The continuous glucose monitoring system (CGMS) can safely lower the blood sugar levels of children with type 1 diabetes (also called insulin-dependent or juvenile diabetes), concludes a new study supported by the Agency for Healthcare Research and Quality (HS10397). The CGMS, whose accuracy and reliability has already been established in adults, is used to measure average blood glucose (BG) levels for up to 3 days. It is used to discover trends in BG levels, which would otherwise go unnoticed with standard hemoglobin A1c (HbA1c) tests (which measures average blood glucose level over the past 3 months) and intermittent finger sticks (which measure actual sugar in the blood at that time).
The CGMS is a tiny glucose-sensing device that is inserted just under the skin of the abdomen and taped in place. The sensor measures levels of BG in tissue every 10 seconds and sends information every 5 minutes via a wire to a pager-sized device that is attached to a belt or pants' waistline. The patient also enters insulin use, food intake, and exercise. After 3 days, the information is downloaded into a computer at the doctor's office. The doctor then makes any necessary adjustments in the diabetes management plan, explain researchers at the University of North Carolina Center for Education and Research on Therapeutics.
They randomized 27 children to an intervention group (18 children) or a control group (9 children). Both groups wore the CGMS for 72-hour periods at 0, 2, and 4 months. Therapy adjustment was based on both CGMS and self-monitoring of blood glucose (SMBG) via finger stick for the intervention group and on SMBG data alone for the control group. Hemoglobin A1c was determined at 0, 2, 4, and 6 months. At study entry, HbA1c levels were similar in the intervention and control groups (8.4 and 8.8, respectively; target HbA1c is usually less than 8 percent in childhood). By the end of the 6-month study, HbA1c levels were significantly lower in the intervention group than the control group (7.8 vs. 8.6). There was no significant difference between the two groups in duration or severity of hypoglycemic events (extremely low blood sugar that can cause weakness, heart palpitations, and shock), which are often associated with tight glycemic control. CGMS monitoring may become an important adjuvant to self-monitoring of blood glucose in the treatment of children with type 1 diabetes, conclude the researchers.
See "Continuous subcutaneous glucose monitoring in children with type 1 diabetes mellitus: A single-blind, randomized, controlled trial," by William H. Lagarde, M.D., Frank P. Barrows, D.O., Marsha L. Davenport, M.D., and others, in the June 2006 Pediatric Diabetes 7, pp. 159-164.