Improved glycemic control through continuous glucose sensor-augmented insulin pump therapy: prospective results from a community and academic practice patient registry.

BACKGROUND: Conducted by highly experienced investigators with abundant time and resources, phase III studies of continuous glucose sensing (CGS) may lack generalizability to everyday clinical practice. METHOD: Community or academic practices in six Central and Eastern European or Mediterranean countries prospectively established an anonymized registry of consecutive patients with type 1 insulin-dependent diabetes mellitus starting CGS-augmented insulin pump therapy with the Paradigm X22 (Medtronic MiniMed, Northridge, CA) under everyday conditions, without prior CGS with another device. We compared glycosylated hemoglobin (GHb) values before and after 3 months of CGS and assessed relationships between insulin therapy variables and glycemia-related variables at weeks 1, 4, and 12 of CGS. RESULTS: Of 102 enrolled patients, 85 (83%) with complete weeks 1, 4, and 12 sensor data and baseline/3-month GHb data were evaluable. Evaluable patients were approximately 54% male and approximately 75% adult (mean age, 33.2 +/- 16.9 years) with longstanding diabetes and high personal/family education levels. Mean GHb declined significantly after 3 months of CGS (7.55 +/- 1.33% at baseline to 6.81 +/- 1.08% after 12 weeks, 0.74% absolute decrease, P < 0.001). The absolute GHb reduction correlated significantly (P < 0.0005) with baseline GHb: larger absolute reductions tended to occur when baseline levels were higher. An increased basal insulin dose as a percentage of the total daily insulin dose and a decreased daily bolus count from week 1 to week 12 of CGS predicted GHb improvement from baseline to week 12. CONCLUSIONS: CGS-augmented insulin pump therapy appears to improve glycemic control in type 1 diabetes in varied everyday practice settings.

Abnormalities of pituitary function after traumatic brain injury in children.

Traumatic brain injury (TBI) is a frequent cause of neuroendocrine dysfunction typically in male adults. Head injuries are also common in childhood, but only a few case reports outlined the endocrine consequences. The aim of this study was to reveal anterior pituitary function in children with history of hospitalization due to mild to severe head trauma. Our endocrine follow-up study was performed between October 2003 and February 2004 in the Pediatric Department of Petz Aladár County Teaching Hospital, Gyor, Hungary. Twenty-six children (17 boys and nine girls, aged 11.47 +/- 0.75 years) at 30.6 +/- 8.3 months after head injury and 21 age-matched controls were enrolled. Basal and stimulated anterior pituitary and peripheral hormone concentrations were measured by routine laboratory methods. Pituitary dysfunction was detected in 61% of patients with TBI history. All growth hormone (GH) parameters measured and calculated were significantly (p < 0.05) lower in TBI group than in controls after L-DOPA stimulation. Similar difference was detected 60 min after insulin provocation. Forty-two percent of all TBI children showed insufficient growth hormone (GH) response in both stimulation tests, 73% of these cases were boys. Cortisol levels of TBI patients were significantly (p < 0.05) lower all through the insulin test than values measured in control group. The degree of pituitary dysfunction was independent from the severity of TBI. Our study confirms the high risk for hypopituitarism in children with TBI despite the lack of obvious clinical symptoms. We suggest screening of pituitary function after any kind of brain trauma requiring hospitalization in childhood.