the introduction of glucometers into daily routine, self-monitoring of plasma/ blood glucose (SMPG/SMBG) became the predominant mode of glucose monitoring 6 . From the year 2000, the use of continuous glucose monitoring systems (CGMS) has shown remarkable benefits for both people with type 1 and type 2 diabetes [7][8][9][10][11][12] . The development of CGMS technology is a great step toward modern diabetes management 13 .…”

Section: Introductionmentioning

confidence: 99%

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Glucose concentrations in blood and tissue - a pilot study on variable time lag

Chlup¹,

Krejčí²,

O’Connell³

et al. 2015

BIOMED PAP

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Aim. The aim of this pilot study was to acquire insight into the parameters of glycaemic control, especially, (1) the time delay (lag phase) between plasma and tissue glucose concentrations in relation to rise and fall in glucose levels and (2) the rate of glucose increase and decrease. Methods. Four healthy people (HP), 4 people with type 1diabetes (DM1) and 4 with type 2 diabetes (DM2) underwent concurrent glucose measurements by means of (1) the continuous glucose monitoring system (CGMS-Medtronic), Medtronic-Minimed, CA, USA, calibrated by the glucometer Calla, Wellion, Austria, and, (2) the Beckman II analyser to measure glucose concentrations in venous plasma. Samples were taken on 4 consecutive days in the fasting state and 4 times after consumption of 50 g glucose. Carelink Personal, MS Excel, Maple and Mat lab were applied to plot the evolution of glucose concentration and analyse the results. The time difference between increase and decrease was calculated for HP, DM 1 and DM 2. Results. In DM1and DM2, glucose tolerance testing (GTT) resulted in slower transport of glucose into subcutaneous tissue than in HP where the lag phase lasted up to 12 min. The maximum increase/decrease rates in DM1 and DM2 vs HP were 0.25 vs < 0.1 mmol/L/min. Conclusion. CGMS is shown to provide reliable plasma glucose concentrations provided the system is calibrated during a steady state. The analysis of glucose change rates improves understanding of metabolic processes better than standard GTT.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Glucose concentrations in blood and tissue - a pilot study on variable time lag

Chlup¹,

Krejčí²,

O’Connell³

et al. 2015

BIOMED PAP

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“…Considering reported data, RT-CGM may possibly be viewed as a behavior-modification tool, and its success is directly dependent on the manner in which it is used. 6 In all the previously mentioned studies there was a positive association between overall sensor use and glycemic profile benefit.…”

Section: Introductionmentioning

confidence: 99%

The SWITCH Study (Sensing With Insulin pump Therapy to Control HbA_1c): Design and Methods of a Randomized Controlled Crossover Trial on Sensor-Augmented Insulin Pump Efficacy in Type 1 Diabetes Suboptimally Controlled with Pump Therapy

Conget¹,

Battelino

Giménez³

et al. 2011

Diabetes Technology & Therapeutics

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Background: Studies investigating the effect of real-time continuous glucose monitoring (CGM) combined with pump therapy on glycemic outcomes in type 1 diabetes are increasing. Pump therapy is well established as a ''gold standard'' for insulin delivery, offering improvements over multiple daily insulin injections. However, there is still a proportion of subjects using continuous subcutaneous insulin infusion in whom goals for metabolic control are far from achieved or benefits of this type of insulin therapy are transient. The SWITCH (Sensing With Insulin pump Therapy to Control HbA 1c [hemoglobin A1c]) study is a multicenter, randomized, controlled, crossover study to evaluate if adding CGM to experienced pump patients with suboptimal metabolic control will provide additional insight enabling clinical and therapeutic benefit. Methods: Subjects meeting the inclusion criteria were randomized to Sensor On or Sensor Off arms for 6 months, after a 1-month run-in period. Following a 4-month washout period, the subjects crossed over to the other study arm for 6 months. The primary end point was the between arm difference in HbA 1c levels. Among others, additional end points include time spent in different glycemic ranges, percentage of patients with HbA 1c <7%, number of hypoglycemic events, glucose variability parameters, safety outcomes, treatment satisfaction, and quality of life. Results: Recruitment occurred between January 2008 and February 2009. A total of 153 patients were randomized. Study completion is anticipated in July 2010. Conclusions: The results will establish if adding CGM to existing, capable, insulin pump users can enable better metabolic control.

