medwireNews: Continuous glucose monitoring (CGM) results in modest but significant improvements in glycemic control in patients with type 2 diabetes using basal–bolus insulin, show further results from the DIAMOND trial.
The trial previously reported positive results for its participants with type 1 diabetes, but it also included 158 patients with insulin-dependent type 2 diabetes, who were aged an average of 60 years, with a median diabetes duration of 17 years.
“Because few studies of CGM in type 2 diabetes have been done, we did not know whether persons with type 2 diabetes would sustain daily use of CGM over 6 months,” write the researchers in the Annals of Internal Medicine.
“However, the amount of CGM use after 24 weeks exceeded our expectations. All but 1 participant in the CGM group who completed the trial were still using CGM after 24 weeks, with more than 90% averaging 6 or more days of CGM use per week.”
The patients achieved “substantial reductions” in glycated hemoglobin (HbA1c) during this time, irrespective of treatment assignment; it fell from 8.5% to 7.7% in patients randomly assigned to CGM and from 8.5% to 8.0% in patients who continued with usual care. However, the adjusted 0.3% difference between the groups, favoring CGM, was statistically significant.
Roy Beck (Jaeb Center for Health Research, Tampa, Florida, USA) and co-researchers also note that this difference represents “a meaningful improvement on a patient level, particularly because it was achieved without a pharmacologic change.”
In all, 79% of the CGM group achieved at least a 0.5% reduction in HbA1c, compared with 51% of the control group, and 53% versus 33% achieved either a 1.0% reduction or a level below 7.0%. Patients were rarely in hypoglycemia, so the effect of CGM on this outcome was unclear.
The researchers say that they tried to mimic usual practice, so did not include formal reviews of glucose trends seen in CGM or any other management strategies that might bias the results towards the CGM group.
And, in a linked editorial, Vanessa Arguello and Matthew Freeby, both from the David Geffen School of Medicine at UCLA in Los Angeles, California, USA, note that anecdotal evidence suggests that “extensive CGM education” can help to maximize its effect on patients’ glycemic control.
They add that “we should seek to further understand patient populations that will benefit most from CGM intervention, such as those with the skills to address glucose variability.”
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