Switch from intermittently scanned to real-time CGM a ‘therapeutic option’
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Adults with type 1 diabetes had improvements in glycemic control after switching from an intermittently scanned continuous glucose monitor to a real-time CGM, according to a study published in Diabetes Technology & Therapeutics.
Researchers analyzed glycemic control data in a cohort of individuals with type 1 diabetes who switched from the Freestyle Libre (Abbott) to Dexcom G4.
“This is not a comparison study between two CGM devices, but a real-life study reporting the benefit of a switch from intermittently scanned CGM to real-time CGM in type 1 diabetes patients with poor glycemic control, even though they have been using Freestyle Libre for at least 1 year,” Yannis Préau, MD, MSc, an endocrinologist in the department of nutrition and diabetes at AP-HM, University Hospital Sainte Marguerite in Marseille, France, told Healio. “In that context, in our department of diabetology, we alternatively propose a switch to Dexcom G4 (system reimbursed by the French Health Insurance) when patients want to keep their usual insulin pump (for continuous subcutaneous insulin infusion) or to continue using multiple daily insulin injection.”
Préau and colleagues conducted an observational study that included 18 adults (12 women; mean age, 48.3 years) with type 1 diabetes who had used Freestyle Libre for at least 1 year and switched to Dexcom G4 between December 2018 and June 2019. All participants changed devices due to severe hypoglycemia events or elevated HbA1c. At baseline, participants attended an initial group training session for using the new device. Researchers obtained glucose data from the last 3 months, biological and demographic information, and set up participants with the Dexcom G4. Data on glucose levels, CGM use and an assessment of the new device were collected from each participant at 3- and 6-month follow-up.
Nine of the participants had elevated HbA1c before switching CGM, and eight had experienced a severe hypoglycemic episode in the previous year.
Compared with baseline, participants had an increase in time in range 3 months after switching devices (41.5% vs. 53.1%; P = .0008), a decrease in time below range (10.9% vs. 5.4%; P = .0009) and lower glucose variability (46.9% vs. 40.1%; P = .0001). There was no change in the figures between the 3-month and 6-month follow-up. In analysis of individual data, 13 of 18 participants had improvements in all three of time in range, time below range and glucose variability.
Of the nine participants who had elevated HbA1c before switching CGM, six had a reduction in HbA1c. Lower HbA1c was seen only among participants who had elevated HbA1c at baseline. No participants had severe hypoglycemia or diabetic ketoacidosis during the follow-up period.
Préau said the study population was small and a larger study should be conducted, but the findings show that switching CGM types could have a positive effect on glycemic control in type 1 diabetes.
“We believe that CGM system switching can be considered as an interesting therapeutic option in patients who may be in therapeutic failure with insulin therapy management,” Préau said. “The choice of the right sensor for the right patient must, therefore, become a priority for the clinician with a view to overall improvement in glycemic control in a personalized medicine setting way. Such approach is a start to support the patient toward a more complex closed-loop system, the reimbursement of which must be effective in the next few months in France. System selection must be centered on the expected glycemic benefit, but also taking into account the quality of life and device satisfaction through standardized questionnaires.”
For more information:
Yannis Préau, MD, can be reached at yannis.preau@ap-hm.fr.
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Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP
This is an interesting study that included 18 adults with type 1 diabetes and suboptimal glycemic management. Results demonstrated that switching from an intermittently scanned CGM to a real-time CGM led to a significant increase in time in range, a reduction in hypoglycemia and less glucose variability.
Some important things to understand about this study are that the intermittently scanned CGM used was the first-generation Freestyle Libre that did not have any alerts and required users to scan to know their glucose level. This is compared to the real-time CGM, which has alerts for high and low glucose levels, although the older Dexcom G4 used in the study required users to calibrate twice daily.
When thinking about how these results apply to today’s clinical practice, the landscape is a little different. Now we have the Freestyle Libre 2, which still must be scanned but has optional alarms for high and low glucose levels. For real-time CGM, we now have the Dexcom G6, which has a predictive low glucose alert and no longer requires calibration. We are seeing CGM technology continue to evolve with advanced features, ease of use and affordability, and more patients than ever are using this technology. Despite the changes to CGM, a great key takeaway from this study is that if your patient is not meeting their individualized glucose targets, consider a change in their technology since often certain devices may work better for certain patients.
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