Effectiveness of early intensive therapy onb-cell preservation in type 1 diabetes

Bruce Buckingham, Roy W. Beck, Katrina J. Ruedy, Peiyao Cheng, Craig Kollman, Stuart A. Weinzimer, Linda DiMeglio, Andrew A. Bremer, Robert Slover, William V. Tamborlane

Research output: Contribution to journalArticle

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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 b-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 b-cell function compared with current standards of care.

Original languageEnglish
Pages (from-to)4030-4035
Number of pages6
JournalDiabetes Care
Volume36
Issue number12
DOIs
StatePublished - Dec 2013

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Secondary Prevention
Type 1 Diabetes Mellitus
C-Peptide
Glucose
Outpatients
Insulin
Standard of Care
Group Psychotherapy
Area Under Curve
Meals
Inpatients
Research Design
Therapeutics
Injections

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Buckingham, B., Beck, R. W., Ruedy, K. J., Cheng, P., Kollman, C., Weinzimer, S. A., ... Tamborlane, W. V. (2013). Effectiveness of early intensive therapy onb-cell preservation in type 1 diabetes. Diabetes Care, 36(12), 4030-4035. https://doi.org/10.2337/dc13-1074

Effectiveness of early intensive therapy onb-cell preservation in type 1 diabetes. / Buckingham, Bruce; Beck, Roy W.; Ruedy, Katrina J.; Cheng, Peiyao; Kollman, Craig; Weinzimer, Stuart A.; DiMeglio, Linda; Bremer, Andrew A.; Slover, Robert; Tamborlane, William V.

In: Diabetes Care, Vol. 36, No. 12, 12.2013, p. 4030-4035.

Research output: Contribution to journalArticle

Buckingham, B, Beck, RW, Ruedy, KJ, Cheng, P, Kollman, C, Weinzimer, SA, DiMeglio, L, Bremer, AA, Slover, R & Tamborlane, WV 2013, 'Effectiveness of early intensive therapy onb-cell preservation in type 1 diabetes', Diabetes Care, vol. 36, no. 12, pp. 4030-4035. https://doi.org/10.2337/dc13-1074
Buckingham B, Beck RW, Ruedy KJ, Cheng P, Kollman C, Weinzimer SA et al. Effectiveness of early intensive therapy onb-cell preservation in type 1 diabetes. Diabetes Care. 2013 Dec;36(12):4030-4035. https://doi.org/10.2337/dc13-1074
Buckingham, Bruce ; Beck, Roy W. ; Ruedy, Katrina J. ; Cheng, Peiyao ; Kollman, Craig ; Weinzimer, Stuart A. ; DiMeglio, Linda ; Bremer, Andrew A. ; Slover, Robert ; Tamborlane, William V. / Effectiveness of early intensive therapy onb-cell preservation in type 1 diabetes. In: Diabetes Care. 2013 ; Vol. 36, No. 12. pp. 4030-4035.
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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 b-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 b-cell function compared with current standards of care.",
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AU - Kollman, Craig

AU - Weinzimer, Stuart A.

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