Continuous Glucose Monitoring Improves Glycemic Control in Patients Using Multiple Insulin Injections

Summary and Comment |
January 26, 2017

Continuous Glucose Monitoring Improves Glycemic Control in Patients Using Multiple Insulin Injections

  1. Thomas L. Schwenk, MD

This works in patients with type 1 diabetes, but applicability to patients with type 2 diabetes and cost are still issues.

  1. Thomas L. Schwenk, MD

Continuous glucose monitoring (CGM; subcutaneous glucose sensing and feedback with high and low glucose alerts) improves glycemic control in patients with type 1 diabetes who use insulin pumps. In two studies, researchers assessed CGM in type 1 diabetic patients without good glycemic control who were using multiple insulin injections. In both studies, mean participant age was about 45, average duration of diabetes was about 20 years, and mean glycosylated hemoglobin (HbA1c) level was about 8.6%.

In a U.S. study, 158 patients were randomized to CGM or to home blood glucose monitoring at least four times daily. At 24 weeks, mean HbA1c levels were reduced by 1.0% in the CGM group and 0.4% in the control group — a significant difference. Severe hypoglycemia (<70 mg/dL) occurred in two patients in each group.

Investigators in Sweden assessed the same issue in a randomized crossover study: 161 patients received CGM or conventional therapy for 26 weeks and then crossed over to the other treatment for 26 weeks. A 17-week washout period occurred between the two treatment periods. All patients were instructed to perform home blood glucose monitoring at least four times daily. Mean HbA1c was 7.9% during CGM and 8.4% during conventional therapy — a significant difference. Severe hypoglycemia occurred in five patients during conventional therapy and in one patient during CGM.

Comment

CGM was superior to usual blood glucose monitoring for glycemic control in patients with type 1 diabetes who use multiple insulin injections, but both research teams and an editorialist note several caveats that preclude immediate clinical adoption: We need longer studies with clinical outcomes, inclusion of patients with less expert and supportive care, and assessment of patient adherence to and acceptance of CGM. In addition, studies should be undertaken to determine whether CGM benefits insulin-requiring patients with type 2 diabetes.

Editor Disclosures at Time of Publication

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

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