Assessment of patient-led or physician-driven continuous glucose monitoring in patients with poorly controlled type 1 diabetes using basal-bolus insulin regimens: a 1-year multicenter study.
Adolescent; Adult; Blood Glucose/analysis; Blood Glucose Self-Monitoring/methods; Child; Diabetes Mellitus, Type 1/blood/drug therapy; Female; Hemoglobin A, Glycosylated/metabolism; Humans; Hypoglycemic Agents/therapeutic use; Insulin/therapeutic use; Male; Middle Aged; Physicians; Young Adult
Abstract :
[en] OBJECTIVE: The benefits of real-time continuous glucose monitoring (CGM) have been demonstrated in patients with type 1 diabetes. Our aim was to compare the effect of two modes of use of CGM, patient led or physician driven, for 1 year in subjects with poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS: Patients with type 1 diabetes aged 8-60 years with HbA(1c) >/= 8% were randomly assigned to three groups (1:1:1). Outcomes for glucose control were assessed at 1 year for two modes of CGM (group 1: patient led; group 2: physician driven) versus conventional self-monitoring of blood glucose (group 3: control). RESULTS: A total of 257 subjects with type 1 diabetes underwent screening. Of these, 197 were randomized, with 178 patients completing the study (age: 36 +/- 14 years; HbA(1c): 8.9 +/- 0.9%). HbA(1c) improved similarly in both CGM groups and was reduced compared with the control group (group 1 vs. group 3: -0.52%, P = 0.0006; group 2 vs. group 3: -0.47%, P = 0.0008; groups 1 + 2 vs. group 3: -0.50%, P < 0.0001). The incidence of hypoglycemia was similar in the three groups. Patient SF-36 questionnaire physical health score improved in both experimental CGM groups (P = 0.004). Sensor consumption was 34% lower in group 2 than in group 1 (median [Q1-Q3] consumption: group 1: 3.42/month [2.20-3.91] vs. group 2: 2.25/month [1.27-2.99], P = 0.001). CONCLUSIONS: Both patient-led and physician-driven CGM provide similar long-term improvement in glucose control in patients with poorly controlled type 1 diabetes, but the physician-driven CGM mode used fewer sensors.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Riveline, Jean-Pierre
Schaepelynck, Pauline
Chaillous, Lucy
Renard, Eric
Sola-Gazagnes, Agnes
Penfornis, Alfred
Tubiana-Rufi, Nadia
Sulmont, Veronique
Catargi, Bogdan
Lukas, Celine
Radermecker, Régis ; Université de Liège > Département des sciences biomédicales et précliniques > Département des sciences biomédicales et précliniques
Assessment of patient-led or physician-driven continuous glucose monitoring in patients with poorly controlled type 1 diabetes using basal-bolus insulin regimens: a 1-year multicenter study.
Publication date :
2012
Journal title :
Diabetes Care
ISSN :
0149-5992
eISSN :
1935-5548
Publisher :
American Diabetes Association, United States - Virginia
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