Dual targets difficult to reach in type 1 diabetes
medwireNews: People with type 1 diabetes treated with multiple daily insulin injections (MDI) struggle to achieve guideline-recommended targets for time in hypoglycemia while simultaneously reaching their glycated hemoglobin (HbA1c) goals, researchers report.
The analysis of data from the GOLD trial found that this was true for both continuous glucose monitoring (CGM) and self-monitoring of blood glucose (SMBG), but the time spent in hypoglycemia was lower with CGM than with SMBG.
Shilan Seyed Ahmadi (NU-Hospital Group, Trollhättan/Uddevalla, Sweden) and co-investigators therefore believe that CGM “is crucial for patients with MDI treatment if they are to have a chance to approach hypoglycemia targets.”
The current study included data for 137 of the original 161 GOLD participants who were randomly assigned to use either CGM with the Dexcom G4 Platinum stand-alone system or SMBG for 26 weeks. After a 17-week wash-out period the participants crossed over to the alternative monitoring system for a further 26 weeks.
The researchers report in Diabetes Care that mean HbA1c and glucose levels were inversely associated with time spent in hypoglycemia during both CGM and SMBG.
For example, the mean time spent in hypoglycemia – defined as below 3.9 mmol/L (70 mg/dL) for individuals with a mean HbA1c of 7.0% (52 mmol/mol) – was 5.4% at the end of CGM use and 9.2% after SMBG.
This proportion decreased by 44% with each 1.0% (10 mmol/mol) increase in HbA1c during CGM use and by 34% per 1.0% increase in HbA1c during SMBG.
When Ahmadi and team took into account recent guidelines for time spent in hypoglycemia, they found that during CGM, 57.1% of participants with a mean HbA1c below 7.5% (58 mmol/mol) spent less than the recommended 1.0% of time with glucose levels below 3.0 mmol/L (54 mg/dL), while 54.8% spent less than the recommended 4.0% of time with levels below 3.9 mmol/L.
At a mean HbA1c level below 7.0% the proportions meeting the targets fell to 27.3% for both cutoffs.
For SMBG the rates were lower still, with 21.7% of individuals meeting both targets at a mean HbA1c of below 7.5%, and 25.0% achieving these goals when the mean HbA1c was below 7.0%.
Ahmadi et al say their results “show that it will remain challenging for many individuals with type 1 diabetes treated with MDI to achieve the targets set for time spent in hypoglycemia in recent international guidelines even with modern CGM devices.”
They add: “For patients using SMBG for glucose monitoring, which is still the most common method in many developed countries for people with type 1 diabetes, few are likely to achieve hypoglycemia targets.”
The authors conclude that people using MDI “will need CGM support” to reach targets for time spent in hypoglycemia and may also “benefit from replacing MDI treatment with semi-closed-loop systems.”
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