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 A. DiMeglio, Andrew A. Bremer, Robert Slover, William V. Tamborlane

Research output: Contribution to journalArticle

41 Scopus citations

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 (US)
Pages (from-to)4030-4035
Number of pages6
JournalDiabetes care
Volume36
Issue number12
DOIs
StatePublished - Dec 1 2013

ASJC Scopus subject areas

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

Fingerprint Dive into the research topics of 'Effectiveness of early intensive therapy onb-cell preservation in type 1 diabetes'. Together they form a unique fingerprint.

  • Cite this

    Buckingham, B., Beck, R. W., Ruedy, K. J., Cheng, P., Kollman, C., Weinzimer, S. A., DiMeglio, L. A., Bremer, A. A., Slover, R., & 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