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Continuous glucose monitoring beneficial in type 1 diabetes

CGM improved control and cut the median daily duration of hypoglycaemia by nearly half

Louise Prime

Thursday, 26 January 2017

People with type 1 diabetes using multiple daily injections of insulin achieved better glycaemic control when they used continuous glucose monitoring (CGM) compared with those on conventional treatment, according to two separate, small studies published this week in JAMA. Hypoglycaemia was also less of a problem among patients using CGM.

The first study* involved 158 men and women in the US who had type 1 diabetes, were using multiple daily insulin injections, and had glycated haemoglobin (HbA1c) levels of 7.5-9.9%. The researchers randomised them to either CGM (105 people) or to usual care (control group – 53 people). The CGM group had a sensor beneath the skin with a transmitter attached, which continuously reported glucose levels and trends to the patient by a handheld monitor. At month six, 93% of the CGM group were using CGM for at least six days per week.

The researchers compared the change in central-laboratory-measured HbA1c level, in the CGM and control groups. In the CGM group, mean HbA1c reduction from baseline was 1.1% at 12 weeks and 1.0% at 24 weeks; in the control group it was 0.5% and 0.4%, respectively.

The median daily duration of hypoglycaemia (defined as < 3.9mmol/l) was 43 minutes in the CGM group and 80 minutes in the control group; two people in each group suffered severe hypoglycaemia events.

The study authors commented: “Among adults with type 1 diabetes who used multiple daily insulin injections, the use of CGM compared with usual care resulted in a greater decrease in HbA1c level during 24 weeks. Further research is needed to assess longer-term effectiveness, as well as clinical outcomes and adverse effects.”

In the second study,** conducted in Sweden, 161 people with type 1 diabetes, who were using multiple daily insulin injections and had glycated haemoglobin (HbA1c) levels of at least 7.5%, were randomised to either CGM or conventional treatment (control group). After 26 weeks, they had a 17-week washout period and then swapped groups for a further 26 weeks.

The researchers found that participants’ mean HbA1c was 7.92% during CGM use, compared with 8.35% during conventional treatment. Severe hypoglycaemia occurred in one person in the CGM group and five people on conventional treatment. Six other outcomes (comprising psychosocial and various glycaemic measures) were also statistically more favourable in the CGM group.

The authors concluded: “In this crossover study of persons with type 1 diabetes treated with multiple daily insulin injections, CGM was associated with a mean HbA1c level that was 0.43% less than conventional treatment. Moreover, glycaemic variability was reduced by CGM. Subjective well-being and treatment satisfaction were greater during CGM than conventional therapy. Further research is needed to assess clinical outcomes and longer-term adverse effects.”


* Beck RW, Riddlesworth T, Ruedy K, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections. The DIAMOND randomized clinical trial. JAMA 2017; 317(4): 371-378. doi:10.1001/jama.2016.19975.

** Lind M, Polonsky W, Hirsch IB, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections. The GOLD randomized clinical trial. JAMA 2017; 317(4): 379-387. doi:10.1001/jama.2016.19976.

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