No registrations found.
ID
Source
Health condition
- preconceptional
- real-time
- glucose monitoring
- diabetes type 1
Sponsors and support
Adress: Heidelberglaan 100
postal code: 3584 CX
city: Utrecht
country: The Netherlands
phone: +31 (0)88 75 555 55
email: info@umcutrecht.nl
Postadres:
Postbus 85500
3508 GA Utrecht
Intervention
Outcome measures
Primary outcome
Absolute reduction in HbA1c (HbA1c at the end of study versus HbA1c at inclusion).
Secondary outcome
1. Incidence of severe hypoglycaemia;
2. Percentage of women with a fall in HbA1c of ≥ 0.4% (≥ 5 mmol/mol);
3. Percentage of women that reach target HbA1c (<7.0% or < 53 mmol/mol);
4. Time to reach target HbA1c (< 7.0% or < 53 mmol/mol);
5. Numbers of consultations (at the clinic, by telephone, by email);
6. Change in glycaemic variability;
7. Composite end point: Reduction of HbA1 ≥ 0.4% (≥ 5 mmol/mol) without an episode of severe hypoglycaemia;
8. Frequency of use RT-CGMS;
9. Fear of hypoglycaemia;
10. Quality-of-life;
11. Satisfaction with the device.
Background summary
Despite major advances in diabetes care the incidence of adverse pregnancy outcomes in women with type 1 diabetes mellitus is still significantly higher than in non-diabetic pregnancies. It is known that suboptimal glucose regulation is associated with adverse pregnancy outcomes: Suboptimal control in the periconceptional period is associated with the development of congenital malformations.
There is general consensus that prepregnancy care and optimal glycaemic control is mandatory to achieve the best possible pregnancy outcome in these women with HbA1c as the parameter reflecting the quality of glycaemic control. The latest guidelines state that we should aim for a preconceptional HbA1c-level as near the normal range as possible to achieve the best outcomes but at least an HbA1c < 7.0% (53 mmol/mol).
With lowering of the HbA1c-level towards the normal range, the risk of hypoglycaemia and severe hypoglycaemia increases, currently posing a barrier to reach best control.
The current mainstay of monitoring glycaemic control (self-measurement of blood glucose levels by finger stick) only provides snapshot images, limiting the possibilities to improve glycaemic control.
Real-Time Continuous Glucose Monitoring System (RT-CGMS) allows instantaneous display of actual glucose values combined with an alert-function when glucose levels or changes in levels fall outside preset individualised limits. Studies have shown that RT-CGMS can improve glycaemic control in patients with type 1 diabetes but the studied populations were heterogenic and no studies have been done with RT-CGMS during the preconceptional or pregnant period. No studies have been done in our population.
Glycaemic variability is a new concept in diabetes care and it has been suggested that the degree of glucose variability may be linked to adverse outcomes. Rt_CGMS may also decrease glucose variability.
Study objective
This study is designed to investigate whether it is possible to achieve substantial improvement of HbA1c values in preconceptional suboptimal regulated type 1 diabetes mellitus (which is HbA1c between 7.0-7.5%) by using RT-CGMS.
Study design
0, 12 and 16 weeks.
Intervention
A total of twenty patients will be randomly assigned between Real-Time Continuous Glucose Monitoring system every other week during 4 months (intervention group) or standard extensive care with two times a blind Continuous Glucose Monitoring System measurement of 48 hours (control group).
Inclusion criteria
1. Diagnosed with diabetes mellitus 1 at least for one year. Diagnosis: diagnosis < 30 years of age AND anti-GAD antibodies AND/OR experienced ketoacidosis;
2. Insulin pump (connectable with of changeable in a RT-CGMS device of Medtronic) for at least 3 months;
3. Reliable performance of SMBG at least 5 times a day for at least 5 days a week;
4. Child wish;
5. Stable HbA1c 7.0 - 7.7 (53-61 mmol/mol): if consecutive values (two months) show a decrease, this decrease is accepted up to (including) 0.5% (5 mmol/mol);
6. Age 18-41 years;
7. Willing to (patient herself) and capable of (as estimated by treating doctor) using RT-CGMS;
8. Able to read and speak Dutch;
9. Written informed consent;
10. Internet access (uploading results sensor).
Exclusion criteria
1. Co-existent medical problems that would interfere with study participation;
2. Use of medication that could influence glycaemic control (for example corticosteroids) in last three months;
3. ≥2 severe hypoglycaemia in the last 6 months (defined as an episode of hypoglycaemia resulting in seizure of coma or the use of glucagon or intravenous glucose for recovery).
Design
Recruitment
Followed up by the following (possibly more current) registration
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| NTR-new | NL2614 |
| NTR-old | NTR2742 |
| CCMO | NL33990.041.10 |
| ISRCTN | ISRCTN wordt niet meer aangevraagd. |
| OMON | NL-OMON36232 |