Welcome to University of Iowa Health Care Today. As many as three-million people in the U.S. have type one diabetes and are dependent on insulin for the rest of their lives. The University of Iowa Children’s Hospital recently participated in a study to determine if continuous glucose monitoring (CGM) devices could help in the long-term management of type one diabetes. Dr. Eva Tsalikian, who was the principal investigator for this study, joins me now by phone to tell us more about the study and the results. Dr. Tsalikian is a professor of pediatrics and Director of Pediatric Endocrinology and Diabetes at UI Children’s Hospital, located in University of Iowa Hospitals and Clinics.
What is type one diabetes?
Type one diabetes is an autoimmune disease that destroys the part of the pancreas where insulin is made, so without insulin, people who are affected by the disease have to take these injections of insulin every day for the rest of their lives.
Who is typically affected by type one diabetes?
Anyone really can be affected by type one diabetes, but most commonly we see it in young children, adolescents, and young adults.
What is a continuous glucose monitoring device (CGM)?
They are devices that if they are worn on the body under the skin, a small needle—almost not a needle—a probe goes under the skin and measures the blood sugar, or rather the interstitial (that means the tissue under the skin) sugar continuously every few minutes. So, although it does not measure it in the blood, it correlates well with what the blood sugar is and people with diabetes can tell what their blood sugar is almost at every minute.
How is a CGM used to control type one diabetes?
It is important to know what the blood sugar is so that one can take the right amount of insulin, or take less, or eat the food—the meals—and snacks. As it is right now, people with diabetes—type one diabetes—have to check their blood sugar several times a day. Most commonly, they check it four or five times a day. That, though, is not enough to know how much insulin to take, when to take it, and how to not get complications of too high or too low blood sugar. With this continuous glucose monitoring, they can continuously know what their blood sugar is; and furthermore, it alerts them to blood sugar going too high or too low and they know how to react to all that.
How many sites were involved in the study?
There were a total of 10 sites in the whole country.
What were patients with type one diabetes asked to do as part of the study?
The patients were asked to wear these devices—the continuous glucose monitoring devices—but not all of them. The study involved 322 people with type one diabetes at different ages; and half of them—it was what is called a randomized clinical trial—so only half of them, but randomly, were assigned to wear the device and the other half, they continued the same way they always had treated their diabetes. At the end of this study, we compared the results of who had better control—the people who always did what they were used to doing or the people who wore the device.
How long did the study last?
The results that were presented this week were for the end of six months. The study continues for another six months.
What were the results of the study?
The results that were reported showed that if the device is worn regularly, maybe not necessarily every day, but almost every day, then the blood sugar control as is indicated by the level of what is called the hemoglobin A1c, a test that tells us how good the control is, the people who wore the device had lower hemoglobin A1c levels—that’s a better control than otherwise. This was mostly true in young adults over 25 years of age and older. Younger children did not have as good results, but they also did not wear the device regularly, so if the device is worn, it can help very much with the control of their diabetes. And the control was improved without going into the problem of the low blood sugar—a very difficult problems that people with diabetes have to deal with.
Why are these study results important to the long-term care of diabetic patients?
The short-term care I mentioned which is not to have the high levels or the low levels that are of course scary and important; but the most important part is that the lower hemoglobin A1c—that means better diabetes control—means prevention of the long-term complications which are the blindness in people, problems with their feet, problems with their kidneys not working—very severe complications.
Is the University involved in any additional research with regard to juvenile diabetes?
Yes, we are. Other than the study I mentioned, we are continuing with the continuous glucose monitoring. We are also involved in studies where we are trying to prevent these low blood sugars. Those are very important, both for young people and for adults, because many activities during a day are affected by that. As an example, exercise in children and, of course, in older people, it’s very important and if we can avoid hypoglycemia, it’s going to make their lives easier. So we are involved in studies that prevent hypoglycemia. In addition, we are involved in studies that we are looking at the relatives of people with type one diabetes. It’s called a trial med type one diabetes study where we check the relatives of those people to make sure they don’t have the tendency for diabetes and to find ways to prevent diabetes from developing.
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