Short reportContinuous glucose monitoring reduces both hypoglycaemia and HbA1c in hypoglycaemia-prone type 1 diabetic patients treated with a portable pumpL’apport d’une mesure continue du glucose réduit le taux d’HbA1c et la fréquence des hypoglycémies chez des patients diabétiques de type 1 traités par pompe portable à insuline et à risque hypoglycémique
Introduction
The current goals of glucose control in patients with type 1 diabetes mellitus (T1DM) include glycated haemoglobin (HbA1c) < 7% together with the lowest possible rate of hypoglycaemia. Besides impaired quality of life (QOL), frequent mild-to-moderate hypoglycaemic episodes have also been associated with an increased risk of severe hypoglycaemia because of a lack of hypoglycaemia awareness [1]. Continuous subcutaneous insulin infusion (CSII) can lead to lower HbA1c levels than with multiple daily insulin injections in T1DM patients [2], [3], with a significant reduction in severe hypoglycaemic episodes [4]. However, a subset of CSII-treated patients still experiences frequent hypoglycaemic events in everyday life [4], [5].
Nevertheless, the increasing availability of continuous glucose monitoring (CGM) is helpful in detecting hyper- and hypoglycaemic deviations that might otherwise go unrecognized with self-monitoring of blood glucose (SMBG) only [6]. Until now, the demonstrated benefits of CGM have focused on reducing HbA1c in patients who were far from achieving their targeted HbA1c levels [7], [8], while outcomes of CGM use on the occurrence of hypoglycaemia have been poorly investigated and for short time-periods only [9]. For this reason, the present study aimed to assess glucose control with 12-week CGM use compared with the usual SMBG in hypoglycaemia-prone T1DM patients treated by CSII. By design, the selected study population consisted of T1DM patients without severe hypoglycaemia or brittle diabetes but, instead, had frequent mild biochemical hypoglycaemia [10]. It is known that repeatedly low glucose levels detected by SMBG may reflect prolonged periods of asymptomatic hypoglycaemia, which may be deleterious for cognitive function and lead to arrhythmias [11].
Section snippets
Methods
The present study included 13 adult T1DM patients – treated by CSII for at least 1 year, with at least four quarterly visits a year to optimalize insulin therapy – who also had more than six recorded capillary blood glucose (CBG) values < 60 mg/dL, according to their metres, within the last 14 days prior to a routine visit to our centre. All of the included patients provided their written informed consent to participate in the observational study, which had been accepted by our institutional
Results
Of the 13 enrolled patients, seven started the study with CGM and six with SMBG only. Four patients withdrew from the study within the first 2 weeks. The three patients who dropped out while using CGM did so because of skin reactions at sensor-insertion sites, an inability to manage CGM data and the discomfort of wearing the CGM system during sports activities, respectively. The single patient who withdrew from the study during the SMBG-only period wished to have an implantable insulin-pump
Discussion
Our study demonstrates the benefits of permanent CGM for 12 weeks with the reduction of low blood glucose values in a subset of T1DM patients prone to hypoglycaemia during CSII. Moreover, the reduction of hypoglycaemic values while using CGM was associated with improvement of HbA1c levels, an unusual finding in patients with T1DM for whom the intensification of insulin therapy to lower HbA1c levels is generally associated with a higher rate of hypoglycaemic episodes [1]. The importance of
Conflict of interest statement
No relevant conflict of interest to declare.
Acknowledgments
We thank the patients, nurses and physicians at our clinic who participated in our investigation. Also, the study was financially supported in part by the Fonds Léon-Fredericq (Leon Fredericq Foundation) at the University of Liège, Belgium.
Some of the data from this study were presented at the 44th Annual Meeting of the European Association for the Study of Diabetes, held in Rome, Italy, 7–11 September 2008.
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