Effectiveness of early intensive therapy on β-cell preservation in type 1 diabetes.

Buckingham B, Beck RW, Ruedy KJ, Cheng P, Kollman C, Weinzimer SA, DiMeglio LA, Bremer AA, Slover R, Tamborlane WV, Diabetes Research in Children Network (DirecNet) Study Group, Type 1 Diabetes TrialNet Study Group
Diabetes Care. 2013 36 (12): 4030-5

PMID: 24130350 · PMCID: PMC3836135 · DOI:10.2337/dc13-1074

OBJECTIVE - To assess effectiveness of inpatient hybrid closed-loop control (HCLC) followed by outpatient sensor-augmented pump (SAP) therapy initiated within 7 days of diagnosis of type 1 diabetes on the preservation of β-cell function at 1 year.

RESEARCH DESIGN AND METHODS - Sixty-eight individuals (mean age 13.3 ± 5.7 years; 35% female, 92% Caucasian) were randomized to HCLC followed by SAP therapy (intensive group; N = 48) or to the usual-care group treated with multiple daily injections or insulin pump therapy (N = 20). Primary outcome was C-peptide concentrations during mixed-meal tolerance tests at 12 months.

RESULTS - Intensive-group participants initiated HCLC a median of 6 days after diagnosis for a median duration of 71.3 h, during which median participant mean glucose concentration was 140 mg/dL (interquartile range 134-153 mg/dL). During outpatient SAP, continuous glucose monitor (CGM) use decreased over time, and at 12 months, only 33% of intensive participants averaged sensor use ≥6 days/week. In the usual-care group, insulin pump and CGM use were initiated prior to 12 months by 15 and 5 participants, respectively. Mean HbA1c levels were similar in both groups throughout the study. At 12 months, the geometric mean (95% CI) of C-peptide area under the curve was 0.43 (0.34-0.52) pmol/mL in the intensive group and 0.52 (0.32-0.75) pmol/mL in the usual-care group (P = 0.49). Thirty-seven (79%) intensive and 16 (80%) usual-care participants had a peak C-peptide concentration ≥0.2 pmol/mL (P = 0.30).

CONCLUSIONS - In new-onset type 1 diabetes, HCLC followed by SAP therapy did not provide benefit in preserving β-cell function compared with current standards of care.

MeSH Terms (17)

Adolescent Adult Blood Glucose Child Diabetes Mellitus, Type 1 Female Follow-Up Studies Glycated Hemoglobin A Humans Hypoglycemic Agents Insulin Insulin-Secreting Cells Insulin Infusion Systems Male Middle Aged Time Factors Treatment Outcome

Connections (1)

This publication is referenced by other Labnodes entities:

Links