Effectiveness of sensor-augmented pump therapy in children and adolescents with type 1 diabetes in the STAR 3 study

Barbara Davis Center for Childhood Diabetes, 1775 Ursula Street, Aurora, CO 80045, USA.
Pediatric Diabetes (Impact Factor: 2.57). 07/2011; 13(1):6-11. DOI: 10.1111/j.1399-5448.2011.00793.x
Source: PubMed


Maintenance of appropriate A1C values and minimization of hyperglycemic excursions are difficult for many pediatric patients with type 1 diabetes. Continuous glucose monitoring (CGM) sensor-augmented pump (SAP) therapy is an alternative to multiple daily injection (MDI) therapy in this population.
Sensor-augmented pump therapy for A1C reduction (STAR 3) was a 1-yr trial that included 82 children (aged 7-12) and 74 adolescents (aged 13-18) with A1C values ranging from 7.4 to 9.5% who were randomized to either SAP or MDI therapy. Quarterly A1C values were obtained from all subjects. CGM studies were carried out at baseline, 6 months, and 12 months to quantify glycemic excursions [calculated as area under the glucose concentration-time curve (AUC)] and variability. In the SAP group, sensor compliance was recorded.
Baseline A1C values were similar in subjects randomized to the SAP (8.26 ± 0.55%) and MDI groups (8.30 ± 0.53%). All subsequent A1C values showed significant (p < 0.05) treatment group differences favoring SAP therapy. Compared with the MDI group, subjects in the SAP group were more likely to meet age-specific A1C targets and had lower AUC values for hyperglycemia with no increased risk of hypoglycemia. Glucose variability improved in the SAP group compared to the MDI group. Children wore CGM sensors more often and were more likely to reach age-specific A1C targets than adolescents.
SAP therapy allows both children and adolescents with marginally or inadequately controlled type 1 diabetes to reduce A1C values, hyperglycemic excursions, and glycemic variability in a rapid, sustainable, and safe manner.

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    • "Further, in the last year, two industry-sponsored trials have shown significant improvements in HbA1c levels in children while also reducing time spent with blood sugar levels in the hypoglycemia range. The STAR3 trial of children using CGM showed a reduction in blood sugar level variability, favoring SAP use [25]. In addition, the SWITCH Study Group’s trial of children and adults showed that, in patients using SAP therapy, HbA1c levels, as well as time spent with blood sugar levels in the hypoglycemia range, were reduced. "
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