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
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.
Figures in this publication
Available from: Noelle S Larson
- "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 . 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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ABSTRACT: Continuous glucose monitoring (CGM), while a relatively new technology, has the potential to transform care for children with type 1 diabetes. Some, but not all studies, have shown that CGM can significantly improve hemoglobin A1c levels and reduce time spent in the hypoglycemic range in children, particularly when used as part of sensor-augmented pump (SAP) therapy. Despite the publication of recent clinical practice guidelines suggesting CGM be offered to all children 8 years of age or older who are likely to benefit, and studies showing that younger children can also benefit, this technology is not yet commonly used by children with type 1 diabetes. Effects of CGM are enhanced when used on a near-daily basis (a use-dependent effect) and with insulin pump therapy. Therefore, coordinated strategies are needed to help children and their families initiate and continue to use this resource for diabetes care. This review introduces CGM to pediatric endocrinologists who are not yet familiar with the finer details of this technology, summarizes current data showing the benefits and limitations of CGM use in children, reviews specific case examples demonstrating when CGM can be helpful, and shows the value of both retrospective and real-time CGM. It is hoped that this information leads to discussion of this technology in pediatric endocrinology clinics as an important next step in improving the care of children with type 1 diabetes.
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ABSTRACT: In den letzten 15 Jahren kam es in der Behandlung von Kindern und Jugendlichen mit Typ-1-Diabetes zu einer deutlichen Intensivierung der Insulintherapie. Vor allem der Einsatz der Insulinpumpen nahm stark zu. Die Mehrzahl der Kleinkinder unter 6 Jahren wird entweder sofort oder kurz nach der Manifestation des Diabetes mit CSII („continuous subcutaneous insulin infusion“) behandelt. Unter ihr kommt es – im Vergleich zur ICT („intensive conventional therapy“) – zu einer signifikanten Reduktion von Hypoglykämien, niedrigeren HbA1c-Werten (HbA1c: Glykohämoglobin) und einer Verbesserung der Lebensqualität. Auch die kontinuierliche Glukosemessung wird im Kindes- und Jugendalter immer häufiger angewendet, entweder über einige Tage zur Therapieoptimierung oder auch dauerhaft als sog. sensorunterstützte Pumpen- oder Insulintherapie. Wird sie regelmäßig und konsequent durchgeführt, kann die Stoffwechseleinstellung ohne vermehrtes Risiko für Hypoglykämien weiter optimiert werden.
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