Reduction in Hemoglobin A1c with Real-Time Continuous Glucose Monitoring: Results from a 12-Week Observational Study

Sansum Diabetes Research Institute, Santa Barbara, California, United States
Diabetes Technology & Therapeutics (Impact Factor: 2.11). 06/2007; 9(3):203-10. DOI: 10.1089/dia.2007.0205
Source: PubMed


Real-time continuous glucose monitoring (CGM) was studied in 140 adults with diabetes over a 12-week period of home use. Hemoglobin A(1c)(HbA1c) was measured on day 1 (baseline) and at weeks 6 and 12.
On day 1, participants received the CGM device (STS(R) System, DexCom, Inc., San Diego, CA) and underwent training on proper use. Insertion of the first sensor was performed under staff supervision. Subjects inserted subsequent sensors on their own. After calibration, the device (a 3-day sensor, receiver, and transmitter) provided users with real-time glucose values updated at 5-min intervals, glucose trend graphs, configurable high/low alerts, and a hypoglycemia alarm (<or=55 mg/dL). Study participants were given supplies sufficient for 3 weeks of device use. Follow-up visits were performed at 3-week intervals for resupply and to download CGM data, with a final visit at the end of week 12.
Overall, a reduction in HbA1c of 0.4 +/- 0.05% (least squares mean +/- SE) was observed, P < 0.0001. Significant HbA1c reductions were observed across subgroups of subjects with both type 1 and 2 diabetes, and those delivering insulin by multiple daily injections and pumps. The largest HbA1c reduction (1.4 +/- 0.4%) was observed in subjects with baseline HbA1c >9.0%. Increased CGM use was associated with greater reductions in HbA1c.
This observational study showed that home use of real-time GCM was safe and well tolerated and associated with a clinically and statistically significant reduction in HbA1c. Large-scale randomized, controlled outcome studies of CGM are indicated.

Full-text preview

Available from:
  • Source
    • "Real-time CGM is also effective in improving glycemic control whether it is associated or not with an insulin pump [42] [43] [44]. In particular, Deiss et al. [45] showed a mean improvement of HbA1c of 1% in a group of 81 adults and 81 children with a poor control (average baseline HbA1c 9.5%) wearing the device continuously compared to a reduction of 0.7% in a group wearing it discontinuously and 0.4% in a third group not wearing it. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Self-monitoring of blood glucose is a fundamental part of diabetes management. It is mandatory for tight glucose control. For the past 30 years, intermittent measurement of capillary blood glucose has been the method of choice for self-monitoring. The main disadvantage of such measurements is that they provide isolated glucose values which do not reflect variations occurring throughout the day and night. Hence systems monitoring blood glucose concentrations on a "continuous basis" have been developed. In clinical studies, different devices were shown to provide useful information on glycemic excursions in people with diabetes with sufficient accuracy. Thus, in clinical practice, this approach has also been shown to help in the medical management leading to a reduction in glycated hemoglobin and glycemic variability. However, because of lack of experience, this technology has yet to replace standard capillary blood glucose monitoring. In this paper, we review the biochemical perspectives of continuous glucose monitoring and its clinical use in type 1 diabetes.
    Full-text · Article · Nov 2008 · Clinical biochemistry

  • No preview · Article ·
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is evidence suggesting that the respiratory response to sedation is different in patients with sleep apnoea, which is common in patients with chronic renal failure (CRF). This study examined the respiratory response of sedation with propofol and alfentanil, whose pharmacokinetics are not affected by the renal function, in CRF patients. Chronic renal failure patients who underwent arteriovenous-fistular surgery (CRF group) and patients who underwent chemoport insertion (control group) were enrolled in this study. Sedation was induced by infusing propofol 1.5 micro/ml and alfentanil 0.2 micro/kg/min continuously in both groups. In the desaturation study, the respiratory rate and peripheral oxygen saturation in room air were checked. In the apnoea-hypopnoea study, the patient's sedation (Observer's Assessment of Alertness/Sedation) score, apnoea-hypopnoea index (AHI) was recorded using a portable ventilation effort recorder (microMesam) while applying 5 l/min of oxygen through a facial mask. The desaturation event was more common (21.5/h vs. 2/h, p = 0.001) in the CRF patients. Apnoea and hypopnoea (AHI: 13.0 vs. 1.6, p = 0.012, per cent of patients with an AHI > 5: 53.3% vs. 7.1%, p = 0.014) occurred more frequently in the CRF patients but the sedation score was not different. Chronic renal failure patients have a higher risk of developing apnoea and hypopnoea during sedation, which highlights the need for careful monitoring and management in these patients.
    No preview · Article · Nov 2007 · International Journal of Clinical Practice
Show more