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Effectiveness of early intensive therapy on β-cell preservation in type 1 diabetes.

Abstract：

OBJECTIVE:To assess effectiveness of inpatient hybrid closed-loop control (HCLC) followed by outpatient sensor-augmented pump (SAP) therapy initiated within 7 days of diagnosis of type 1 diabetes on the preservation of β-cell function at 1 year. RESEARCH DESIGN AND METHODS:Sixty-eight individuals (mean age 13.3 ± 5.7 years; 35% female, 92% Caucasian) were randomized to HCLC followed by SAP therapy (intensive group; N = 48) or to the usual-care group treated with multiple daily injections or insulin pump therapy (N = 20). Primary outcome was C-peptide concentrations during mixed-meal tolerance tests at 12 months. RESULTS:Intensive-group participants initiated HCLC a median of 6 days after diagnosis for a median duration of 71.3 h, during which median participant mean glucose concentration was 140 mg/dL (interquartile range 134-153 mg/dL). During outpatient SAP, continuous glucose monitor (CGM) use decreased over time, and at 12 months, only 33% of intensive participants averaged sensor use ≥6 days/week. In the usual-care group, insulin pump and CGM use were initiated prior to 12 months by 15 and 5 participants, respectively. Mean HbA1c levels were similar in both groups throughout the study. At 12 months, the geometric mean (95% CI) of C-peptide area under the curve was 0.43 (0.34-0.52) pmol/mL in the intensive group and 0.52 (0.32-0.75) pmol/mL in the usual-care group (P = 0.49). Thirty-seven (79%) intensive and 16 (80%) usual-care participants had a peak C-peptide concentration ≥0.2 pmol/mL (P = 0.30). CONCLUSIONS:In new-onset type 1 diabetes, HCLC followed by SAP therapy did not provide benefit in preserving β-cell function compared with current standards of care.

journal_name

Diabetes Care

journal_title

Diabetes care

authors

Buckingham B,Beck RW,Ruedy KJ,Cheng P,Kollman C,Weinzimer SA,DiMeglio LA,Bremer AA,Slover R,Tamborlane WV,Diabetes Research in Children Network (DirecNet) Study Group.,Type 1 Diabetes TrialNet Study Group.

doi

10.2337/dc13-1074

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

4030-5

issue

eissn

0149-5992

issn

1935-5548

pii

dc13-1074

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Effectiveness of early intensive therapy on β-cell preservation in type 1 diabetes.