BENEFITS OF THREE-MONTH CONTINUOUS GLUCOSE MONITORING FOR PERSONS WITH DIABETES USING INSULIN PUMPS AND SENSORS

Karolina Peterson,Josef Bartek,Dalibor Novotny,Pavla Kudlova,Jana Zapletalova,Rudolf Chlup,Veronika Matuskova

doi:10.5507/bp.2009.008

Abstract

The latest Paradigm 722 insulin pump, Medtronic MiniMed, USA, enables daily reading of 288 interstitial fluid glucose concentrations determined by a sensor inserted into subcutaneous tissue; the sensor signals are transmitted into the insulin pump, enabling the patient to see real-time glucose concentration on the display and adapt further treatment. To assess the evolution of HbA1c over the course of a 3-month period in two cohorts of persons with type 1 (n=39) or type 2 (n=3) diabetes (PWD): 1) PWD on Paradigm 722 using sensors for continuous glucose monitoring (CGM group), 2) PWD on other types of insulin pumps performing intensive self-monitoring as before (3 to 6 times/d) on glucometer Linus, Wellion, Agamatrix (control group). Compliant PWDs using insulin pump with insulin aspart for several previous months were included in the study. Seventeen were put on Paradigm 722 with CGM and 25 were included in the control group. Paired t-test and the statistical program SPSS v.15.0 were used to analyze the data. There was no significant difference in age between the two groups (P=0.996), in diabetes duration (P=0.482) or in daily insulin dose (P=0.469). In the CGM group (but not in the control group) HbA1c/IFCC dropped from 6.98+/-0.43 % to 5.98+/-0.36 % (P=0.006) within 1 month and remained reduced. The use of the Paradigm 722 insulin pump with CGM resulted in significant improvement in HbA1c which appeared within one month and remained throughout the whole 3-month study period. No significant improvement in HbA1c was seen in the control group.

Highlights

In persons with diabetes (PWD) self-monitoring of the concentration of glucose in plasma (SMPG) is a basic means of preserving compensation[1, 2]
There were no significant differences found between groups in the following parameters: age at diabetes diagnosis, age at inclusion into the study, male/female ratio in both groups, duration of the insulin pump therapy and daily insulin dose (Table 1)
Benefits of three-month continuous glucose monitoring for persons with diabetes using insulin pumps and sensors 49

Summary

Introduction

In persons with diabetes (PWD) self-monitoring of the concentration of glucose in plasma (SMPG) is a basic means of preserving compensation[1, 2]. The emergence of test strips and glucometers in the last 30 years has enabled the glucose concentration self-monitoring and this has gradually replaced the relatively inaccurate and inconvenient measurement of glucose in urine[3,4,5,6,7,8,9,10,11,12,13]. In 1993, the well known study DCCT (Diabetes Control and Complications Trial) emphasized that in PWD1 SMPG should be performed at least four times daily and subsequently corrected with intensive insulin therapy[17, 18]. Intensive self-monitoring is of particular importance in PWD on continuous subcutaneous insulin infusion. The latest Paradigm 722 insulin pump, Medtronic MiniMed, USA, enables daily reading of 288 interstitial fluid glucose concentrations determined by a sensor inserted into subcutaneous tissue; the sensor signals are transmitted into the insulin pump, enabling the patient to see real-time glucose concentration on the display and adapt further treatment

Methods

Results

Discussion

Conclusion