Patient behaviors associated with optimum glycemic outcomes with sensor-augmented pump therapy: insights from the STAR 3 study.
OBJECTIVE
The purpose of this analysis was to identify patient behaviors that led to optimum glycemic outcomes in subjects with type 1 diabetes (T1DM) who transitioned from multiple daily injections (MDI) therapy to sensor-augmented pump (SAP) therapy.


METHODS
Sensor-augmented pump Therapy for A1C Reduction (STAR 3), a randomized controlled trial, assigned 485 suboptimally controlled T1DM subjects to either MDI therapy (n = 241) or SAP therapy (n = 244). We categorized subjects in the latter group according to age at enrollment and glycated hemoglobin (A1C) value after using the SAP system for 12 months. Pairwise comparisons of how the pump features were used between SAP subjects with the highest and lowest end-of-study A1C values were made via t tests.


RESULTS
Larger decreases in A1C values were significantly correlated with increasing sensor use in both the adult and pediatric age groups. Subjects in the low-A1C cohorts of both pediatric and adult age groups gave themselves smaller and more frequent boluses and used the Bolus Wizard bolus estimation calculator more frequently than subjects in age-matched high-A1C cohorts. Children in the low-A1C cohort used less insulin than children in the high-A1C cohort. There was no additional hypoglycemia in either the adult or pediatric low-A1C cohorts versus their high-A1C counterparts.


CONCLUSIONS
Both adult and pediatric patients with T1DM on SAP who use CGM sensors more often will have a greater decrease in their A1C values than those who do not demonstrate these behaviors. Routine use of CGM may lead to smaller and more frequent bolus dosing, enabling this population to safely reach their A1C goals.