Hypoglycemia awareness increased with use of sensor-augmented pump therapy. Diabetes Care June 2012.
Using the Paradigm Veo system from Medtronic, accompanied by education sessions and patient-led assistance, patients with type 1 diabetes developed awareness of hypoglycemia, according to preliminary findings from a cohort study in Australia.
Patients with type 1 diabetes on insulin pump therapy with little awareness about hypoglycemia participated in a 6-month trial comparing their standard pump therapy with the Veo, which allows insulin to automatically suspend up to 2 hours when the sensor glucose levels fall to less than 60 mg/dL.
Trang T. Ly, MBBS, DCh, FRACP, a pediatric endocrinologist and research fellow at Princess Margaret Hospital in Australia, and colleagues designed the study that consisted of 24 patients aged 4 to 50 years.
Patients received a questionnaire, followed by random assignment to 3-hour face-to-face education sessions, and patient-led assistance via phone or email. For 6 months, patients also used the Veo system to determine low-glucose suspend events.
When glucose levels fell to less than the threshold of 60 mg/dL, an alarm was signaled by the pump. In a situation where a patient did not respond to the alarm, insulin would be suspended up to 2 hours after standard basal insulin, the researchers said. Patients could intervene, but if no intervention occurred, the pump cycled on a 6-hour continuous cycle of 2 hours of insulin followed by 4 hours of basal insulin.
There were 45.8 severe hypoglycemic events per 100 patient-years before use of the Veo system, and the HbA1c level improved from 7.8% at baseline, to 7.4% at 6 months. However, the HbA1c level increased from months 3 to 6 in the study (P=.517). Throughout the entire study, the sensor was worn 2,493 of 4,218 patient-days, with 1.3 low-glucose suspend events occurring per day, 40% of which occurred overnight.
After the Veo system intervention, 79% of patients continued to wear the system for another 6 months.
There were no serious adverse outcomes during this study, and hypoglycemia awareness scores improved after the completion of the study. Final results have yet to be reported.
From ADA/diabetes pro
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