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Predictive low-glucose insulin suspension reduces duration of nocturnal hypoglycemia in children without increasing ketosis
Diabetes Care
  • Bruce A. Buckingham, Stanford University
  • Dan Raghinaru, Jaeb Center for Health Research
  • Fraser Cameron, Rensselaer Polytechnic Institute
  • B. Wayne Bequette, Rensselaer Polytechnic Institute
  • H. Peter Chase, Barbara Davis Center for Childhood Diabetes
  • David M. Maahs, Barbara Davis Center for Childhood Diabetes
  • Robert Slover, Barbara Davis Center for Childhood Diabetes
  • R. Paul Wadwa, Barbara Davis Center for Childhood Diabetes
  • Darrell M. Wilson, Stanford University
  • Trang Ly, Stanford University
  • Tandy Aye, Stanford University
  • Irene Hramiak, St. Joseph's Health Care London
  • Cheril Clarson, London Health Sciences Centre
  • Robert Stein, London Health Sciences Centre
  • Patricia H. Gallego, London Health Sciences Centre
  • John Lum, Jaeb Center for Health Research
  • Judy Sibayan, Jaeb Center for Health Research
  • Craig Kollman, Jaeb Center for Health Research
  • Roy W. Beck, Jaeb Center for Health Research
Document Type
Article
Publication Date
7-1-2015
URL with Digital Object Identifier
10.2337/dc14-3053
Abstract

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.

Citation Information
Bruce A. Buckingham, Dan Raghinaru, Fraser Cameron, B. Wayne Bequette, et al.. "Predictive low-glucose insulin suspension reduces duration of nocturnal hypoglycemia in children without increasing ketosis" Diabetes Care Vol. 38 Iss. 7 (2015) p. 1197 - 1204
Available at: http://works.bepress.com/cheril-clarson/20/