medwireNews: Use of intermittently scanned continuous glucose monitoring (isCGM) is associated with an increased likelihood for treatment intensification in people with type 2 diabetes, a study shows.
“This suggests that either [isCGM] is being prescribed in situations where the physician decides that there is a need to escalate the patient’s therapy, or it is possible that after prescribing [isCGM] the need for escalating therapy becomes more evident, with consequent treatment progression,” write the study authors.
“In both scenarios it appears that [isCGM] is being proactively initiated with patients who require more intensive or complex treatment to manage their diabetes.”
Researchers Stewart Harris (Western University, Canada) and Fleur Levrat-Guillen (Abbott Laboratories Ltd, Maidenhead, UK) used a medical insurance claims database to identify 373,871 adults with type 2 diabetes who had potential for treatment escalation (ie, were not on a basal–bolus insulin regimen). This included 37% who had not received glucose-lowering medications prior to study enrollment; of the remaining 63%, 88% were taking non-insulin therapies and 12% were on basal insulin at enrollment.
A total of 7160 study participants started on isCGM within the first 6 months after their enrollment date, and these individuals were significantly more likely to experience treatment intensification than those who continued to use self-monitored blood glucose over the full 24-month study period.
The relative increase in this likelihood ranged from 1.86-fold among people on non-insulin medications who were medication-naïve at enrollment to 2.81-fold among those on basal insulin and preceding medication use.
By the end of the study period, between 53% and 90% of people self-monitoring their blood glucose remained on the same treatment that they had started on, compared with just 31% to 74% of those using isCGM.
This suggests that people in the isCGM group “had more dynamic changes in their treatment progression” than those who continued self-monitoring, writes the team in Diabetes, Obesity and Metabolism.
In addition, among people not initially using insulin, a much larger proportion of those given isCGM were escalated to insulin compared with those self-monitoring, with for example rates of 20–42% versus 8–13% among people initially on injectable non-insulin therapies.
Harris and Levrat-Guillen note that the increased risk for hypoglycemia with insulin treatment creates a barrier to starting the medication among people with type 2 diabetes who need it to reduce their glucose levels.
They believe that the ability to closely monitor glucose levels with isCGM, reducing the risk for severe hypoglycemia, may increase people’s comfort with use of insulin and “provides a clear rationale” for offering isCGM to people with type 2 diabetes who need to escalate to insulin.
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