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Naomi Weintrob, MD; Amir Schechter, MA; Hadassa Benzaquen, CDE; Shlomit Shalitin, MD; Pearl Lilos, BSc; Avinoam Galatzer, MA; Moshe Phillip, MD

Arch Pediatr Adolesc Med. 2004;158:677-684.

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 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.

From the Institute for Endocrinology and Diabetes, National Center of Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tiqva (Drs Weintrob, Shalitin, and Phillip, Mss Benzaquen and Lilos, and Mr Galatzer), Sackler Faculty of Medicine, Tel Aviv, Israel (Drs Weintrob, Shalitin, and Phillip), and Abramson Center for Medical Physics, School of Physics and Astronomy, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv (Mr Schechter).

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