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      Impacto de la utilización de sistemas de medición de glucosa intersticial en el control glucémico en pacientes pediátricos con diabetes mellitus tipo 1 Translated title: Impact of the use of intersticial glucose sensors on glycemic control in pediatric patients with type 1 diabetes mellitus

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          Abstract

          Resumen: Introducción: El adecuado control glucémico en la diabetes mellitus tipo 1 (DM-1) es fundamental. Existen sistemas de medición de glucosa intersticial (MGI) que permiten realizar ajustes terapéuticos más específicos. El objetivo del estudio fue determinar el impacto de sistemas MGI en el control glucémico en pacientes menores de 18 años con DM-1. Material y métodos: Estudio de tipo cohorte retrospectiva. Los datos se recogieron de la historia clínica del paciente y de una encuesta realizada a los pacientes y sus padres o tutores. Resultados: De un total de 120 pacientes, 63 utilizaban un sistema MGI; después de seis meses de su uso se observó reducción significativa (p < 0.05) de las cifras de hemoglobina glucosilida, pasando de 7.5% ± 0.6 a 7.13% ± 0.47. Además, hubo disminución significativa de la variabilidad glucémica, del número de glucemias capilares y de la frecuencia de hipoglucemias leve y grave. Conclusiones: Los sistemas MGI ayudan a mejorar el control glucémico de los pacientes pediátricos con DM-1.

          Translated abstract

          Abstract: Introduction: Adequate glycemic control in type-1 diabetes mellitus (DM) is essential. Interstitial glucose measurement (IGM) systems allow specific therapeutic adjustments. The aim of the study was to determine the impact of IGM systems in glycemic control in patients under 18 years with type-1 DM. Material and methods: Retrospective cohort study. Data were collected from medical records of the patient, as well as a survey of patients and their parents or guardians. Results: Of a total of 120 patients, 63 used an IGM system; after six months of use, a significant reduction (p < 0.05) in the glycated hemoglobin levels was observed, going from 7.5% ± 0.6 to 7.13% ± 0.47. In addition, there was a significant decrease in glycemic variability, in the number of capillary blood glucose levels and in the frequency of mild and severe hypoglycemia. Conclusions: The IGM systems help improve glycemic control in pediatric patients with type-1 DM.

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          Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes.

          Richard M. Bergenstal, William Tamborlane, Andrew Ahmann … (2010)
          Recently developed technologies for the treatment of type 1 diabetes mellitus include a variety of pumps and pumps with glucose sensors. In this 1-year, multicenter, randomized, controlled trial, we compared the efficacy of sensor-augmented pump therapy (pump therapy) with that of a regimen of multiple daily insulin injections (injection therapy) in 485 patients (329 adults and 156 children) with inadequately controlled type 1 diabetes. Patients received recombinant insulin analogues and were supervised by expert clinical teams. The primary end point was the change from the baseline glycated hemoglobin level. At 1 year, the baseline mean glycated hemoglobin level (8.3% in the two study groups) had decreased to 7.5% in the pump-therapy group, as compared with 8.1% in the injection-therapy group (P<0.001). The proportion of patients who reached the glycated hemoglobin target (<7%) was greater in the pump-therapy group than in the injection-therapy group. The rate of severe hypoglycemia in the pump-therapy group (13.31 cases per 100 person-years) did not differ significantly from that in the injection-therapy group (13.48 per 100 person-years, P=0.58). There was no significant weight gain in either group. In both adults and children with inadequately controlled type 1 diabetes, sensor-augmented pump therapy resulted in significant improvement in glycated hemoglobin levels, as compared with injection therapy. A significantly greater proportion of both adults and children in the pump-therapy group than in the injection-therapy group reached the target glycated hemoglobin level. (Funded by Medtronic and others; ClinicalTrials.gov number, NCT00417989.) 2010 Massachusetts Medical Society
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            The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial

