title: Safety of using real-time sensor glucose values for treatment decisions in adolescents with poorly controlled type 1 diabetes mellitus: a pilot study.
abstract: This study explored the safety of using real-time sensor glucose (SG) data for treatment decisions in adolescents with poorly controlled type 1 diabetes.
  
  
  
  Ten adolescents with type 1 diabetes, HbA1c ≥9% on insulin pumps were admitted to the clinical research center and a continuous glucose sensor was inserted. Plasma glucose was measured at least hourly using Yellow Springs Instrument's (YSI) glucose analyzer. Starting at dinner, SG rather than YSI was used for treatment decisions unless YSI was <70 mg/dL (<3.9 mmol/L) or specific criteria indicating SG and YSI were very discordant were met. Participants were discharged after lunch the next day.
  
  
  
  Ten participants (seven males; 15.2-17.8 year old) completed the study. The range of differences between high glucose correction doses using SG vs YSI for calculations was -2 (SG < YSI dose) to +1 (SG > YSI dose); this difference was two units in only 2 of 23 correction doses given (all SG < YSI dose). There were five episodes of mild hypoglycemia in two patients, two of which occurred after using SG for dose calculations. There was no severe hypoglycemia and no YSI glucose >350 mg/dL (19.4 mmol/L). Mean (±SE) pre- and postmeal YSI glucose were 163 ± 11 and 183 ± 12 mg/dL (9.1 ± 0.6 and 10.2 ± 0.7 mmol/L), respectively.
  
  
  
  Use of real-time continuous glucose monitoring for treatment decisions was safe and did not result in significant over- or undertreatment. Use of SG for treatment decisions under supervised inpatient conditions is a suitable alternative to repeated fingerstick glucose monitoring. Outpatient studies using SG in real-time are needed.
authors.affiliation: Division of Endocrinology, Nemours Children's Health System, Jacksonville, Florida.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Fox
authors.affiliation: Division of Endocrinology, Nemours Children's Health System, Jacksonville, Florida.
authors.forename: Emilie
authors.initials: E
authors.lastname: Balkman
authors.affiliation: Division of Endocrinology, Nemours Children's Health System, Jacksonville, Florida.
authors.forename: Kim
authors.initials: K
authors.lastname: Englert
authors.affiliation: Biostatistics Core, Alfred I. duPont Hospital for Children, Wilmington, Delaware.
authors.forename: Jobayer
authors.initials: J
authors.lastname: Hossain
authors.affiliation: Division of Endocrinology, Nemours Children's Health System, Jacksonville, Florida.
authors.forename: Nelly
authors.initials: N
authors.lastname: Mauras
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006776:Hospitals, Pediatric; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control; D007003:Hypoglycemia / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology / 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*; D008297:Male; D018670:Monitoring, Ambulatory / Q000009:adverse effects*; D010865:Pilot Projects; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: continuous glucose monitoring; pediatrics; type 1 diabetes