Continuous Glucose Monitoring Can Lower HbA1c in Insulin-Treated Type 2 Diabetic Patients

Summary and Comment |
August 31, 2017

Continuous Glucose Monitoring Can Lower HbA1c in Insulin-Treated Type 2 Diabetic Patients

  1. Bruce Soloway, MD

But whether lowering glycosylated hemoglobin improves clinically important outcomes is unclear.

  1. Bruce Soloway, 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, whether they inject insulin or use insulin pumps. However, whether CGM benefits patients with type 2 diabetes who use insulin is unclear.

With funding from a CGM device manufacturer, researchers enrolled 158 patients (mean age, 60) with type 2 diabetes (glycosylated hemoglobin [HbA1c] level, 7.5%–9.9%; mean diabetes duration, 17 years) who used multiple daily insulin injections. Patients were recruited from North American endocrinology practices and were randomized to either CGM or fingerstick blood glucose monitoring ≥4 times daily for 24 weeks. Treating physicians adjusted insulin doses at their discretion. Control patients wore blinded CGM devices for the last week of the trial to collect detailed data on glycemic control.

Mean HbA1c levels fell from 8.5% at baseline in both groups to 7.7% in the CGM group and 8.0% in the control group at 24 weeks — a significant difference. CGM patients spent more time daily with glucose levels between 70 mg/dL and 180 mg/dL than did controls. CGM patients used their devices almost daily in the last month of the trial and expressed high levels of satisfaction with the technology. No serious study-related adverse events occurred in either group.

Comment

This study suggests that, in some patients with type 2 diabetes, CGM might lower HbA1c levels compared with standard fingerstick monitoring. However, because the study did not specify a glycemic treatment target, it doesn't prove that information from CGM — as opposed to other differences in how treating physicians managed CGM and fingerstick-monitored patients — was responsible for the lower HbA1c values. Moreover, the trial was short and set in specialty practices, and the investigators didn't assess clinical outcomes or cost-effectiveness.

Editor Disclosures at Time of Publication

  • Disclosures for Bruce Soloway, MD at time of publication Nothing to disclose

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