            T. Battelino, I Conget, BIRGITTE B. OLSEN … (2012)
            Aims/hypothesis The aim of this multicentre, randomised, controlled crossover study was to determine the efficacy of adding continuous glucose monitoring (CGM) to insulin pump therapy (CSII) in type 1 diabetes. Methods Children and adults (n = 153) on CSII with HbA1c 7.5–9.5% (58.5–80.3 mmol/mol) were randomised to (CGM) a Sensor On or Sensor Off arm for 6 months. After 4 months’ washout, participants crossed over to the other arm for 6 months. Paediatric and adult participants were separately electronically randomised through the case report form according to a predefined randomisation sequence in eight secondary and tertiary centres. The primary outcome was the difference in HbA1c levels between arms after 6 months. Results Seventy-seven participants were randomised to the On/Off sequence and 76 to the Off/On sequence; all were included in the primary analysis. The mean difference in HbA1c was –0.43% (–4.74 mmol/mol) in favour of the Sensor On arm (8.04% [64.34 mmol/mol] vs 8.47% [69.08 mmol/mol]; 95% CI −0.32%, −0.55% [−3.50, −6.01 mmol/mol]; p < 0.001). Following cessation of glucose sensing, HbA1c reverted to baseline levels. Less time was spent with sensor glucose <3.9 mmol/l during the Sensor On arm than in the Sensor Off arm (19 vs 31 min/day; p = 0.009). The mean number of daily boluses increased in the Sensor On arm (6.8 ± 2.5 vs 5.8 ± 1.9, p < 0.0001), together with the frequency of use of the temporary basal rate (0.75 ± 1.11 vs 0.26 ± 0.47, p < 0.0001) and manual insulin suspend (0.91 ± 1.25 vs 0.70 ± 0.75, p < 0.018) functions. Four vs two events of severe hypoglycaemia occurred in the Sensor On and Sensor Off arm, respectively (p = 0.40). Conclusions/interpretation Continuous glucose monitoring was associated with decreased HbA1c levels and time spent in hypoglycaemia in individuals with type 1 diabetes using CSII. More frequent self-adjustments of insulin therapy may have contributed to these effects. Trial registration ClinicalTrials.gov registration no. NCT00598663. Funding The study was funded by Medtronic International Trading Sarl Switzerland.
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              Continuous glucose monitoring and intensive treatment of type 1 diabetes.

              Craig Kollman, Tim Wysocki, Stuart A. Weinzimer … (2008)
              The value of continuous glucose monitoring in the management of type 1 diabetes mellitus has not been determined. In a multicenter clinical trial, we randomly assigned 322 adults and children who were already receiving intensive therapy for type 1 diabetes to a group with continuous glucose monitoring or to a control group performing home monitoring with a blood glucose meter. All the patients were stratified into three groups according to age and had a glycated hemoglobin level of 7.0 to 10.0%. The primary outcome was the change in the glycated hemoglobin level at 26 weeks. The changes in glycated hemoglobin levels in the two study groups varied markedly according to age group (P=0.003), with a significant difference among patients 25 years of age or older that favored the continuous-monitoring group (mean difference in change, -0.53%; 95% confidence interval [CI], -0.71 to -0.35; P<0.001). The between-group difference was not significant among those who were 15 to 24 years of age (mean difference, 0.08; 95% CI, -0.17 to 0.33; P=0.52) or among those who were 8 to 14 years of age (mean difference, -0.13; 95% CI, -0.38 to 0.11; P=0.29). Secondary glycated hemoglobin outcomes were better in the continuous-monitoring group than in the control group among the oldest and youngest patients but not among those who were 15 to 24 years of age. The use of continuous glucose monitoring averaged 6.0 or more days per week for 83% of patients 25 years of age or older, 30% of those 15 to 24 years of age, and 50% of those 8 to 14 years of age. The rate of severe hypoglycemia was low and did not differ between the two study groups; however, the trial was not powered to detect such a difference. Continuous glucose monitoring can be associated with improved glycemic control in adults with type 1 diabetes. Further work is needed to identify barriers to effectiveness of continuous monitoring in children and adolescents. (ClinicalTrials.gov number, NCT00406133.) 2008 Massachusetts Medical Society
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                Author and article information

                Journal
                Journal ID (publisher-id): rmp
                Title: Revista mexicana de pediatría
                Abbreviated Title: Rev. mex. pediatr.
                Publisher: Sociedad Mexicana de Pediatría A.C. (Ciudad de México, Ciudad de México, Mexico )
                ISSN (Print): 0035-0052
                Publication date (Print and electronic): February 2020
                Volume: 87
                Issue: 1
                Pages: 13-17
                Affiliations
                [3] Zaragoza orgnameHospital Universitario Miguel Servet orgdiv1Unidad de Endocrinología y Diabetes Pediátrica España
                [1] Zaragoza orgnameHospital Universitario Miguel Servet España
                [2] Zaragoza Aragón orgnameUniversidad de Zaragoza Spain
                Article
                Publisher ID: S0035-00522020000100013 Publisher ID: S0035-0052(20)08700100013
                DOI: 10.35366/93262
                SO-VID: faba6cd5-0b68-41ff-b076-c5cb9d32dfe4
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Date accepted : 05 January 2020
                Date received : 11 June 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 5
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                Subject: Artículos originales

                Keywords: Type 1 diabetes mellitus,adolescentes,niños,HbA1c,sistemas de medición de glucosa intersticial,control glucémico,Diabetes mellitus tipo 1,adolescents,children,interstitial glucose measurement systems,glycemic control
                Data availability:
                Keywords: Type 1 diabetes mellitus, adolescentes, niños, HbA1c, sistemas de medición de glucosa intersticial, control glucémico, Diabetes mellitus tipo 1, adolescents, children, interstitial glucose measurement systems, glycemic control

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