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Diabetes Care. 2015 Jul;38(7):1197-204. doi: 10.2337/dc14-3053. Epub 2015 Jun 6.

Predictive Low-Glucose Insulin Suspension Reduces Duration of Nocturnal Hypoglycemia in Children Without Increasing Ketosis.

Author information

1
Stanford University, Stanford, CA.
2
Jaeb Center for Health Research, Tampa, FL.
3
Rensselaer Polytechnic Institute, Troy, NY.
4
Barbara Davis Center for Childhood Diabetes, Aurora, CO.
5
St. Joseph's Health Care, London, ON, Canada.
6
Children's Hospital, London Health Sciences Centre, London, ON, Canada.
7
Jaeb Center for Health Research, Tampa, FL rbeck@jaeb.org.

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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01823341.

PMID:
26049549
PMCID:
PMC4477332
DOI:
10.2337/dc14-3053
[Indexed for MEDLINE]
Free PMC Article

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