[en] The effectiveness of a specific educational programme involving the use of a real-time glucose-sensor system to improve glucose control was investigated in patients with type 1 diabetes (glucose sensor combined with a portable insulin pump--Paradigm Real Time) and in patients with type 2 diabetes poorly controlled despite insulin therapy (Guardian RT one week per month for 3 months compared to blood glucose self-monitoring). Both studies showed a reduction in glycated haemoglobin (HbA1c) levels with the glucose sensor, associated with less symptomatic hypoglycaemic episodes. Despite some technical difficulties (mainly in patients with type 2 diabetes), this approach represents a useful tool for therapeutic education. These promising results justify the initiation of larger studies evaluating glucose sensor use in well selected diabetic patients. [fr] L’efficacité d’un programme éducationnel fondé sur l’utilisation d’une mesure continue du
glucose avec un affichage en temps réel a été évaluée chez des patients diabétiques de type 1
(système couplé à une pompe à insuline externe - Paradigm Real Time®) et chez des patients
diabétiques de type 2 mal contrôlés sous insuline (système Guardian RT® une semaine par
mois pendant 3 mois versus automesure classique). Ces deux essais pilote montrent une
diminution du taux d’hémoglobine glyquée (HbA1c) avec le « glucose sensor », avec moins
d’hypoglycémies symptomatiques. Malgré certaines difficultés techniques (surtout chez les
diabétiques de type 2), l’approche représente un outil intéressant d’éducation thérapeutique.
Ces résultats prometteurs plaident pour des études de plus grande envergure chez des patients
diabétiques bien sélectionnés.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Thielen, Vinciane ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Radermecker, Régis ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Renard, Eric
Bringer, Jacques
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Language :
French
Title :
Education therapeutique et mesure continue de la glycemie chez le patient diabetique insulino-traite.
Alternative titles :
[en] Therapeutic education and continuous glucose monitoring in insulin-treated diabetic patients
American Diabetes Association. Standards of medical care in diabetes - 2010. Diabetes Care 2010;33 (Suppl. 1):S11-S61.
* Guerci B. La variabilité glycémique asymptomatique: comment l'évaluer et quelle est son incidence clinique? Diabetes Metab 2003;29:179-88.
* Siegelaar SE, Holleman F, Hoekstra JB, DeVries JH. Glucose variability: Does it matter? Endocr Rev 2010;31:171-82.
Pickup JC, Kidd J, Burmiston S, Yemane N. Determinants of glycaemic control in type I diabetes during intensified therapy with multiple daily insulin injections or continuous subcutaneous insulin infusion: Importance of blood glucose variability. Diabetes Metab Res Rev 2006;22:232-7.
Praet SF, Manders RJ, Meex RC, et al. Glycaemic instability is an underestimated problem in type 2 diabetes. Clin Sci 2006;111:119-26.
Radermecker RP, Selam JL, Scheen A. Intérêt du monitoring continu du glucose interstitiel chez le patient diabétique de type 1. Med Hyg 2003;61:1540-5.
Klonoff DC. Continuous glucose monitoring: Roadmap for 21st century diabetes therapy. Diabetes Care 2005;28:1231-9.
Hermanides J, DeVries JH. Sense and nonsense in sensors. Diabetologia 2010;53:593-6.
Wolpert HA. Continuous glucose monitoring - Coming of age. N Engl J Med 2010; June 29, epub ahead of print
Renard E. Insulinothérapie par pompe à insuline: autosurveillance glycémique continue ou traditionnelle? Diabetes Metab 2003;29:2S54-62.
Garg S, Schwartz S, Edelman S. Improved glucose excursions using an implantable real-time continuous glucose sensor in adults with type 1 diabetes. Diabetes Care 2004;27:734-8. (Pubitemid 38280542)
** Bergenstal RM, Tamborlane WV, Ahmann A, et al. Effectiveness of sensor-augmented insulin-pump therapy in type I diabetes. N Engl J Med 2010; June 29, epub ahead of print.
