Real-time continuous glucose monitoring together with telemedical assistance improves glycemic control and glucose stability in pump-treated patients.
BACKGROUND
Real-time continuous glucose monitoring (CGM) has recently been incorporated into routine diabetes management because of the potential advantages it offers for glycemic control. The aim of our study was to evaluate the impact of the use of real-time CGM together with a telemedicine system in hemoglobin A1c and glucose variability in patients with type 1 diabetes treated with insulin pumps.


METHODS
Ten patients (five women, 41.2 [range, 21-62] years old, duration of diabetes 14.9 [range, 3-52] years) were included in this randomized crossover study. Patients used the DIABTel telemedicine system throughout the study, and real-time CGM was used for 3 days every week during the intervention phase. At the end of the control phase, a blind 3-day CGM was performed. Glucose variability was evaluated using the Glucose Risk Index (GRI), a comparative analysis of continuous glucose values over two consecutive hours.


RESULTS
Hemoglobin A1c decreased significantly (8.1 +/- 1.1% vs. 7.3 +/- 0.8%; P = 0.007) after the intervention phase, while no changes were observed during the control phase. The mean number of daily capillary glucose readings was higher during the intervention phase (4.7 +/- 1.1 vs. 3.8 +/- 1.0; P < 0.01), because of an increase in random analyses (1.22 +/- 0.3 vs. 0.58 +/- 0.1; P < 0.01), and there was also a significant increase in the mean number of bolus doses per day (5.23 +/- 1.1 vs. 4.4 +/- 0.8; P < 0.05). The GRI was higher during the control phase than during the experimental phase (9.6 vs. 6.25; P < 0.05).


CONCLUSIONS
Real-time CGM in conjunction with the DIABTel system improves glycemic control and glucose stability in pump-treated patients with type 1 diabetes.
Rigla
Mercedes
M
Endocrinology, Hospital de Sant Pau, Barcelona, Spain. mrigla@santpau.es
Hernando
M Elena
ME
Gómez
Enrique J
EJ
Brugués
Eulalia
E
García-Sáez
Gema
G
Capel
Ismael
I
Pons
Belén
B
de Leiva
Alberto
A
D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy*; D004867:Equipment Design; D006706:Homeostasis; D006801:Humans; D007332:Insulin Infusion Systems; D018670:Monitoring, Ambulatory / Q000379:methods; D019095:Point-of-Care Systems; D017216:Telemedicine / Q000379:methods
D001786:Blood Glucose