medwireNews: Structured monitoring of blood glucose improves its control regardless of the device used, although continuous glucose monitoring (CGM) is better than self-monitored blood glucose (SMBG) for reducing hypoglycemia, shows a randomized trial.
The researchers say their study underlines the value of structured SMBG, as opposed to daily or random checks, because the structured approach provides “concentrated and more descriptive daytime data profiles – offering insight into glucose fluctuations and time in ranges, even though overnight glucose values are still missing.”
They observe that although CGM use is increasing in type 2 diabetes, this is impeded by factors including expense, patient preferences, and difficulties dealing with large amounts of complex data in primary care.
“Attention now needs to focus on which patient populations benefit the most from CGM usage compared to [SMBG],” say Deborah Mullen (University of Tennessee At Chattanooga, USA) and co-researchers.
For the trial, the team enrolled 114 people with type 2 diabetes and a glycated hemoglobin (HbA1c) level of at least 7.0% (53 mmol/mol) despite treatment.
These participants were randomly assigned to either use SMBG four times daily or CGM for the 16-week trial. At clinic visits, every 4 weeks, glucose monitoring data were used as the basis for lifestyle and medication changes to optimize glucose control.
By week 16, average HbA1c had fallen from 7.85% to 7.03% (62 to 53 mmol/mol) in the SMBG group and from 8.19% to 7.07% (66 to 54 mmol/mol) in the CGM group. The respective reductions of 0.82% (9 mmol/mol) and 1.12% (12 mmol/mol) were both statistically significant relative to baseline levels, but were not statistically different from each other.
Based on blinded CGM data gathered at baseline and weeks 8 and 16, both groups had significant improvements in secondary measures including glucose area under the curve, time in range, and the rate of hyperglycemia.
However, the SMBG group had a significant increase in the rate of hypoglycemia, whereas the CGM group had a nonsignificant reduction, report the researchers in the Journal of Diabetes and its Complications.
A prespecified secondary analysis showed that these differences were driven by participants taking medications with high hypoglycemia risk, that is, sulfonylureas and insulin. By contrast, hypoglycemia rates rose very slightly in both groups among those taking incretin-based therapies.
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J Diabetes Complications 2021; doi:10.1016/j.jdiacomp.2021.108106