SLR - November 2009 - David Allen
References:
The Juvenile Research Foundation (2008). Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes. The New England Journal of Medicine, Volume 359:1464-1476, October 2, 2008, Number 14.
Scientific Literature Review
Reviewed by: David Allen, DPM
Residency Program: Central Alabama Veterans Health Care System
Podiatric Relevance:
Diabetic foot disease is a global health concern with moral, economic and social implications. Improved methods of treatment with respect to the glycemic control of diabetic patients can only benefit the podiatric community.
Methods:
322 patients over the age of 8 participated in this randomized multi-centered clinical trial. Each patient was diagnosed with Type 1 Diabetes and used either an insulin pump or 3 insulin injections daily. All participants had a glycated Hg of 7.0%-10.0%. Patients were separated into continuous monitoring and control groups with three age-specific subgroups. The study was conducted in an attempt to evaluate any change related to the decrease in glycated Hg levels over a period of 26 weeks.
Results:
165 patients were assigned to the continuous monitoring group and 157 to the control group. There were 114 patients allocated to the 8-14 age group, 110 to the 15-24 age group, and 98 to the 25+ age group. Within the 25+ age group, patients with continuous monitoring demonstrated a reduction in mean glycated Hg level by 10.0%, and more arrived at the glycated Hg level of 7.0%. This outcome relates an improved glycemic control among the continuously monitored group.
There was no remarkable changes noted between the two 15-24 year old groups. The mean decrease in mean glycated Hg levels between the two groups was 0.2%. Continuous monitoring does not play enough of a role to justify adoption of this treatment within this age group.
Patients within the 8-14 year age group on continuous monitoring had a mean decrease in glycated Hg with no great difference in change between the two groups. Both groups within the 8-14 year old age group did produce greater than 10% decrease in glycated Hg levels. This indicates no difference in outcome with continued monitoring at this age group.
Conclusion:
Age was seen to play a role in better results in decreasing glycated Hg with continuous monitoring. The 25+ age group displayed a much greater benefit from continuous monitoring of glucose in reducing glycated Hg levels and approaching levels of less than 7.0%.