Intermittently scanned CGM linked to lower HbA1c than finger sticks in type 1 diabetes
Click Here to Manage Email Alerts
Intermittently scanned continuous glucose monitoring use is associated with greater improvements in HbA1c in type 1 diabetes at 24 weeks compared with finger-stick testing, according to study findings.
“In this multicenter randomized trial funded by Diabetes UK, we found that an intermittently scanned CGM with alarms in adults with type 1 diabetes and high HbA1c levels can safely reduce HbA1c and improve the time spent in target glucose levels while reducing the burden of hypoglycemia,” Lalantha Leelarathna, FRCP, PhD, consultant diabetologist at the diabetes, endocrinology and metabolism center at Manchester Royal Infirmary in the U.K., told Healio.
Leelarathna and colleagues conducted a randomized controlled trial in which 156 people aged 16 years and older with type 1 diabetes for at least 1 year and an HbA1c between 7.5% and 11% were randomly assigned to use the FreeStyle Libre 2 (Abbott) intermittently scanned CGM or to conduct self-monitoring of blood glucose with finger-stick testing for 24 weeks (mean age, 44 years; 97% white; 44% women). Participants were recruited from seven diabetes clinics and one primary care clinic in the U.K. All participants used CGM for 10 to 14 days before randomization to acquire baseline data. HbA1c was measured at screening, 12 and 24 weeks. Change in HbA1c at 24 weeks was the primary outcome. Researchers also collected time in range, duration of hypoglycemia and hyperglycemia, mean glucose and glucose variability for participants, with a blinded CGM used from days 22 to 24 in the finger-stick group. All participants completed the Type 1 Diabetes Distress Scale questionnaire; the Diabetes Fear of Injecting and Self-Testing Questionnaire, Fear of Self-Injection component; the Diabetes Eating Problem Survey-Revised; the Diabetes Treatment Satisfaction Questionnaire (DTSQ); the Patient Health Questionnaire 9-item version; and the Glucose Monitoring Satisfaction Survey (GMSS).
The findings were published in The New England Journal of Medicine.
CGM linked to greater HbA1c reductions
The primary analysis included 72 participants in the CGM group and 69 in the finger-stick group. The CGM group had a higher mean HbA1c at baseline compared with the group using finger sticks (8.7% vs. 8.5%). At 24 weeks, HbA1c decreased to 7.9% in the CGM group compared with a smaller decrease to 8.3% in the finger-stick group (P < .001). The CGM group also had an HbA1c about 0.3 percentage points lower than the group using finger sticks at 12 weeks.
Participants using CGM were more likely to have an HbA1c of less than 7.5% at 24 weeks (adjusted OR = 2.47; 95% CI, 1.08-5.68) and have an HbA1c improvement by at least 0.5 percentage points (aOR = 4.74; 95% CI, 2.1-10.71) or 1 percentage point (aOR = 4.3; 95% CI, 1.67-11.09) compared with those using finger sticks.
Higher satisfaction with CGM use
The CGM group spent 9% more time in range, 3% less time in hypoglycemia and 6% less time in hyperglycemia compared with the finger-stick group. Participants using CGM also had a higher score on the DTSQ and the GMSS compared with the finger-stick group. No other differences were observed for the other questionnaires.
There were few adverse events in the trial, with two participants in the finger-stick group having severe hypoglycemic episodes and one person in the CGM group having a diabetic ketoacidosis episode. Two participants in the finger-stick group experienced ketosis that did not result in hospitalization.
“Our study results have global implications for glucose monitoring in type 1 diabetes,” Leelarathna said. “Our results show intermittently scanned CGM with alarms helped people with type 1 diabetes to lower their overall blood glucose levels, spend more time in the glucose target range, with less high and low glucose levels. People using the intermittently scanned CGM also reported improved diabetes treatment satisfaction. These improvements are likely to reduce the risk of developing long-term diabetes complications and save money in the longer term. We are undertaking a dedicated health-economic analysis that will further help policymakers and international professional organizations to recommend this form of therapy.”
Leelarathna said future research should focus on reducing glucose alarm burden, the impact of socioeconomic deprivation on glycemic outcomes, reducing variation in access to technology, cost-effectiveness and qualitative studies on the impact of glucose monitoring.
For more information:
Lalantha Leelarathna, FRCP, PhD, can be reached at lalantha.leelarathna@manchester.ac.uk.
Collapse
Click Here to Manage Email Alerts