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BMJ 2008; 337 doi: (Published 16 September 2008) Cite this as: BMJ 2008;337:a1661

Continuous glucose monitoring works best for adults

Continuous monitoring of interstitial glucose sounds like a good idea for people with type 1 diabetes. The monitoring devices only work if you wear them, however. In the latest trial, continuous monitoring improved glycaemic control over 26 weeks in adults aged over 25, but not in younger age groups—possibly because 83% of the older adults wore their device for at least six days a week, compared with only 30% of 14-24 year olds and 50% of 8-14 years olds (P<0.001 for older adults v the other two groups). Controls of all ages used traditional glucose meters and did finger prick tests at least four times a day.

Among adults older than 25 years, continuous monitoring with one of three devices reduced glycated haemoglobin (mean difference in change from baseline −0.53%, 95% CI −0.71 to −0.35) and improved other measures of glycaemic control without increasing the risk of symptomatic or biochemical hypoglycaemia.

All trial participants had relatively well controlled diabetes to start with, and most were using insulin pumps. The rest had multiple daily injections. They or their parents were well educated, and all had shown they were able to wear and work a monitor. These findings, particularly the positive ones, may not apply to less well motivated patients with diabetes, say the authors.

US medical schools must promote diversity

US medical schools are doing a poor job of increasing the racial diversity of their students, says an editorial (pp 1203-5). Currently only 10-15% of students come from under-represented minorities despite predictions that those minorities will collectively make up more than half the US population by 2050. Diversity within medical schools matters because doctors from minority backgrounds are more likely to serve minority communities, and because patients from minority backgrounds often prefer doctors who share their culture and language. There’s good evidence that a diverse …

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