title: Evaluation of an algorithm to guide patients with type 1 diabetes treated with continuous subcutaneous insulin infusion on how to respond to real-time continuous glucose levels: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate an algorithm guiding responses of continuous subcutaneous insulin infusion (CSII)-treated type 1 diabetic patients using real-time continuous glucose monitoring (RT-CGM).
  
  
  METHODS
  Sixty CSII-treated type 1 diabetic participants (aged 13-70 years, including adult and adolescent subgroups, with A1C <or=9.5%) were randomized in age-, sex-, and A1C-matched pairs. Phase 1 was an open 16-week multicenter randomized controlled trial. Group A was treated with CSII/RT-CGM with the algorithm, and group B was treated with CSII/RT-CGM without the algorithm. The primary outcome was the difference in time in target (4-10 mmol/l) glucose range on 6-day masked CGM. Secondary outcomes were differences in A1C, low (<or=3.9 mmol/l) glucose CGM time, and glycemic variability. Phase 2 was the week 16-32 follow-up. Group A was returned to usual care, and group B was provided with the algorithm. Glycemia parameters were as above. Comparisons were made between baseline and 16 weeks and 32 weeks.
  
  
  RESULTS
  In phase 1, after withdrawals 29 of 30 subjects were left in group A and 28 of 30 subjects were left in group B. The change in target glucose time did not differ between groups. A1C fell (mean 7.9% [95% CI 7.7-8.2to 7.6% [7.2-8.0]; P < 0.03) in group A but not in group B (7.8% [7.5-8.1] to 7.7 [7.3-8.0]; NS) with no difference between groups. More subjects in group A achieved A1C <or=7% than those in group B (2 of 29 to 14 of 29 vs. 4 of 28 to 7 of 28; P = 0.015). In phase 2, one participant was lost from each group. In group A, A1C returned to baseline with RT-CGM discontinuation but did not change in group B, who continued RT-CGM with addition of the algorithm.
  
  
  CONCLUSIONS
  Early but not late algorithm provision to type 1 diabetic patients using CSII/RT-CGM did not increase the target glucose time but increased achievement of A1C <or=7%. Upon RT-CGM cessation, A1C returned to baseline.
authors.affiliation: Department of Medicine, The University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia.
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Jenkins
authors.forename: Balasubramanium
authors.initials: B
authors.lastname: Krishnamurthy
authors.forename: James D
authors.initials: JD
authors.lastname: Best
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Cameron
authors.forename: Peter G
authors.initials: PG
authors.lastname: Colman
authors.forename: Steven
authors.initials: S
authors.lastname: Farish
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hamblin
authors.forename: Michele A
authors.initials: MA
authors.lastname: O'Connell
authors.forename: Christine
authors.initials: C
authors.lastname: Rodda
authors.forename: Kevin
authors.initials: K
authors.lastname: Rowley
authors.forename: Helena
authors.initials: H
authors.lastname: Teede
authors.forename: David N
authors.initials: DN
authors.lastname: O'Neal
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000031:analogs & derivatives / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008962:Models, Theoretical; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C025617:glucosylated hemoglobin A