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Predictive Low-Glucose Insulin Suspension Reduces Duration of Nocturnal Hypoglycemia in Children Without Increasing Ketosis

OBJECTIVE: Nocturnal hypoglycemia can cause seizures and is a major impediment to tight glycemic control, especially in young children with type 1 diabetes. We conducted an in-home randomized trial to assess the efficacy and safety of a continuous glucose monitor–based overnight predictive low-gluco...

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Autores principales: Buckingham, Bruce A., Raghinaru, Dan, Cameron, Fraser, Bequette, B. Wayne, Chase, H. Peter, Maahs, David M., Slover, Robert, Wadwa, R. Paul, Wilson, Darrell M., Ly, Trang, Aye, Tandy, Hramiak, Irene, Clarson, Cheril, Stein, Robert, Gallego, Patricia H., Lum, John, Sibayan, Judy, Kollman, Craig, Beck, Roy W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477332/
https://www.ncbi.nlm.nih.gov/pubmed/26049549
http://dx.doi.org/10.2337/dc14-3053
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author Buckingham, Bruce A.
Raghinaru, Dan
Cameron, Fraser
Bequette, B. Wayne
Chase, H. Peter
Maahs, David M.
Slover, Robert
Wadwa, R. Paul
Wilson, Darrell M.
Ly, Trang
Aye, Tandy
Hramiak, Irene
Clarson, Cheril
Stein, Robert
Gallego, Patricia H.
Lum, John
Sibayan, Judy
Kollman, Craig
Beck, Roy W.
author_facet Buckingham, Bruce A.
Raghinaru, Dan
Cameron, Fraser
Bequette, B. Wayne
Chase, H. Peter
Maahs, David M.
Slover, Robert
Wadwa, R. Paul
Wilson, Darrell M.
Ly, Trang
Aye, Tandy
Hramiak, Irene
Clarson, Cheril
Stein, Robert
Gallego, Patricia H.
Lum, John
Sibayan, Judy
Kollman, Craig
Beck, Roy W.
author_sort Buckingham, Bruce A.
collection PubMed
description OBJECTIVE: Nocturnal hypoglycemia can cause seizures and is a major impediment to tight glycemic control, especially in young children with type 1 diabetes. We conducted an in-home randomized trial to assess the efficacy and safety of a continuous glucose monitor–based overnight predictive low-glucose suspend (PLGS) system. RESEARCH DESIGN AND METHODS: In two age-groups of children with type 1 diabetes (11–14 and 4–10 years of age), a 42-night trial for each child was conducted wherein each night was assigned randomly to either having the PLGS system active (intervention night) or inactive (control night). The primary outcome was percent time <70 mg/dL overnight. RESULTS: Median time at <70 mg/dL was reduced by 54% from 10.1% on control nights to 4.6% on intervention nights (P < 0.001) in 11–14-year-olds (n = 45) and by 50% from 6.2% to 3.1% (P < 0.001) in 4–10-year-olds (n = 36). Mean overnight glucose was lower on control versus intervention nights in both age-groups (144 ± 18 vs. 152 ± 19 mg/dL [P < 0.001] and 153 ± 14 vs. 160 ± 16 mg/dL [P = 0.004], respectively). Mean morning blood glucose was 159 ± 29 vs. 176 ± 28 mg/dL (P < 0.001) in the 11–14-year-olds and 154 ± 25 vs. 158 ± 22 mg/dL (P = 0.11) in the 4–10-year-olds, respectively. No differences were found between intervention and control in either age-group in morning blood ketosis. CONCLUSIONS: In 4–14-year-olds, use of a nocturnal PLGS system can substantially reduce overnight hypoglycemia without an increase in morning ketosis, although overnight mean glucose is slightly higher.
