Sept. 8, 2008
Researchers help show continuous glucose monitoring improves blood sugar control
Patients with type 1 diabetes who used continuous glucose monitoring (CGM) devices to help manage their disease experienced significant improvements in blood sugar control, according to initial results of a major multicenter clinical trial funded by the Juvenile Diabetes Research Foundation (JDRF).
Results from the study were presented today during the European Association for the Study of Diabetes (EASD) annual meeting in Rome, and portions of the data will be published in the October 2 issue of the New England Journal of Medicine, available online today at http://nejm.org.
The CGM study is a randomized, controlled trial involving 322 patients spanning the age range of eight to 72 years at 10 sites, which included academic, community, and managed care based practices at the Atlanta Diabetes Associates, the Joslin Diabetes Center, Kaiser Permanente Southern California, Nemours Children's Clinic-Jacksonville, Fla., the Lucile Packard Children's Hospital at Stanford University, the Barbara Davis Center for Childhood Diabetes at the University of Colorado Denver, University of Iowa Children's Hospital, the University of Washington, and Yale University, and coordinated by the Jaeb Center for Health Research in Tampa, Fla.
Patients were assigned to either CGM or a control group using standard blood sugar monitoring and were followed for 26 weeks to assess effects on blood sugar control, principally assessed by measurement of the HbA1c level. At enrollment into the study, patients had HbA1c levels of 7 to 10 percent (the goal for adults with type 1 diabetes generally is a level below 7 percent and for children and adolescents below 7.5-8 percent). Three age groups were analyzed separately: 8 to 14 years of age, 15 to 24 years of age, and 25 years of age or older.
Improvements in blood sugar control were greatest for CGM patients 25 years of age or older, whose HbA1c levels decreased (improved) during the study by an average of 0.53 percent compared with control patients (p<0.001); improvements in secondary measurements were also significantly greater in CGM patients, including the percentage of patients able to achieve an HbA1c level below 7 percent, or a 10 percent relative or 0.5 percent absolute drop in HbA1c. The improvement in HbA1c occurred without an increase in hypoglycemia (low blood sugar), which is the worry when attempting to tighten glucose control. In children aged 8-14 years old, the average decrease in HbA1c was not significantly different in the CGM and control groups; however, those in the CGM group were more likely to lower their HbA1c by at least 10 percent and achieve HbA1c levels below 7 percent compared with the control group. Fifteen- to 24-year-old CGM patients as a group did not experience significant improvements in glucose control compared with the control group.
CGM use varied with age, averaging at least six days a week over the course of the trial in 83 percent of the patients 25 years and older, but dropping off to 30 percent of the 15 to 24 year olds and 50 percent of the 8 to 14 year olds (for whom CGM use typically involved their parents' assistance). Although the study was not specifically designed to assess the effect of frequency of CGM use on HbA1c, an analysis presented at EASD suggested that patients within all three age groups, including teens and young adults, who used the device at least six days a week had substantially lower HbA1c levels after six months compared with patients who used CGM less than six days a week.
"These results are very important, because they show that continuous glucose monitors are more than simply devices of convenience for people with diabetes -- they are tools that can substantially improve blood sugar control when used regularly," said Eva Tsalikian, M.D., UI Children"s Hospital. "Based on the findings of previous studies, better control of glucose levels over the long term can be expected to translate to a lower risk of complications for people with Type 1 diabetes."
"The lower levels of regular CGM use among children and teenagers observed in this study underscore the importance of continued research into a closed-loop artificial pancreas -- a device that uses CGM data to administer appropriate doses of insulin through a pump without the need for involvement of the patient or for young children and their parents," said Dr. Aaron Kowalski, Program Director for Metabolic Control at JDRF.
About type 1 diabetes:
Type 1 diabetes is an autoimmune disease that affects children, adolescents, and adults, in which the immune system attacks cells in the pancreas that produce insulin, a hormone that enables people to convert food into energy. People with type 1 diabetes are dependent on insulin for the rest of their life. But insulin is not a cure, and people with diabetes are at significant risk for a wide range of serious complications, including heart disease, blindness and kidney disease. As many as 3 million people in the U.S. have type 1 diabetes.
About CGM Devices:
CGM devices, manufactured by several companies and approved by the FDA as an adjunctive therapeutic for diabetes, provide both a real-time snapshot of the glucose levels of a person with diabetes, as well as trend information on whether glucose is moving upwards or downwards, and how fast. Devices also provide warnings when the glucose is becoming too high or too low.
JDRF is the leading charitable funder and advocate of type 1 (juvenile) diabetes research worldwide. The mission of JDRF is to find a cure for diabetes and its complications through the support of research. Type 1 diabetes is a disease that strikes children suddenly and requires multiple injections of insulin daily or a continuous infusion of insulin through a pump. Insulin, however, is not a cure for diabetes, nor does it prevent its eventual and devastating complications that may include kidney failure, blindness, heart disease, stroke, and amputation.
Since its founding in 1970 by parents of children with type 1 diabetes, JDRF has awarded more than $1.16 billion to diabetes research, including more than $156 million in FY2008. In FY2007, the Foundation funded more than 1,000 centers, grants and fellowships in 22 countries.
CGM devices, improved glycemic control, and artificial pancreas technologies are key areas of research within JDRF's Metabolic Control cure therapeutic focus. In addition to improving the quality of life for people with type 1 diabetes, cure therapeutics impacting metabolic control reduce the risk of developing the various complications of diabetes, and will likely enhance the effectiveness of ability of other research leading to a cure.
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