title: Real-time continuous glucose monitoring together with telemedical assistance improves glycemic control and glucose stability in pump-treated patients.
abstract: 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.
authors.affiliation: Endocrinology, Hospital de Sant Pau, Barcelona, Spain. mrigla@santpau.es
authors.forename: Mercedes
authors.initials: M
authors.lastname: Rigla
authors.forename: M Elena
authors.initials: ME
authors.lastname: Hernando
authors.forename: Enrique J
authors.initials: EJ
authors.lastname: Gómez
authors.forename: Eulalia
authors.initials: E
authors.lastname: Brugués
authors.forename: Gema
authors.initials: G
authors.lastname: García-Sáez
authors.forename: Ismael
authors.initials: I
authors.lastname: Capel
authors.forename: Belén
authors.initials: B
authors.lastname: Pons
authors.forename: Alberto
authors.initials: A
authors.lastname: de Leiva
mesh_terms: 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
chemical_list: D001786:Blood Glucose