Thielen V, Place J, Gerbaud S, et al. Education on sensor-augmented pump use improves glucose control in type 1 diabetic patients. Diabetes Metab 2010;36: 170-1.
Thielen V, Scheen A, Bringer J, Renard E. Attempt to improve glucose control in type 2 diabetic patients by education about real-time glucose monitoring. Diabetes Metab 2010;36:240-3.
* Raccah D, Sulmont V, Reznik Y, et al. Incremental value of continuous glucose monitoring when starting pump therapy in patients with poorly controlled type 1 diabetes: The RealTrend study. Diabetes Care 2009;32:2245-50.
Grimm J-J, Berger W, Ruiz J. Insulinothérapie fonctionnelle: éducation des patients et algorithmes. Diabetes Metab 2002;28(Suppl.):2S15-8.
* The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med 2008;359:1464-76.
Hirsch IB, Abelseth J, Bode BW, et al. Sensor-augmented insulin pump therapy: Results of the first randomized treat-to-target study. Diabetes Technol Ther 2008;10:377-83.
Cemeroglu AP, Stone R, Kleis L, et al. Use of a real-time continuous glucose monitoring system in children and young adults on insulin pump therapy: Patients' and caregivers' perception of benefit. Pediatr Diabetes 2010;11:182-7.
Leinung M, Thompson S, Nardacci E. Benefits of continuous glucose monitor use in clinical practice. Endocr Pract 2010;16:371-5.
Radermecker RP, Saint Remy A, Bringer J, Renard E. Permanent use of a continuous glucose monitor significantly reduces hypoglycaemia and HbA1c in type 1 diabetic patients treated by insulin pump with high occurence of hypoglycaemia (Abstract). Diabetologia 2008; 51 (Suppl. 1):S435.
Rubin RR, Peyrot M. Treatment satisfaction and quality of life for an integrated continuous glucose monitoring/insulin pump system compared to self-monitoring plus an insulin pump. J Diabetes Sci Technol 2009;3:1402-10.
Jenkins AJ, Krishnamurthy B, Best JD, et al. Evaluation of an algorithm to guide patients with type 1 diabetes treated with continuous subcutaneous insulin infusion on how to respond to real-time continuous glucose levels: A randomized controlled trial. Diabetes Care 2010;33:1242-8.
Huang ES, O'Grady M, Basu A, et al. The cost-effectiveness of continuous glucose monitoring in type I diabetes. Diabetes Care 2010;33:1269-74.
Kohnert KD, Vogt L, Augstein P, et al. Relationships between glucose variability and conventional measures of glycemic control in continuously monitored patients with type 2 diabetes. Horm Metab Res 2009;41:137-41.
Weber KK, Lohmann T, Busch K, et al. High frequency of unrecognized hypoglycaemias in patients with type 2 diabetes is discovered by continuous glucose monitoring. Exp Clin Endocrinol Diabetes 2007;115: 491-4.
Zick R, Petersen B, Richter M, et al. Comparison of continuous blood glucose measurement with conventional documentation of hypoglycemia in patients with type 2 diabetes on multiple daily insulin injection therapy. Diabetes Technol Ther 2007;9:483-92. (Pubitemid 350158791)
Hay LC, Wilmshurst EG, Fulcher G. Unrecognized hypo- and hyperglycemia in well-controlled patients with type 2 diabetes mellitus: The results of continuous glucose monitoring. Diabetes Technol Ther 2003;5:19-26.
* Monnier L, Colette C, Boegner C, et al. Continuous glucose monitoring in patients with type 2 diabetes: Why? When? Whom? Diabetes Metab 2007; 33:247-52.
Halford J, Harris C. Determining clinical and psychological benefits and barriers with continuous glucose monitoring therapy. Diabetes Technol Ther 2010;12: 201-5.