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Real-time continuous glucose monitoring improved glycemic control in type 2 diabetes

Vigersky R. Diabetes Care. 2012;35:32-38.

Issue: February 2012

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Patients with type 2 diabetes who are not on prandial insulin saw improved glycemic control when they used real-time continuous glucose monitoring intermittently for 12 weeks, according to researchers from the Walter Reed National Military Medical Center.

The study was a randomized controlled trial that included 100 adults with type 2 diabetes who were not on prandial insulin. The patients were randomly assigned to real-time continuous glucose monitoring (RT-CGM) with self-monitoring blood glucose or SMBG only.

Those who were randomly assigned to RT-CGM used a Dexcom Seven device that monitored blood glucose 2 weeks on, 1 week off for 3 months. Alarms were activated when blood glucose levels were less than 70 mg/dL and more than 180 mg/dL. After the 3 months, these patients continued with SMBG for the rest of the study. SMBG included testing for blood glucose levels before meals and at bedtime. The primary outcome of the study was HbA1c level during the course of the study.

There was a significant difference in HbA1c levels between the two groups at the end of the 3-month period. The mean unadjusted HbA1c level decreased 1% at 12 weeks in the RT-CGM group and 0.5% in the SMBG group. At 24 weeks, the HbA1c level decreased 1.2% in the RT-CGM group and 0.5% in the SMBG group. At 38 weeks, the HbA1c level decreased 0.8% in the RT-CGM group and 0.5% in the SMBG group. At 52 weeks, the HbA1c level decreased 0.8% in the RT-CGM group and 0.2% in the SMBG group.

After adjusting for covariates, there was a significantly greater decline in HbA1c during the course of the study in the RT-CGM group.

“The magnitude of the improvement was comparable to the reported ‘add-on’ pharmacotherapy, and it did so without any greater intensification of pharmacotherapy compared with the SMBG group,” the researchers wrote.

Disclosure: DexCom Corporation provided funding and in-kind support for this study. The researchers report no other relevant financial disclosures.

The results of this study were not unexpected since increasing the frequency of home glucose monitoring has invariably been shown to improve glycemic control. Therefore a crossover study would have been more meaningful and convincing. In addition, this group of patients had a minimal or no risk for hypoglycemia and a 7- to 10-day monitoring period would have been more practical and meaningful since the cost of 12 weeks of monitoring in everyone with type 2 diabetes would be prohibitive.

– David S.H. Bell, MD, FACE, FACP
Endocrine Today Editorial Board member

Disclosure: Dr. Bell reports no relevant financial disclosures.

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