medwireNews: Two clinical trials published in JAMA show that continuous glucose monitoring (CGM) can improve glycemic control in patients with type 1 diabetes who take insulin by means of multiple daily injections.
Previous studies of CGM “have either completely or predominantly included insulin pump users, although the majority of adults with type 1 diabetes deliver insulin via injections,” say Roy Beck (Jaeb Center for Health Research, Tampa, Florida, USA) and co-authors of one of the studies.
Their study, based in the USA, included 105 patients who were randomly assigned to use CGM for 24 weeks and 53 who continued to self-monitor their blood glucose as usual. The second study, based in Sweden, included 142 patients who undertook 26 weeks of CGM or usual care, followed by the alternative strategy, in a randomized order with a 17-week washout period between the two.
In the US study (the DIAMOND trial), average glycated hemoglobin (HbA1c) levels fell, from a starting average of 8.6%, by 1.1% in the CGM group and by 0.4% in the control group, with the difference between the two groups being statistically significant.
And in the Swedish study (the GOLD trial), patients’ HbA1c levels averaged 7.92% during the CGM phase versus 8.35% during the self-monitoring phase, which was again a significant difference. HbA1c returned to baseline levels during the washout period after the CGM phase, indicating that “the effectiveness of CGM depends on uninterrupted use during multiple daily insulin injections treatment,” say Marcus Lind (Uddevalla Hospital) and co-researchers.
This study also included psychosocial variables, and found that patients scored significantly better during the CGM than control periods on instruments including the Diabetes Treatment Satisfaction Questionnaire, the World Health Organization-5 Well-Being Index, and the Hypoglycemia Confidence Questionnaire.
Writing in an editorial, Mayer Davidson (Charles R Drew University of Medicine and Science, Los Angeles, California, USA) questions whether CGM, being expensive, will be seen as worthwhile to healthcare funders, given the relatively small benefits it brings – benefits that could turn out to be limited to the relatively motivated patients who participate in clinical trials and might not apply to insulin-dependent type 2 diabetes patients, who have less variable glucose levels.
Furthermore, he notes that the relationship between glucose levels and treatment adjustments is more complex and changeable for CGM than for self-monitored blood glucose.
“This will preclude most nonendocrinologists and possibly some endocrinologists from using CGM (real-time or masked) in light of their time constraints in managing care for many patients with diabetes,” says Davidson.
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