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spelling pubmed-44773322016-07-01 Predictive Low-Glucose Insulin Suspension Reduces Duration of Nocturnal Hypoglycemia in Children Without Increasing Ketosis Buckingham, Bruce A. Raghinaru, Dan Cameron, Fraser Bequette, B. Wayne Chase, H. Peter Maahs, David M. Slover, Robert Wadwa, R. Paul Wilson, Darrell M. Ly, Trang Aye, Tandy Hramiak, Irene Clarson, Cheril Stein, Robert Gallego, Patricia H. Lum, John Sibayan, Judy Kollman, Craig Beck, Roy W. Diabetes Care Diabetes Care Symposium OBJECTIVE: Nocturnal hypoglycemia can cause seizures and is a major impediment to tight glycemic control, especially in young children with type 1 diabetes. We conducted an in-home randomized trial to assess the efficacy and safety of a continuous glucose monitor–based overnight predictive low-glucose suspend (PLGS) system. RESEARCH DESIGN AND METHODS: In two age-groups of children with type 1 diabetes (11–14 and 4–10 years of age), a 42-night trial for each child was conducted wherein each night was assigned randomly to either having the PLGS system active (intervention night) or inactive (control night). The primary outcome was percent time <70 mg/dL overnight. RESULTS: Median time at <70 mg/dL was reduced by 54% from 10.1% on control nights to 4.6% on intervention nights (P < 0.001) in 11–14-year-olds (n = 45) and by 50% from 6.2% to 3.1% (P < 0.001) in 4–10-year-olds (n = 36). Mean overnight glucose was lower on control versus intervention nights in both age-groups (144 ± 18 vs. 152 ± 19 mg/dL [P < 0.001] and 153 ± 14 vs. 160 ± 16 mg/dL [P = 0.004], respectively). Mean morning blood glucose was 159 ± 29 vs. 176 ± 28 mg/dL (P < 0.001) in the 11–14-year-olds and 154 ± 25 vs. 158 ± 22 mg/dL (P = 0.11) in the 4–10-year-olds, respectively. No differences were found between intervention and control in either age-group in morning blood ketosis. CONCLUSIONS: In 4–14-year-olds, use of a nocturnal PLGS system can substantially reduce overnight hypoglycemia without an increase in morning ketosis, although overnight mean glucose is slightly higher. American Diabetes Association 2015-07 2015-06-11 /pmc/articles/PMC4477332/ /pubmed/26049549 http://dx.doi.org/10.2337/dc14-3053 Text en © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
spellingShingle Diabetes Care Symposium
Buckingham, Bruce A.
Raghinaru, Dan
Cameron, Fraser
Bequette, B. Wayne
Chase, H. Peter
Maahs, David M.
Slover, Robert
Wadwa, R. Paul
Wilson, Darrell M.
Ly, Trang
Aye, Tandy
Hramiak, Irene
Clarson, Cheril
Stein, Robert
Gallego, Patricia H.
Lum, John
Sibayan, Judy
Kollman, Craig
Beck, Roy W.
Predictive Low-Glucose Insulin Suspension Reduces Duration of Nocturnal Hypoglycemia in Children Without Increasing Ketosis
title Predictive Low-Glucose Insulin Suspension Reduces Duration of Nocturnal Hypoglycemia in Children Without Increasing Ketosis
title_full Predictive Low-Glucose Insulin Suspension Reduces Duration of Nocturnal Hypoglycemia in Children Without Increasing Ketosis
title_fullStr Predictive Low-Glucose Insulin Suspension Reduces Duration of Nocturnal Hypoglycemia in Children Without Increasing Ketosis
title_full_unstemmed Predictive Low-Glucose Insulin Suspension Reduces Duration of Nocturnal Hypoglycemia in Children Without Increasing Ketosis
title_short Predictive Low-Glucose Insulin Suspension Reduces Duration of Nocturnal Hypoglycemia in Children Without Increasing Ketosis
title_sort predictive low-glucose insulin suspension reduces duration of nocturnal hypoglycemia in children without increasing ketosis
topic Diabetes Care Symposium
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477332/
https://www.ncbi.nlm.nih.gov/pubmed/26049549
http://dx.doi.org/10.2337/dc14-3053
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