Type 1 diabetes - redGDPS

Ongoing managementphysician. The study found no difference between the groups in terms of HbA 1c levels(8.6 ± 1.7% versus 8.6 ± 1.2%, p = 0.89), occurrence of mild to moderate hypoglycaemic events(2.9 times/day versus 3.0 times/day, p = 0.91) or patient satisfaction.Cost analysis was performed on the use of modem-transmitted blood glucose information. Thecost estimates included patients’/families’ out of pocket expenses and time as well as healthservice costs and the cost of the new technology. The intervention group incurred fewer expensesand less lost productivity (parental time off work) than the control group (p < 0.001). Since therewere no reported differences in adverse outcomes, the lower cost of the intervention group madeit a viable alternative at almost half the cost ($163 versus $305). However, sensitivity analysis onthe resources that are most difficult to value (lost time/productivity, costs of new technology) wasnot performed. Also, the relatively high reported fee for a clinic visit ($246, range $235–310)accounted for most of the cost of the standard care group. The cost of specialist clinic visits forpatients of all ages was reported in a survey of UK providers to be £67 at 1997 prices, 373 which isa much lower cost and so the relative cost effectiveness would not be the same in the UK.Plastic insulin dose guide compared with paper algorithmAn RCT compared a plastic insulin dose guide with a paper algorithm as a guide for patientadjustedinsulin dose in 40 children with type 1 diabetes. The study found no significantdifference in HbA 1c levels. However, mean blood glucose levels decreased with the dose guidecompared with the algorithm (9.2 ± 1.2 mmol/l versus 11.8 ± 1.6 mmol/l), whereas patientacceptance increased with the dose guide (5.0 versus 3.4 Likert 0–5 scale), and the timeneeded to teach the patient to use the guide increased (from 18 to 43 minutes). 374 [evidencelevel Ib]Alternative body sites for blood glucose monitoringSeven observational studies examined the impact of blood glucose monitoring at alternativesites. None of the studies looked specifically at children or young people, and none of thestudies investigated long-term outcomes related to complications or glycaemic control. Sevenstudies compared blood glucose measurements from the traditional site (the finger) to those froman alternative site (for example, the arm). Six studies found strong correlations between forearmblood glucose monitoring and finger blood glucose monitoring. 375–380 [evidence level IIa] Onestudy found changes in blood glucose after a meal may be identified at finger sites beforedetection at forearm or thigh sites. 381 [evidence level IIa] Two studies looked at patientacceptability of alternative sites for blood glucose monitoring. One study found that 76% ofpatients preferred a monitor that could be used for sites other than the finger (n = 121 patientswith type 1 or type 2 diabetes). 382 [evidence level IIa] The second study reported that 97% ofpatients found arm blood glucose testing less painful than finger testing (n = 378 patients withtype 1 or type 2 diabetes). 378 [evidence level IIa]Continuous glucose monitoring systemsSelf-monitoring of blood glucose provides a snapshot of glucose levels during the day, butmarked glycaemic excursions can be missed in periods when no glucose level is taken.Continuous glucose monitoring systems (CGMSs) measure interstitial fluid glucose and provideinformation about continuous glucose fluctuations that is not captured by intermittent bloodglucose testing. 383 [evidence level IV]CGMSs require calibration with finger-stick tests and supplement, but do not replace,conventional blood glucose testing. 383 [evidence level IV] CGMS measurements correspond toblood glucose values taken approximately 13–18 minutes earlier and may differ from bloodglucose monitor readings. 383 [evidence level IV] We identified two groups of CGMSs: invasivedesigns and non-invasive designs.Invasive continuous glucose monitoring systemsInvasive continuous glucose monitoring systems can be used for up to 72 hours. 384 [evidencelevel IV]We found two RCTs evaluating the invasive CGMS MiniMed®. In one RCT (n = 11 children andyoung people), the intervention group used the invasive CGMS for 18 days out of a 30-day period75