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“…48 Continuous glucose sensing-augmented insulin pump therapy is a further technological advance, whereby sensor-augmented insulin pump therapy integrates real-time CGM with CSII, a technique that has demonstrated improvements in glycemic control in clinical trials and real-world settings. [49][50][51] SMBG versus retrospective CGM Although the CGMS detected significantly more incidences of hypoglycemia and postprandial hyperglycemia compared with standard blood glucose testing, the day-to-day variability was similar between the two groups, and, with a sensor failure rate of 28%, 52 the effectiveness of this method of CGM is debatable.…”

Section: Sensor-augmented Insulin Pump Therapymentioning

confidence: 80%

Evolution of Devices in Diabetes Management

Penfornis

Personeni

Borot

2011

Diabetes Technology & Therapeutics

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Recent technological advancements in insulin administration and glucose monitoring have allowed patients with diabetes to become increasingly involved in their own care. Devices replacing the traditional vial and syringe, such as insulin pens, are gaining popularity and offer simple and convenient insulin administration. Pen devices are associated with improved dose accuracy, reducing the risk of hypo- or hyperglycemia, and are continually being updated with new safety features in order to optimize their performance. In patients for whom glucose variability remains a problem, continuous subcutaneous insulin infusion via an implanted canula or continuous intraperitoneal insulin infusion via an implanted pump is safe and effective when used correctly, although cost can be a limitation. More accurate retrospective and real-time continuous monitoring devices, which can better detect blood glucose excursions, have become standard components of modern-day diabetes management. The most recent devices have sensor-signaling capabilities with wireless data transmission, leading to reduced time delay and more accurate alerts. Ultimately, though, while self-management remains a critical factor in improving glycemic control at present, human error may undermine even the most accurate treatment interventions. A key long-term goal in diabetes management is, therefore, to develop an automated and accurate closed-loop system for blood glucose monitoring and insulin delivery to better reflect the physiological mechanisms of glucose homeostasis and remove the "human" element. This "artificial pancreas" would offer the most innovative intervention for diabetes management and has the potential to considerably reduce the patient's burden of self-care.

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Improved Glycemic Control through Continuous Glucose Sensor-Augmented Insulin Pump Therapy: Prospective Results from a Community and Academic Practice Patient Registry

Cited by 23 publications

References 23 publications

Glucose concentrations in blood and tissue - a pilot study on variable time lag

Glucose concentrations in blood and tissue - a pilot study on variable time lag

The SWITCH Study (Sensing With Insulin pump Therapy to Control HbA_1c): Design and Methods of a Randomized Controlled Crossover Trial on Sensor-Augmented Insulin Pump Efficacy in Type 1 Diabetes Suboptimally Controlled with Pump Therapy

Evolution of Devices in Diabetes Management

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Improved Glycemic Control through Continuous Glucose Sensor-Augmented Insulin Pump Therapy: Prospective Results from a Community and Academic Practice Patient Registry

Cited by 23 publications

References 23 publications

Glucose concentrations in blood and tissue - a pilot study on variable time lag

Glucose concentrations in blood and tissue - a pilot study on variable time lag

The SWITCH Study (Sensing With Insulin pump Therapy to Control HbA1c): Design and Methods of a Randomized Controlled Crossover Trial on Sensor-Augmented Insulin Pump Efficacy in Type 1 Diabetes Suboptimally Controlled with Pump Therapy

Evolution of Devices in Diabetes Management

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The SWITCH Study (Sensing With Insulin pump Therapy to Control HbA_1c): Design and Methods of a Randomized Controlled Crossover Trial on Sensor-Augmented Insulin Pump Efficacy in Type 1 Diabetes Suboptimally Controlled with Pump Therapy