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Glycemic patterns detected by continuous subcutaneous glucose sensing in children and adolescents with type 1 diabetes mellitus treated by multiple daily injections vs continuous subcutaneous insulin infusion.
Arch Pediatr Adolesc Med. 2004 Jul; 158(7):677-84.AP

Abstract

OBJECTIVE

To compare glycemic patterns by mode of therapy in children with type 1 diabetes mellitus using the Continuous Glucose Monitoring System (CGMS).

DESIGN

Open randomized crossover comparing 3(1/2) months of multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII).

SETTING

Tertiary care, university-affiliated medical center. Patients Twenty-three children and adolescents with type 1 diabetes mellitus.

INTERVENTIONS

The CGMS was applied for 72 hours after 1 month and at the end of each study arm.

MAIN OUTCOME MEASURES

Hemoglobin A(1c) levels and glucose level profiles were compared between the 2 study arms and the 2 sensor applications for each arm.

RESULTS

The arms were similar for mean (SD) hemoglobin A(1c) levels (CSII, 8.0% [0.8%]; and MDI, 8.2% [0.8%]) and glucose levels. Areas under the curve were significantly larger during MDI for nocturnal and 24-hour hypoglycemia (P =.01 and.04, respectively) and for postprandial hypoglycemia and hyperglycemia (P =.03 and.05, respectively). The rate of hyperglycemia increased during CSII (P =.03), but 24-hour duration and area under the curve for hyperglycemia were similar. Compared with the first CGMS reading in each arm, the second had a longer mean duration of postprandial within-target glucose levels (P =.04), tendency for lower rate of diurnal hypoglycemic events (P =.1), shorter duration of nocturnal hypoglycemia (P =.05), and smaller 24-hour area under the curve for hypoglycemia (P =.04).

CONCLUSIONS

Intensive treatment with CSII seemed to be associated with slightly better prebreakfast, postprandial, and within-target glucose profiles than MDI, as well as a smaller area under the curve for hypoglycemia. Lower hypoglycemia-related variables in the second sensor reading in each arm indicate that the CGMS may serve as an educational tool to decrease the rate and magnitude of hypoglycemia.

Authors+Show Affiliations

Institute for Endocrinology and Diabetes, National Center of Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. nweintrob@clalit.org.ilNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15237068

Citation

Weintrob, Naomi, et al. "Glycemic Patterns Detected By Continuous Subcutaneous Glucose Sensing in Children and Adolescents With Type 1 Diabetes Mellitus Treated By Multiple Daily Injections Vs Continuous Subcutaneous Insulin Infusion." Archives of Pediatrics & Adolescent Medicine, vol. 158, no. 7, 2004, pp. 677-84.
Weintrob N, Schechter A, Benzaquen H, et al. Glycemic patterns detected by continuous subcutaneous glucose sensing in children and adolescents with type 1 diabetes mellitus treated by multiple daily injections vs continuous subcutaneous insulin infusion. Arch Pediatr Adolesc Med. 2004;158(7):677-84.
Weintrob, N., Schechter, A., Benzaquen, H., Shalitin, S., Lilos, P., Galatzer, A., & Phillip, M. (2004). Glycemic patterns detected by continuous subcutaneous glucose sensing in children and adolescents with type 1 diabetes mellitus treated by multiple daily injections vs continuous subcutaneous insulin infusion. Archives of Pediatrics & Adolescent Medicine, 158(7), 677-84.
Weintrob N, et al. Glycemic Patterns Detected By Continuous Subcutaneous Glucose Sensing in Children and Adolescents With Type 1 Diabetes Mellitus Treated By Multiple Daily Injections Vs Continuous Subcutaneous Insulin Infusion. Arch Pediatr Adolesc Med. 2004;158(7):677-84. PubMed PMID: 15237068.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glycemic patterns detected by continuous subcutaneous glucose sensing in children and adolescents with type 1 diabetes mellitus treated by multiple daily injections vs continuous subcutaneous insulin infusion. AU - Weintrob,Naomi, AU - Schechter,Amir, AU - Benzaquen,Hadassa, AU - Shalitin,Shlomit, AU - Lilos,Pearl, AU - Galatzer,Avinoam, AU - Phillip,Moshe, PY - 2004/7/9/pubmed PY - 2004/8/13/medline PY - 2004/7/9/entrez SP - 677 EP - 84 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 158 IS - 7 N2 - OBJECTIVE: To compare glycemic patterns by mode of therapy in children with type 1 diabetes mellitus using the Continuous Glucose Monitoring System (CGMS). DESIGN: Open randomized crossover comparing 3(1/2) months of multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII). SETTING: Tertiary care, university-affiliated medical center. Patients Twenty-three children and adolescents with type 1 diabetes mellitus. INTERVENTIONS: The CGMS was applied for 72 hours after 1 month and at the end of each study arm. MAIN OUTCOME MEASURES: Hemoglobin A(1c) levels and glucose level profiles were compared between the 2 study arms and the 2 sensor applications for each arm. RESULTS: The arms were similar for mean (SD) hemoglobin A(1c) levels (CSII, 8.0% [0.8%]; and MDI, 8.2% [0.8%]) and glucose levels. Areas under the curve were significantly larger during MDI for nocturnal and 24-hour hypoglycemia (P =.01 and.04, respectively) and for postprandial hypoglycemia and hyperglycemia (P =.03 and.05, respectively). The rate of hyperglycemia increased during CSII (P =.03), but 24-hour duration and area under the curve for hyperglycemia were similar. Compared with the first CGMS reading in each arm, the second had a longer mean duration of postprandial within-target glucose levels (P =.04), tendency for lower rate of diurnal hypoglycemic events (P =.1), shorter duration of nocturnal hypoglycemia (P =.05), and smaller 24-hour area under the curve for hypoglycemia (P =.04). CONCLUSIONS: Intensive treatment with CSII seemed to be associated with slightly better prebreakfast, postprandial, and within-target glucose profiles than MDI, as well as a smaller area under the curve for hypoglycemia. Lower hypoglycemia-related variables in the second sensor reading in each arm indicate that the CGMS may serve as an educational tool to decrease the rate and magnitude of hypoglycemia. SN - 1072-4710 UR - https://www.unboundmedicine.com/medline/citation/15237068/Glycemic_patterns_detected_by_continuous_subcutaneous_glucose_sensing_in_children_and_adolescents_with_type_1_diabetes_mellitus_treated_by_multiple_daily_injections_vs_continuous_subcutaneous_insulin_infusion_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/archpedi.158.7.677 DB - PRIME DP - Unbound Medicine ER -