title: Can integrated technology improve self-care behavior in youth with type 1 diabetes? A randomized crossover trial of automated pump function.
abstract: Automated blood glucose (BG) and insulin pump systems allow wireless transmission of all BG readings to a user's pump. This study aimed to assess whether use of such a system, as compared with a manual BG entry insulin pump, resulted in higher mean daily frequency of BGs recorded after 6 months. A 12-month randomized crossover trial, comprising 2 phases, was conducted. All participants used insulin pump devices with automated vs manual BG entry for 6 months each; order of system use was randomly assigned. Device interactions were assessed from pump and glucometer downloads. Thirty-five participants were enrolled; 9 withdrew during the study. Use of the automated insulin pump system resulted in higher mean daily BG recorded over 6 months of use when compared to a manual BG entry system (5.8 ± 1.7 vs 5.0 ± 1.9; P = .02 [95% confidence interval, 0.14 to 1.58]). Bolus frequency was similar between groups. No HbA1c difference was observed between groups at 6 months (8.0% [64 mmol/l] ± 1.3 automated vs 7.7% [61 mmol/l] ± 0.9 manual; P = .38). Post hoc analysis demonstrated improved ΔHbA1c with automated system use in an adolescent subgroup with suboptimal baseline BG frequency (-0.9% vs + 0.5%; P = .003). Use of an automated glucometer/insulin pump resulted in higher number of BGs recorded over 6 months when compared to an insulin pump with manual BG entry. This may be especially beneficial for adolescent manual system users who enter <5 BGs per day into their pump.
authors.affiliation: Department of Endocrinology, Murdoch Childrens Research Institute and the Royal Children's Hospital, Parkville, VIC, Australia orlaneylon@hotmail.com.
authors.forename: Orla M
authors.initials: OM
authors.lastname: Neylon
authors.affiliation: Department of Endocrinology, Murdoch Childrens Research Institute and the Royal Children's Hospital, Parkville, VIC, Australia.
authors.forename: Michele A
authors.initials: MA
authors.lastname: O'Connell
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, VIC, Australia.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Donath
authors.affiliation: Department of Endocrinology, Murdoch Childrens Research Institute and the Royal Children's Hospital, Parkville, VIC, Australia.
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Cameron
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation*; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D007332:Insulin Infusion Systems; D008297:Male; D017060:Patient Satisfaction; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: adherence; blood glucose; insulin pump; type 1 diabetes; wireless