Meendering, A.L. (2013) The effect of a continuous glucose monitoring sensor as a diagnostic tool on HbA1c levels in children with type 1 Diabetes Mellitus. thesis, Medicine.
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Abstract
Introduction: Type 1 diabetes mellitus (T1DM) is one of the most frequent chronic disorders in children, with 65000 children diagnosed globally every year and results from defective beta cells in the islets of Langerhans of the pancreas combined with insulin resistance. This leads to insulin deficiency and subsequent hyperglycaemia. Most patients check their blood glucose level using the fingerprickmethod and a blood glucose meter (self-monitoring of blood glucose, SMBG). However, this provides information only about the blood glucose at the moment the blood was sampled. When using a continuous glucose monitoring system (CGMS) blood glucose levels are measured semi-continuously. Literature on the effects of a CGMS is conflicting and there is little literature on the effects of using a CGMS for a single, short period only. The aim of this study is to evaluate the effect of a CGMS used once for a short period of two to seventeen days on glycosylated haemoglobin (HbA1c) levels in children with T1DM, compared to self-monitoring of blood glucose (SMBG). When patients receive a CGMS, this is combined with evaluation of the sensor acquired information by members of the paediatrics diabetes team, education for the patient and his carers on how to improve his glycaemic control and possible adjustments in insulin regimen. This combination of a CGMS with evaluation, education and insulin adjustments is abbreviated as CGMS+. Methods: In this retrospective study 109 patients with type 1 diabetes treated with an insulin pump were divided in a case group that received a CGMS+ for two to seventeen days and a control group that performed SMBG. HbA1c levels at baseline, on short term (< six months after baseline HbA1c) and on long term (> six months after baseline HbA1c) were extracted from patients files. Information about the total daily doses of insulin (TDD), the basal/bolus ratio and the amount of hypo- and hyperglycaemic events was also registered. By using students t-tests and Mann-Whitney tests, differences in change in HbA1c, insulin regimen and hypo- and hyperglycaemic events between the intervention group and the control group were analyzed. Paired t-tests an Wilcoxon signed-ranks tests were used to analyse differences within both groups between HbA1c levels at baseline and at second and third measurement. Results: A significant between group difference in change in glycosylated hemoglobin levels was seen favoring the intervention group in the short term, but not in the long term. In children under twelve years of age a significant decrease in HbA1c of 5,58 mmol/l was seen in the long term. Moreover, in this group HbA1c levels decreased significantly more in the intervention group compared to the control group. There were no beneficial effects of a CGMS+ compared to SMBG on HbA1c levels in adolescents. Regarding changes in TDD, basal/bolus ratio and hypo- and hyperglycemic events, there were no provable differences between the intervention group and the control group. Conclusion: Our results show that a CGMS+ leads to an improvement of HbA1c in the short term compared to SMBG in children with type 1 diabetes mellitus. In the long term this difference disappeared, although a trend to a beneficial influence of a CGMS+ still exists. A CGMS+ is mainly effective in lowering HbA1c levels in children under 12 years of age with a favourable effect compared to SMBG in the short term as well as in the long term. In adolescents there was no provable effect of a CGMS+ on HbA1c levels. Effects of a CGMS on TDD, basal/bolus ratio and hypo- and hyperglycemic events could not be demonstrated in this study.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Dassel, A.C.M. and Deventer Hospital |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/163 |
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