Evidence-Based Medicine in Pediatric Endocrinology

Abstract

c Leicester Royal Infirmary, Leicester University Hospitals Trust, Leicester, UK As this is an evidence-based medicine chapter, by definition we aim for the integration of best research evidence with clinical expertise and patient values [1] and strive to apply this evidence to all our decisions in clinical practice in pediatric endocrinology. As before, we have included a selection of the best evidence-based medicine papers across the breadth of this specialty with the primary aim of informing and supporting you -the clinicians -to provide the best clinical care for your patients. In addition to this evidence, we refer you to the consensus statements and guidelines that ESPE and other endocrine societies have published over the past year. Although we have included rigorous studies on the metabolic outcome of growth hormone (GH) treatment, as much of the information on GH safety currently comes from preliminary cohort analyses where the evidence of potential risks is not yet of sufficient power, we have not discussed these, but refer you to presentations at the ESPE meeting itself. Reliable evidence is likely to be produced in subsequent years. Group. jdrfapp@jaeb.org Diabetes Care 2010;33:17-22. Background: The authors aimed to determine whether continuous glucose monitoring (CGM) is effective in the management of type 1 diabetes when implemented in clinical practice. Methods: A 6-month randomized controlled trial (RCT) was undertaken to evaluate CGM in children, adolescents, and adults with type 1 diabetes. CGM was commenced in patients with an outpatient training session, two follow-up phone calls, and outpatient visits at 1, 4, 13, and 26 weeks. The control group had a less intensive training and follow-up. Those with starting HbA1c >/=7.0%, the main aim was change in HbA1c at 6 months. Mechanism of the yearResults: The frequency of use of CGM decreased from 7.0 days/week in the first month in the > or =25-year-old group, 6.3 days/week in the 15-to 24-year-olds, and 6.8 days/week in the 8-to 14-yearolds to 6.5, 3.3, and 3.7 days/week at the end of the study period, respectively (p < 0.001 for all age groups). Those with a starting HbA1c >/=7.0% demonstrated a reduction in HbA1c with CGM in all groups at 6 months (p = 0.02). Severe hypoglycemia decreased from 27.7 events per 100 person-years (in control group 6 months) to 15.0 events per 100 person-years in the 6-month follow-up CGM phase (p = 0.08). Conclusions: Frequent use of CGM in a clinical care setting improves HbA1c and also reduces hypoglycemia. Sustained frequent use of CGM is less likely in children and adolescents. 194Gary Butler/Carrie Williams/Stephen O'Riordan Quality-of-life measures in children and adults with type 1 diabetes: Juvenile Diabetes Research Foundation Continuous Glucose Monitoring randomized trialLawrence JM, Beck RW, Laffel L, Wysocki T, Xing D, Huang ES, Ives B, Kollman C, Lee J, Ruedy KJ, Tamborlane WV Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Diabetes Care 2010;33:2175-77. Back...