title: Real-time continuous glucose monitoring or continuous subcutaneous insulin infusion, what goes first?: results of a pilot study.
abstract: BACKGROUND
  Dual devices allow both continuous subcutaneous insulin infusion (CSII) and real-time (RT) continuous glucose monitoring (CGM). Patients usually start with CSII, adding RT-CGM later (CGM post-CSII). Lack of use of RT-CGM is the main limiting factor of dual device results. Initiating RT-CGM before CSII (CGM pre-CSII) could increase RT-CGM frequency use and further improve glycemic control.
  
  
  METHODS
  In this 26-week pilot study, we randomly assigned, via sealed envelopes, 16 CSII and RT-CGM to naive patients 14 years of age or older with type 1 diabetes mellitus (T1DM) to CGM post-CSII or CGM pre-CSII. The Paradigm® Veo™ (Medtronic Inc., Northridge, CA) was the dual device used in all patients. The primary end point was frequency of use of RT-CGM between both groups at week 26.
  
  
  RESULTS
  We detected a significant higher RT-CGM frequency use in the CGM pre-CSII group at week 26 (78.4±10.9% vs. 56.0±40.8%; P=0.01), although we did not detect hemoglobin A1c level differences. In addition, CGM pre-CSII patients presented less time in hypoglycemia (average daily area under curve <70 mg/dL per 24 h, 0.87±1.02 mg/dL/day vs. 3.32±2.19 mg/dL/day; P=0.021), and no severe hypoglycemia events were detected during 26 weeks in this group.
  
  
  CONCLUSIONS
  CGM pre-CSII is effective in increasing RT-CGM frequency use in T1DM patients. This is accompanied by a significant reduction in time in hypoglycemia.
authors: Service of Endocrinology, Ciudad Real University Hospital, Ciudad Real, Spain. mirendjmf1976@gmail.com
authors: Jesus
authors: J
authors: Moreno-Fernandez
authors: Francisco Javier
authors: FJ
authors: Gomez
authors: Montserrat
authors: M
authors: Gazquez
authors: Marta
authors: M
authors: Pedroche
authors: Alvaro
authors: A
authors: García-Manzanares
authors: Jose Maria
authors: JM
authors: Tenias
authors: Pedro
authors: P
authors: Benito
authors: Ines Rosa
authors: IR
authors: Gomez
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D045604:Extracellular Fluid / Q000378:metabolism*; D005500:Follow-Up Studies; D005947:Glucose / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects; D008422:Materials Testing; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000009:adverse effects / Q000295:instrumentation; D017060:Patient Satisfaction; D010865:Pilot Projects; D011788:Quality of Life; D013030:Spain; D055815:Young Adult
chemical_list: D005947:Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human