EASD: CGMS Making Strides in Improving A1C
Reprinted with permission by Close Concerns
The results of two major clinical trials were announced at the 2008 meeting of the European Association for the Study of Diabetes (EASD).
In one of the two studies, the Juvenile Diabetes Research Foundation (JDRF) assessed the use of continuous glucose monitoring systems (CGMS) in adults and teenagers. The landmark JDRF-sponsored study attempted to determine the effect of CGM on A1c and glucose control. As the name suggests, CGM devices continuously (sampling glucose values between 1-5 times per minute) measure glucose through the use of a small glucose sensor inserted and held in place just below the skin. The sensor measures changes in interstitial fluid glucose levels and sends the information to a small monitor.
Previous CGM research has suggested that when used often, these devices can help improve blood glucose control. Unlike finger-stick blood glucose measurements, which only measure glucose levels at discrete/separate points in time, CGMs are able to identify glucose trends over multiple hours (or days) so users can better adjust insulin, meal, and exercise programs and improve glycemic control.
In the JDRF study, participants were randomly assigned to one of the three commercially available CGM systems (Abbott's Navigator, DexCom's SEVEN, or Medtronic's MiniMed Paradigm). The major finding of the study was that patients who used the CGM system frequently experienced significant drops in A1c in the six-month time frame. In adults over 25, CGM use significantly reduced A1c by 0.53% after six months. In adolescents and young adults 18-24 years, there was no significant difference in A1c overall, but more importantly, secondary endpoints reached statistical significance for all age groups. These data reflect the usage of CGM devices and diabetes management. While 83% of adults used the devices at least six days a week, only 50% of children and 30% of teens did the same. For all those that used CGM frequently, positive results were seen.
UK Prospective Diabetes Study (UKPDS)
Another study making news at the 2008 EASD meeting was the follow-up study to the UK Prospective Diabetes Study (UKPDS). The original UKPDS study was done in the 1980s to assess the long-term effects of blood sugar and blood pressure control in patients with type 2 diabetes. Data from the initial 20-year study showed that complications of type 2 diabetes (including eye disease, kidney failure, and strokes) could be significantly reduced by improving blood glucose and blood pressure control.
At this year's EASD meeting, investigators announced the results of the 10-year follow-up study which found that good glycemic control in the past had lasting benefits in terms of macrovascular (heart disease and stroke) and microvascular (eye, kidney and nerve diseases) complications. Better glucose control decreased the risk for microvascular complications while better blood pressure control decreased risk for macrovascular and microvascular complications. These results suggest that early therapy could possibly delay or prevent the later stages of diabetes (and complications) with significant risk reduction of heart attack and diabetes-related death.
During the Question and Answer session, Dr. Rury Holman (University of Oxford, UK), a principal investigator in the UKPDS trial from the very start and one of the most famous endocrinologists on the globe, noted: "If you treat patients early, you have extended benefit… You cannot wait to treat diabetes and should start treatment as soon as it is diagnosed. You will get added benefit by treating people early before waiting for them to get complications or waiting until glucose levels are extremely high." It seems clear that if we as patients look at for ourselves early, we're much less likely to get complications like blindness, heart disease, etc – in the words of one of our favorite doctors, Dr. Bill Polonsky of the Behavioral Diabetes Institute in San Diego, "Well-controlled diabetes is the leading cause of nothing!"
Kelly Close is editor in chief of diaTribe (www.diaTribe.us), a free online newsletter for patients looking for more information on products and research.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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