medwireNews: People with impaired hypoglycemia awareness become more proactive about treating low blood glucose when they start using continuous glucose monitoring (CGM), but do not adjust their insulin usage, show data from HypoDE.
The researchers identified “a behavioral shift from reacting to present hypoglycemia to prophylactically preventing impending hypoglycemia.”
But the overall lack of adjustments to insulin dosage suggests that “the full potential” of real-time CGM may not have been realized in this trial, they write in BMJ Open Diabetes Research & Care.
The team assessed 135 people with type 1 diabetes who completed the HypoDE study, including keeping a logbook of glucose measurements, insulin doses, and carbohydrate consumption. The participants were around 46 years of age, on average, and all had impaired hypoglycemia awareness.
Use of CGM significantly reduced the number of hypoglycemic episodes that people experienced, from an average of 2.2 per week at baseline to 0.7 per week during follow-up, whereas this remained stable at 3.2 events/week among control participants who continued to self-monitor their blood glucose.
In line with this, the average glucose level at which the CGM users opted to use rescue carbohydrates significantly increased, from 70.8 to 78.8 mg/dL (3.9 to 4.4 mmol/L), whereas it remained stable in the control group, giving an adjusted difference between the groups of 7.6 mg/dL (0.4 mmol/L).
And each 1 mg/dL increase in the blood glucose threshold used to apply rescue carbohydrates was associated with a 2% reduction in the risk for hypoglycemic events, independent of factors including rescue carbohydrate portion size.
“The pronounced effectiveness of this rather small action might be a reason why no further systematic adjustments were made,” suggest Delia Waldenmaier (Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Germany) and study co-authors.
They note that whereas some participants “reported becoming more active in adjusting their therapy, others became rather passive relying on alarms.”
Overall carbohydrate intake did not change in either group during the 26 weeks of follow-up, and neither did the insulin-to-carbohydrate ratio used for meal boluses, nor daily doses of basal or bolus insulin.
“There is, thus, still the potential of enhancing the beneficial effects of CGM if more systematic therapy adjustments were made,” conclude the researchers.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group