medwireNews: Brief, repeated use of real-time continuous glucose monitoring (rtCGM) may help to improve glycemic control in people with type 2 diabetes who would otherwise need to escalate to insulin, suggests a small randomized trial.
The study participants used rtCGM for just 1 week, after being taught how to use the device, and this resulted in significant reductions in glycated hemoglobin (HbA1c) at 3 months after randomization, relative to no use.
“Despite evolving diabetes treatments, including the use of artificial pancreas systems, insulin therapy still can be burdensome,” write the researchers in Diabetes, Obesity and Metabolism.
“Therefore, if proven effective, lifestyle modification using RT-CGM may be a reasonably attractive substitute for insulin initiation among these populations.”
The team recruited people who had type 2 diabetes and poorly controlled blood glucose (HbA1c 7.5–10.0%, 58–86 mmol/mol) despite using three or more classes of oral antidiabetic medications. They were an average age of 53.5 years, with an average diabetes duration of 11.1 years and HbA1c of 8.2% (66 mmol/mol).
Eighteen people were assigned to just one period of rtCGM use. Their HbA1c level at 3 months had reduced by a significant average of 0.60% (adjusted difference vs 15 control participants), but the difference of 0.67% at 6 months was no longer statistically significant.
A further 15 people were assigned to two periods of rtCGM use. Their HbA1c level fell by an adjusted average of 0.64% in the first 3 months, at which point they used rtCGM again for an additional week. By month 6, their adjusted reduction in HbA1c averaged 0.68%, which remained statistically significant.
Cheol-Young Park (Sungkyunkwan University School of Medicine, Seoul, Republic of Korea) and co-researchers found that the benefits of rtCGM were limited to people who already self-monitored their blood glucose levels at least 1.5 times/day (the median for the population).
In this subgroup, one period of rtCGM use resulted in an average adjusted HbA1c reduction of 0.88% at 3 months and 0.85% at 6 months, while two periods of use produced corresponding reductions of 0.97% and 1.15%. All changes were statistically significant.
This suggests that the blood glucose information from more frequent self-monitoring may have helped motivate these people to maintain the lifestyle changes prompted by the period of rtCGM use, the team suggests.
Park and colleagues say that the “optimal duration and interval” of rtCGM use in their study population remains unclear, but stress that their strategy of brief periods of use is “significantly more convenient and economical” than longer-term options.
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