news  2 0 0 8

First independent study data shows that Continuous Home Glucosa Monitoring (CHGM) can improve diabetes control

The data were released at noon on September 8 in Rome in the 44 th meeting of the European Association for the Study of Diabetes and published 2 hours later in the well known New England Journal of Medicine.

Funded and directed by the JDRF (Juvenile Diabetes Research Foundation) The data were unveiled in Rome by the following investigators Kowalski, Lawrence, Tamborlane, Wolper, Hirsch y Laffel, representing to all the group of investigators who participated in the study in the 10 differents medical institutions in 10 different cities in the USA.

All the participants were given the option to choose between the 3 different CHGM systems that are available in the Status and hopefully soon in the EU.

The 3 different CHGM devices are produced by Laboratories (Navigator), Medtronic (Guardian real time) y Dexcom (Seven sensors),all of them are able to measure the interstitial glucose concentration continuously quite different from the all systems that require a blood drop from a finger each time you want to know your glucose values and provides only a static glucose value ,since the glucose concentration is continuous changing you never know where your glucose is heading.

The main advantage of that system is that providing a glucose value continuously gives the educated and motivated patient a key information that allows to minimize the glucose swings.

Is important to remark that we can’t say yet goodbye to the all glucose meters since the CHGM system has been approved as adjunctive therapy and all the systems requires to be calibrated by comparison with the glucose value obtained from a finger stick glucose meter.

In the study, the researchers found that adults gained substantially better control of their diabetes when using continuous glucose monitoring versus a group using conventional, intermittent blood sugar management.

Improved diabetes control was determined by using what is called the hemoglobin A1c test.

During the study, the investigator assigned 322 adults and children with type I diabetes to one of four brands of continuous blood sugar monitors, or home monitoring with a standard blood glucose meter.

Over 26 weeks, the researchers found that, for patients 25 years of age and older, continuous blood sugar monitoring showed significant improvements in blood sugar control.

For patients 15 to 24 years old, the difference between the groups was not significant, primarily because the younger patients were less likely to use the equipment continuously.

Among patients 25 years of age and older, continuous blood sugar monitoring was used by 83 percent of participants for six days or more per week. For younger patients, only 30 percent of those 15 to 24 used continuous monitoring, as did 50 percent of those aged 8 to 14.

The reduction in the A1c value in the 25 years of age and older was 0,53 and this reduction was obtained without increasing the number of hypoglycaemic episodes and as you know this was the most limiting factor for getting A1c values under 7 for the type 1 diabetes patient.

Another possible benefit pointed by Dr Irl Hirsch from the University of Washington in Seattle, a participant investigator maybe that with the appropriate use of this devices will be possible to reduce the glucose swings (glucose variability) and it was suggested that glucose variability through increasing the oxidative stress and other less known mechanism can have and impact in the cause or aggravation of the diabetic complication.

Dr Hirsch also pointed that a great task has to be done for educating e both patients and health care providers prescribing the CHGM devices in order to get the most benefits of the CHGM and right now he is a little sceptical about how will be possible to achieve the maximum effectiveness in the “real world” out of the study because many professionals have already commented him that they wonder how ot get the “extra” time that those patients require during each visit since at the present the confess that they don’t even have time to download the glucose values stored in the glucose meters of the patients spite the fact that most of the current glucose meters has this capability.

The JDRF has decided to continue with the study for another 6 months to find out if the obtained benefits will remain after a longer period of CHGM.

In my opinion CHGM when use properly with the” right patient” and under the supervision and support of the “right diabetic specialist team” It is really a great tool and sooner than later CHGM should become a normal practice for type 1 diabetics and this is the beginning of a new era in the treatment of the type 1 diabetic patient.
Ramiro Antuña de Alaiz
Education Treatment Unit
back to news 2008