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Effect of Sensor-Augmented Pump Treatment Versus Multiple Daily Injections on Albuminuria: A 1-Year Randomized Study.
- Source :
-
The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2015 Nov; Vol. 100 (11), pp. 4181-8. Date of Electronic Publication: 2015 Sep 21. - Publication Year :
- 2015
-
Abstract
- Context: The effect of glycemic control on persisting albuminuria remains unclear. Insulin delivery and glucose variability may be important.<br />Objective: This study aimed to investigate the effect of 1-year treatment with sensor-augmented insulin pump (SAP) or multiple daily injections (MDIs) on albuminuria.<br />Design, Patients, and Methods: This was a randomized controlled open-label parallel trial composed of 60 patients with type 1 diabetes with a history of albuminuria and on stable renin-angiotensin system inhibition, were randomly assigned to SAP or MDI. Urine albumin creatinine ratio (UACR) was measured in three urine samples at all visits. Glucose variability and glomerular filtration rate ((51)Cr-EDTA-GFR) were measured at beginning and study end. Using linear mixed model, change in UACR between groups was analyzed as intention to treat.<br />Main Outcome Measure: Change in UACR was measured.<br />Results: Fifty-five patients (SAP, n = 26; MDI, n = 29) completed the study. Diabetes duration (mean ± SD, 33 ± 12 y), UACR (geometric mean, 99 mg/g; interquartile range, 37-233 mg/g), (51)Cr-EDTA-GFR (94 ± 22 mL/min/1.73m(2)), glycosylated hemoglobin (HbA1c) (9.0 ± 1.1%), glucose variability (calculated as SD), 4.0 ± 1.0 mmol/l; no-group differences (P ≥ .06 for all). After 1 year, change in UACR was mean, -13%; 95% confidence interval, -39 to 22 with SAP vs mean, 30%; 95% CI, -12 to 92% on MDI treatment (unadjusted P = .051; adjusted for HbA1c, P = .04). HbA1c decreased 1.3 ± 1.0 vs 0.6 ± 1.0% (P = .013), glucose variability decreased 0.9 ± 1.1 vs 0.3 ± 1.0 mmol/L (P = .04), and (51)Cr-EDTA-GFR declined 5.6 ± 9.6 vs 3.4 ± 13 mL/min/1.73m(2) (P = .50) with SAP vs MDI treatment. There were no changes in blood pressure (P ≥ .27).<br />Conclusion: SAP treatment reduced UACR in a randomized controlled trial in type 1 diabetes patients with a history of albuminuria on stable renin-angiotensin system inhibition. Significance was reached after adjustment. SAP treatment reduced HbA1c and glucose variability (calculated as SD).
- Subjects :
- Adolescent
Adult
Aged
Biosensing Techniques
Blood Glucose metabolism
Blood Pressure
Creatinine urine
Diabetes Mellitus, Type 1 drug therapy
Diabetes Mellitus, Type 1 urine
Female
Glomerular Filtration Rate
Glycated Hemoglobin analysis
Glycated Hemoglobin metabolism
Humans
Hypoglycemic Agents adverse effects
Insulin adverse effects
Male
Middle Aged
Treatment Outcome
Young Adult
Albuminuria drug therapy
Hypoglycemic Agents administration & dosage
Hypoglycemic Agents therapeutic use
Insulin administration & dosage
Insulin therapeutic use
Insulin Infusion Systems
Subjects
Details
- Language :
- English
- ISSN :
- 1945-7197
- Volume :
- 100
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- The Journal of clinical endocrinology and metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 26390102
- Full Text :
- https://doi.org/10.1210/jc.2015-2839