title: Sensor and software use for the glycaemic management of insulin-treated type 1 and type 2 diabetes patients.
abstract: Lowering glucose levels, while avoiding hypoglycaemia, can be challenging in insulin-treated patients with diabetes. We evaluated the role of ambulatory glucose profile in optimising glycaemic control in this population. Insulin-treated patients with type 1 and type 2 diabetes were recruited into a prospective, multicentre, 100-day study and randomised to control (n = 28) or intervention (n = 59) groups. The intervention group used ambulatory glucose profile, generated by continuous glucose monitoring, to assess daily glucose levels, whereas the controls relied on capillary glucose testing. Patients were reviewed at days 30 and 45 by the health care professional to adjust insulin therapy. Comparing first and last 2 weeks of the study, ambulatory glucose profile-monitored type 2 diabetes patients (n = 28) showed increased time in euglycaemia (mean ± standard deviation) by 1.4 ± 3.5 h/day (p = 0.0427) associated with reduction in HbA1c from 77 ± 15 to 67 ± 13 mmol/mol (p = 0.0002) without increased hypoglycaemia. Type 1 diabetes patients (n = 25) showed reduction in hypoglycaemia from 1.4 ± 1.7 to 0.8 ± 0.8 h/day (p = 0.0472) associated with a marginal HbA1c decrease from 75 ± 10 to 72 ± 8 mmol/mol (p = 0.0508). Largely similar findings were observed comparing intervention and control groups at end of study. In conclusion, ambulatory glucose profile helps glycaemic management in insulin-treated diabetes patients by increasing time spent in euglycaemia and decreasing HbA1c in type 2 diabetes patients, while reducing hypoglycaemia in type 1 diabetes patients.
authors.affiliation: St. James's University Hospital, Leeds Teaching Hospitals Trust and LIGHT Laboratories, University of Leeds, Leeds, UK R.Ajjan@leeds.ac.uk.
authors.forename: Ramzi A
authors.initials: RA
authors.lastname: Ajjan
authors.affiliation: County Durham and Darlington NHS Foundation Trust, County Durham, UK.
authors.forename: Kamal
authors.initials: K
authors.lastname: Abougila
authors.affiliation: Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, UK.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Bellary
authors.affiliation: University Hospital Ayr, Ayr, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Collier
authors.affiliation: Rotherham Hospital NHS Foundation Trust, Rotherham, UK.
authors.forename: Bernd
authors.initials: B
authors.lastname: Franke
authors.affiliation: Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, UK.
authors.forename: Edward B
authors.initials: EB
authors.lastname: Jude
authors.affiliation: Ipswich Hospital NHS Trust, Ipswich, UK.
authors.forename: Gerry
authors.initials: G
authors.lastname: Rayman
authors.affiliation: Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Robinson
authors.affiliation: Royal Wolverhampton NHS Trust, Wolverhampton, UK.
authors.forename: Baldev M
authors.initials: BM
authors.lastname: Singh
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation* / Q000379:methods; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D058998:Remote Sensing Technology; D012985:Software Design; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Ambulatory glucose profile; glycaemia self-monitoring of blood glucose; type 1 diabetes; type 2 diabetes