medwireNews: A pilot randomized study suggests that continuous glucose monitoring (CGM) may be better than flash monitoring for reducing hypoglycemia in type 1 diabetes patients with impaired awareness.
But despite the reduced hypoglycemia neither approach significantly improved patients’ awareness of it, report Nick Oliver (Imperial College, London, UK) and co-researchers.
The proportion with a Gold score of at least 4, indicating impaired hypoglycemia awareness, did decline during the 8 weeks of follow-up, from 90% among CGM users and 85% among flash glucose monitoring users to 60% in both groups, indicating the return of hypoglycemia awareness in a proportion of patients. However, there was no significant change in the median Gold score in either group over time.
The research team recruited a high-risk population; all 40 participants had a severe hypoglycemic event within the previous 12 months or had a Gold score of at least 4. Their average age was 49.5 years and 60% were men.
During follow-up, time spent in hypoglycemia (<3.3 mmol/L) fell from 4.5% to 2.4% in the 19 patients assigned to CGM, whereas it remained stable in the 20 assigned to flash glucose monitoring, at a respective 6.7% and 6.8%.
Use of CGM was also associated with reduced fear about hypoglycemia; patients’ median Hypoglycaemia Fear Score II total and Worry subscale scores fell significantly, from 59.5 to 49.5 and from 40.5 to 30.0, respectively, whereas they remained stable or slightly increased among patients using flash monitoring.
Writing in Diabetic Medicine, the researchers suggest that the alerts and alarms incorporated in CGM could explain the better results with this approach in their study. They say “it is striking to note that, alongside a reduction in exposure to hypoglycaemia, we have demonstrated a reduction in hypoglycaemia fear and worry,” adding that this is “one of the major barriers to optimal glucose control.”
The team also addresses the fact that flash glucose monitoring reduced time in hypoglycemia in the IMPACT study, attributing this to different study populations, as IMPACT excluded people with impaired hypoglycemic awareness.
These divergent findings may indicate “that evidence-based clinical pathways for monitoring should be different for people with impaired awareness,” they suggest.
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