Continuous glucose monitoring-guided insulin adjustment in children and adolescents on near-physiological insulin regimens. Diabetes Care 2006

OBJECTIVE — This randomized controlled trial assesses the effect on glycemic control of continuous glucose monitoring system (CGMS)-guided insulin therapy adjustment in young people with type 1 diabetes on intensive diabetes treatment regimens with continuous subcu-taneous insulin infusion (CSII) or glargine. RESEARCHDESIGNANDMETHODS — Pediatric subjects were recruited if they had an HbA1c (A1C)10 % and had been on CSII or glargine for at least 3 months. Thirty-six subjects were randomized to insulin adjustment on the basis of 72 h of CGMS every 3 weeks or inter-mittent self-monitoring of blood glucose (SMBG) for 3 months. A1C and fructosamine were measured at baseline and 6 and 12 weeks. Follow-up A1C was measured at 6 months. Mean baseline A1C was 8.2 % (n 19) in the CGMS group and 7.9 % (n 17) in the control group. RESULTS — There was a significant improvement in A1C from baseline values in both groups, but there was no difference in the degree of improvement in A1C at 12 weeks between the CGMS (0.4 % [95 % CI0.7 to0.1]) and the control group (0.4 % [0.8 to 0.2]). In the CGMS group, improved A1C was at the cost of increased duration of hypoglycemia. CONCLUSIONS — CGMS is no more useful than intermittent fingerstick SMBG and fre