Real-world CGM data support better outcomes in type 1 diabetes
medwireNews: Research shows that continuous glucose monitoring (CGM) reduces hypoglycemia risk and improves patient-reported outcomes among people with type 1 diabetes in real-world practice.
CGM reduced the proportion of time spent in hypoglycemia (<3.9 mmol/L; 70 mg/dL) from an average of 11.1% at baseline to 5.6% during the first 2 weeks of CGM use and 4.5% after 12 months.
“This indicates that longer use of [real-time] CGM helps in preventing hypoglycemic events which is important in a patient population that was selected mainly on the basis of problematic hypoglycemia,” say Pieter Gillard (University Hospitals Leuven, Belgium) and study co-authors.
Over half (56%) of the patients were selected for CGM on the basis of hypoglycemia, and 26% were chosen because of insufficient and variable glycemic control. The 515 patients were recipients of CGM through a national reimbursement program, which allowed diabetes specialists to select patients for the scheme but limited the number that could be included, which the researchers say “forced the diabetes teams to choose the patients whom they thought would benefit most from [real-time] CGM.”
Furthermore, the rate of hospital admission for severe hypoglycemia or ketoacidosis fell from 16% in the year before the patients started on CGM to just 4% in the first year of use, which the team stresses represents a large reduction in healthcare costs.
The number of diabetes-related hospital admission days also fell, from a corresponding 54 to 18 days per 100 patient–years, and patients reported fewer diabetes-related work absences.
On average, the patients used CGM 87.5% of the time during the first year, and their quality of life significantly improved over this time, including on the two diabetes-specific measures – Problem Areas in Diabetes-short form and Hypoglycemia Fear Survey-Worry.
“We believe our data confirm the validity of the Belgian strategy, as clinical teams eventually selected highly motivated patients, who derived a high benefit from the novel technology,” write the researchers in The Journal of Clinical Endocrinology & Metabolism.
They note that patients had to use CGM more than 70% of the time or forfeit further reimbursement, which they suggest was a strong motivating factor.
The reduction in hypoglycemia risk was accompanied by a slight but significant increase in the time spent in hyperglycemia and reduction in time spent in range. Nevertheless, patients’ glycated hemoglobin levels fell by an average of 0.3%, which the researchers regard as being clinically significant as well as showing that the glycemic control improvements reported in randomized trials can be replicated in the real world.
Glucose variability, as measured by the coefficient of variation of glucose readings, only slightly decreased during the study period, from 38.7% in the first 2 weeks to 37.9% by 12 months.
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