CGM benefits persist with long-term use
medwireNews: The COMISAIR-2 researchers have reported that use of continuous glucose monitoring (CGM) by people with type 1 diabetes remains high over 3 years, resulting in continued glycemic benefits.
As they reported at the 55th EASD Annual Meeting in Barcelona, Spain, Jan Šoupal (Charles University, Prague, Czech Republic) and team followed up people with type 1 diabetes who, in discussion with their physicians, had opted to use CGM or self-monitoring of blood glucose (SMBG), each with either multiple daily injections (MDI) or an insulin pump.
“In our study, we allowed participants to choose the insulin/monitoring option that met their individual needs, which reflects real-life decision-making in most practices,” the team writes in the accompanying publication in Diabetes Care.
The researchers previously found that the 48 people who selected CGM achieved significantly lower glycated hemoglobin (HbA1c) levels after 1 year of use than the 46 who continued to use SMBG, and they now report that this difference persisted after 3 years.
Average HbA1c levels at this point were 7.0% and 6.9% for CGM users who combined it with MDI or an insulin pump, respectively, compared with a corresponding 8.0% and 7.7% among SMBG users with these insulin-delivery modes. These values represented a significant reduction from levels at study entry for the CGM users, but not for the SMBG group.
The CGM users also significantly increased their time within target blood glucose range (3.9–10.0 mmol/L; 70–180 mg/dL), compared with at baseline, and reduced their time in hypoglycemia. For those using MDI, for example, time in range rose from 48.7% to 69.0%, and time in hypoglycemia fell from 9.4% to 5.5%. These indices did not significantly improve in the SMBG group.
Notably, people in the CGM group slightly increased their use of the monitoring devices between years 1 and 3 with, for example, average use rising from 85.7% to 88.0% in the CGM plus MDI group. This suggests that CGM “was perceived to be a valuable tool in [participants’] self-management regimens,” writes the team.
They believe this high use accounts for the fact that people in the CGM group administered significantly more insulin boluses than those in the SMBG group, at an average of 6.9 versus 4.5, and that more achieved HbA1c values below 7.0%, “suggesting the perceived value translated into improved clinical outcomes.”
The researchers highlight that outcomes for CGM users were similar regardless of whether they administered insulin via multiple injections or a pump, suggesting that CGM plus MDI “can be considered an equivalent but more cost-effective treatment alternative to sensor-augmented pumps for many individuals with [type 1 diabetes].”
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