Glycemic patterns detected by continuous subcutaneous glucose sensing in children and adolescents with type 1 diabetes mellitus treated by multiple daily injections vs continuous subcutaneous insulin infusion

Objective: To compare glycemic patterns by mode of therapy in children with type 1 diabetes mellitus using the Continuous Glucose Monitoring System (CGMS). Design: Open randomized crossover comparing 3 1/2 months of multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII). Setting: Tertiary care, university-affiliated medical center. Patients: Twenty-three children and adolescents with type 1 diabetes mellitus. Interventions: The CGMS was applied for 72 hours after 1 month and at the end of each study arm. Main Outcome Measures: Hemoglobin A(1c) levels and glucose level profiles were compared between the 2 study arms and the 2 sensor applications for each arm. Results: The arms were similar for mean (SD) hemoglobin A(1c) levels (CSII, 8.0% [0.8%]; and MDI, 8.2% [0.8%]) and glucose levels. Areas under the curve were significantly larger during MDI for nocturnal and 24-hour hypoglycemia (P = .01 and .04, respectively) and for postprandial hypoglycemia and hyperglycemia (P = .03 and .05, respectively). The rate of hyperglycemia increased during CSII (P = .03), but 24-hour duration and area under the curve for hyperglycemia were similar. Compared with the first CGMS reading in each arm, the second had a longer mean duration of postprandial within-target glucose levels (P = .04), tendency for lower rate of diurnal hypoglycemic events (P = .1), shorter duration of nocturnal hypoglycemia (P = .05), and smaller 24-hour area under the curve for hypoglycemia (P = .04). Conclusions: Intensive treatment with CSII seemed to be associated with slightly better prebreakfast, postprandial, and within-target glucose profiles than MDI, as well as a smaller area under the curve for hypoglycemia. Lower hypoglycemia-related variables in the second sensor reading in each arm indicate that the CGMS may serve as an educational tool to decrease the rate and magnitude of hypoglycemia.