Type 2 Diabetes Clinical Trial
Official title:
Continuous Glucose Monitoring in Youth With Type 2 Diabetes
The purpose of this study is to use a continuous glucose monitor (CGM) to describe the day to day blood glucose variability in youth with type 2 diabetes. The hypothesis is that CGM will identify caloric and exercise related variation in blood glucose that is not identified by the subjects' current regimen of intermittent finger stick blood glucose measurements.
The TODAY study and other studies have reported disappointing results of intensive life-style
programs alone or in combination with metformin in maintaining optimal control of type 2
diabetes (T2D) in adolescents. Continuous glucose monitoring (CGM) has been successful in
lifestyle modification in adults with T2D but use of CGM has not been studied in youth with
T2D. Thus the feasibility of this technology should be evaluated in this patient population
as it may prove to be an effective adjunct to treatment in the future.
Youth with type 2 diabetes will be approached for enrollment in this study. The study will be
explained to volunteers who meet eligibility criteria and informed consent/assent will be
obtained. Demographic data will be recorded. A medical history will be performed. A urine
pregnancy test (in women) will be measured to confirm eligibility. Height, weight, BMI,
percent body fat, fat mass, and fat free mass will be measured. Hemoglobin A1c (HbA1c) will
be measured. After enrollment a blinded CGM will be placed. CGM is a device inserted under
the skin on the abdomen which monitors glucose levels every 5 minutes, recording this
information. CGM is commonly worn by kids with type 1 diabetes. The study will allow
collection of information on glucose variability in much greater detail than can be seen from
intermittent fingerstick glucose values or from an oral glucose tolerance test. Subjects will
meet with a nutritionist to learn how to keep a food record. They will be given empty food
records to complete for each day. They will also be given an accelerometer and instructed in
its use, however they will remain blinded to the data obtained. The study will be 5 days in
length. Subjects will be urged to continue their normal eating and activity behaviors. During
the study period blood sugar and CGM data will be recorded via glucometer and sensor
downloads, dietary intake via food record, and activity via accelerometer. Glucometer testing
of blood glucose is required at least every 12 hours to calibrate the CGM. To minimize the
need for overnight tests to calibrate the CGM, subjects will be asked to check their blood
sugar using a glucometer 3 times a day, preferably fasting in the morning before breakfast,
before dinner, and at bedtime. To optimize the accuracy of dietary intake records, subjects
will be contacted frequently and the food record information recorded by study personnel.
Subjects will be given a "morning checklist" to keep in a visible area to improve compliance
by reminding them to keep study devices with them all day. At the follow-up visit the CGM
will be downloaded revealing blood glucose tracings for the study period. Additionally the
completed food records will be collected and the accelerometer will be downloaded.
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