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New Methods Found to Better Monitor Glucose, Control Insulin

Sherita Hill Golden (Johns Hopkins University)

Sherita Hill Golden (Johns Hopkins University)

Researchers at the medical centers of Johns Hopkins University in Baltimore and Case Western Reserve University in Cleveland have found newer technologies to monitor blood sugar and replenish insulin for people with type 1 diabetes to work more effectively in many cases than traditional methods. The findings of the team led by Johns Hopkins medical professor Sherita Hill Golden (pictured left) are reported online this week in the journal Annals of Internal Medicine.

Diabetes is a condition where the body cannot properly manage the level of glucose or sugar in the blood. In type 1 diabetes, the body does not make insulin, the hormone that regulates the body’s use of glucose. Individuals with type 1 diabetes need insulin to keep blood sugar levels even before and after meals and at all other times. Between 5 and 10 percent of people with diabetes have type 1, which used to be known as juvenile-onset diabetes.

Golden and colleagues reviewed and re-analyzed data from 33 randomized clinical trials that compared the newer technologies to conventional methods of monitoring and controlling blood sugar levels. The study focused on two of the newer technologies for diabetes patients: real-time continuous glucose monitoring devices and insulin pumps.

Continuous monitoring devices track blood sugar levels all day and night, as often as every five minutes, using a sensor that is attached to the abdomen with a small needle held in place by tape. Patients still need to prick their fingers two to four times a day to make sure the device is working properly, but that is still less than as many as eight to 10 times a day for patients trying to strictly control blood sugar.

Golden’s team found that patients at all ages with with type 1 diabetes — children, teens, and adults — who used continuous monitoring had lower blood glucose levels than those who used finger stick testing alone. Patients using continuous monitoring also spent less overall time with too much blood sugar (hyperglycemia). Both the new technology and traditional methods worked equally well to control hypoglycemia, the condition of blood sugar levels being too low.

An insulin pump is a devices with a small tube and needle that goes under the skin in the belly area, and provides insulin continuously, as needed. People with diabetes can either program the device with the push of a button based on finger stick glucose measurements, or link the pump to a continuous monitor, in what is called a sensor-augmented pump.

The researchers found little difference in blood sugar control in those who give themselves multiple insulin shots a day compared to those who used insulin pumps. However, patients with with type 1 diabetes who used the sensor-augmented pumps — models integrated with real-time continuous glucose monitoring devices — did much better controlling blood sugar than those who used finger stick testing and shots.

A key factor in the decision to use one of these newer devices is their costs, which are higher than traditional methods, and not covered by all insurance plans, including Medicare. Golden says it is important to make sure they are used by patients who will get the most benefit from them. “Those who use the devices as prescribed do the best at maintaining blood sugar control,” says Golden. “Adherence is the key to effectiveness.”

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