medwireNews: The results of two studies published in JAMA indicate that real-time continuous glucose monitoring (CGM) benefits people with type 1 or type 2 diabetes on a range of insulin regimens and from a wide variety of backgrounds.
In an editorial published alongside the randomized trial and the observational study, Monica Peek and Celeste Thomas, both from the University of Chicago in Illinois, USA, observe that the randomized trial recruited participants with type 2 diabetes “who have disproportionately had barriers to fully accessing health care and health care–related technology and also have had disproportionately lower rates of adherence to diabetes treatment plans.”
Just over half (53%) of the 175 participants in the US trial were Hispanic or Latino, African–American, Asian, or other minority group; a similar proportion had less than a college degree; and less than half had private healthcare insurance.
All participants were using basal insulin to control their blood glucose levels, and other diabetes medications were allowed, except for prandial insulin. Studies such as the DIAMOND trial previously demonstrated the benefits of CGM in people with type 2 diabetes using basal–bolus insulin.
At baseline, the average glycated hemoglobin (HbA1c) levels were 9.1% and 9.0% in the 116 and 59 participants randomly assigned to use CGM or continue with self-monitored blood glucose (SMBG), respectively. But after 8 months there was a significant improvement favoring the CGM group, with corresponding levels of 8.0% and 8.4%.
Time in range was also significantly higher in participants using CGM, at 59% versus 43% in the SMBG group (the latter measured using blinded CGM). Roy Beck (Jaeb Center for Health Research Foundation, Tampa, Florida, USA) and study co-authors note that the difference is equivalent to an additional 3.6 hours per day within the recommended range.
There were no significant differences between the groups in insulin dose or medication changes, leading the editorialists to attribute the improvements in glycemic measures to increased patient engagement.
“Activated patients are a powerful part of achieving diabetes control,” they write.
Peek and Thomas also observe that the trial participants rated CGM use positively in terms of high benefit and low hassle, “suggesting a willingness of this diverse patient population to engage with the technology.”
In the observational study, Andrew Karter (Kaiser Permanente, Oakland, California, USA) and colleagues found similar significant benefits in a study of 41,753 people with type 1 or type 2 diabetes in primary care, 3806 of whom initiated CGM. Their average HbA1c levels fell from 8.17% to 7.76%, compared with 8.28% to 8.19% among 37,947 people who did not initiate CGM, giving a weighted and adjusted difference of 0.4% favoring CGM use, which was statistically significant.
The majority of the study participants were of White race, and they were on a variety of insulin regimens, with around two-thirds using long-acting insulins.
Nine percent of the CGM initiators had type 2 diabetes, and they appeared to derive the largest benefits from starting CGM, achieving a 0.56% HbA1c reduction versus non-initiators with type 2 diabetes, which was significantly greater than the 0.39% reduction seen for CGM initiators versus non-initiators with type 1 diabetes.
Of note, 97% of the participants with type 2 diabetes were on a basal–bolus insulin regimen, which Peek and Thomas note is in line with current recommendations for CGM use in this group. But they stress that the studies in combination indicate that people on any insulin-based treatment regimen could benefit from CGM.
These studies together “provide a powerful narrative that CGM may be a useful technology that helps control diabetes among multiple patient groups,” say the editorialists.
They conclude: “The time has come to broaden access to CGM for patients with type 2 diabetes.”
The findings of the randomized trial were also presented at the virtual ATTD 2021 conference, by lead study author Thomas Martens (Park Nicollet Internal Medicine, Minneapolis, Minnesota, USA).
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JAMA 2021; doi:10.1001/jama.2021.7444
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