Reducing glycaemic variability in type 1 diabetes self-management with a continuous glucose monitoring system based on wired enzyme technology

Abstract

Aims/hypothesis This study was designed to investigate the use and impact of a continuous glucose monitoring system (the FreeStyle Navigator) under home-use conditions in the self-management of type 1 diabetes. Methods A 20 day masked phase, when real-time data and alarms were not available, was compared with a subsequent 40 day unmasked phase for a number of specified measures of glycaemic variability. HbA 1c (measured by DCA 2000) and a hypoglycaemia fear survey were recorded at the start and end of the study. Results The study included 48 patients with type 1 diabetes (mean age 35.7±10.9, range 18-61 years; diabetes duration 17.0±9.5 years). Two patients did not complete the study for personal reasons. Comparing masked (all 20 days) and unmasked (last 20 days) phases, the following reductions were seen: time outside euglycaemia from 11.0 to 9.5 h/day (p=0.002); glucose SD from 3.5 to 3.2 mmol/l (p<0.001); hyperglycaemic time (>10.0 mmol/l) from 10.3 to 8.9 h/day (p=0.0035); mean amplitude of glycaemic excursions (peak to nadir) down by 10% (p<0.001); high blood glucose index down by 18% (p=0.0014); and glycaemic risk assessment diabetes equation score down by 12% (p= 0.0013). Hypoglycaemic time (<3.9 mmol/l) decreased from 0.70 to 0

Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment

“…Such Fig. 1 HbA 1c in patients with regular sensor use (≥1 sensor/week; n=37; upper curve) and those in the combined group with no or low sensor use (<1 sensor/week; n=95; lower curve) compared by Kaplan-Meier plot and logrank test (p=0.032) reduction in variability has been observed previously in short-term interventions in children and adults [6]. Patients with CGM performed fewer finger pricks per day than those without CGM but it should be noted that CGM systems cannot eliminate the need for self monitoring blood glucose using an exogenous meter.…”

“…High number of blood glucose tests per day was shown to be the most important factor related to an improved HbA 1c level in adolescents [4]. In short-term studies, the use of continuous glucose monitoring (CGM) has been shown to improve glycaemic control and variability, both in children and in adults with long-standing type 1 diabetes [5,6], whereas in a long-term study lasting 26 weeks, a beneficial effect of CGM was seen only in adults [7]. Despite problems that may be related to the inconvenience of wearing CGM devices, low compliance and consequently poor glycaemic results, particularly in young patients, may be associated with difficulties in implementing the information from the system and adjusting the therapy accordingly.…”

Real-Life Utilization of Real-Time Continuous Glucose Monitoring: The Complete Picture

“…1,5,6,9,10 This is not to say that pediatric patients do not benefit from RT-CGM use. The DirecNet Study Group 2 and Danne and colleagues 4 both noted that an increased frequency of RT-CGM use in the pediatric population was associated with better glycemic control and more metabolic benefits, such as decreased glucose variability and less hypoglycemia. 12 What is not highlighted in these studies is the difficulty that the subjects had with sensor use.…”

“…Many studies demonstrate the significant beneficial impact of this technology on glycemic control. [1][2][3][4][5][6][7][8][9][10][11][12][13] However, it is not enough to simply give people with diabetes a RT-CGM system, train them on its use, and send them home with it. They must actually use it for it to work.…”

Comparative Effectiveness of Basal-BolusVersusPremix Analog Insulin on Glycemic Variability and Patient-Centered Outcomes during Insulin Intensification in Type 1 and Type 2 Diabetes: A Randomized, Controlled, Crossover Trial

“…One study concluded that glycemic variability is one of the components of glycemic disorders in patients with diabetes and that the use of CGM will need to be increased to promote better assessment and management of glycemic variability in both type 1 and type 2 diabetes (8). Another study found that a CGM system had a positive effect on the self-management of diabetes by lowering glycemic variability (9).…”