title: Comparison of Different Treatment Modalities for Type 1 Diabetes, Including Sensor-Augmented Insulin Regimens, in 52 Weeks of Follow-Up: A COMISAIR Study.
abstract: To compare different treatment modalities for patients with type 1 diabetes (T1D) based on real-time continuous glucose monitoring (RT-CGM) or self-monitoring of blood glucose (SMBG) combined with multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII).
  
  
  
  Sixty-five T1D patients were followed up for a year. Of these, 27 started RT-CGM as part of a sensor-augmented insulin regimen (SAIR); within this SAIR group, 15 subjects started sensor-augmented pump (SAP) therapy and the remaining 12 continued with MDIs (MDIs + RT-CGM). A second group of 20 patients initiated CSII without RT-CGM, while a third group of 18 subjects continued on MDIs and SMBG. The main endpoints were reduction of HbA1c, glycemic variability (GV), and incidence of hypoglycemia.
  
  
  
  After a year, the baseline mean HbA1c in the SAIR group (8.3%) decreased to 7.1% (P < 0.0001); both SAIR subgroups, SAP and MDIs + RT-CGM, showed comparable improvement. The CSII group also had reduced HbA1c (8.4% ± 0.9% vs. 7.9% ± 0.7%; P < 0.05). Both SAIRs were superior to MDIs (P = 0.002) and CSII (P = 0.0032). GV was also lowered, both in the SAIR (P < 0.0001) and CSII (P < 0.05) groups. Reduced incidence of hypoglycemia was observed only with SAIR (8% ± 4% vs. 6% ± 3%; P < 0.01).
  
  
  
  Both SAIRs, SAP and MDIs + RT-CGM, provided significant and comparable decrease of HbA1c with concurrent reduction of hypoglycemia. This improvement was greater than that seen with CSII. The combination of RT-CGM and MDIs can be a suitable alternative to SAP for some patients.
authors.affiliation: 1 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague , Czech Republic .
authors.forename: Jan
authors.initials: J
authors.lastname: Šoupal
authors.affiliation: 2 Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague , Czech Republic .
authors.forename: Lenka
authors.initials: L
authors.lastname: Petruželková
authors.affiliation: 1 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague , Czech Republic .
authors.forename: Milan
authors.initials: M
authors.lastname: Flekač
authors.affiliation: 1 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague , Czech Republic .
authors.forename: Tomáš
authors.initials: T
authors.lastname: Pelcl
authors.affiliation: 1 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague , Czech Republic .
authors.forename: Martin
authors.initials: M
authors.lastname: Matoulek
authors.affiliation: 1 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague , Czech Republic .
authors.forename: Martina
authors.initials: M
authors.lastname: Daňková
authors.affiliation: 1 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague , Czech Republic .
authors.forename: Jan
authors.initials: J
authors.lastname: Škrha
authors.affiliation: 1 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague , Czech Republic .
authors.forename: Štěpán
authors.initials: Š
authors.lastname: Svačina
authors.affiliation: 1 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague , Czech Republic .
authors.forename: Martin
authors.initials: M
authors.lastname: Prázný
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin