A pilot study of the continuous glucose monitoring system - Clinical decisions and glycemic control after its use in pediatric type 1 diabetic subjects

OBJECTIVE - To determine whether the continuous glucose monitoring system ( CGMS) (MiniMed, Sylmar, CA) could be used to make clinical decisions and wh ether it has an impact on glycemia in pediatric type I diabetic subjects. RESEARCH DESIGN AND METHODS - Pediatric subjects were recruited if they had HbA(1c) >8.0% with management problems (n = 35) or episodes of severe or n octurnal hypoglycemia or hypoglycemia unawareness associated with HbA(1c) l ess than or equal to8.0% (n = 12). A total of 47 patients with a mean HbA(1 c) value of 8.6 +/- 1.6% (mean age 11.8 +/- 4.6 years, youngest 2.7 years, and diabetes duration 5.5 +/- 3.5 years) on three to four insulin injection s/day (n = 24) or insulin pump therapy (n = 23) were followed with the CGMS for a mean of 69.5 +/- 28 h. Comparisons were made between the number of h igh (>150 mg/dl) and low (<70 mg/dl) glucose patterns discerned with the se nsor or the logbook, and HbA(1c) levels were evaluated. RESULTS - In patients on injection therapy, 30 high or low glucose patterns were discerned with the logbook records and 120 patterns with the CGMS. Sp ecific alterations of the diabetes regimen were made. An overall significan t change in HbA(1c), from 3 months before wearing the sensor to 6 months af ter (analysis of variance 0.04), was found in the subjects. Post hoc analys is showed a significant change in HbA(1c) from 8.6 +/- 1.5% at baseline to 8.4 +/- 1.3% at 3 months (paired Student's t test 0.03). CONCLUSIONS - The CGMS can be used by pediatric patients to detect abnormal patterns of glycemia. The information that was obtained could be used to a lter the diabetes regimen and impact glycemic outcome.