‘It may save lives’: CGM use cuts mortality risk in type 1, type 2 diabetes
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Key takeaways:
- CGM metrics such as estimated blood glucose, time in range and coefficient of variation are linked to all-cause mortality risk.
- Adults with type 1 and type 2 diabetes have a lower risk for death if they use CGM.
Continuous glucose monitoring can lower mortality risk in addition to improving glycemic control for people with diabetes, according to a speaker at the World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease.
Peter D. Reaven, MD, professor and clinical scholar of internal medicine in the division of endocrinology at the University of Arizona College of Medicine and director of the diabetes research program at the Phoenix Veterans Affairs Health Care System, stated there are limited real-world data on CGM metrics and their associations with health outcomes. However, using data from people with type 1 or type 2 diabetes attending a VA clinic in the U.S., researchers found CGM can provide benefits beyond reducing glucose levels.
“CGM metrics appear to be linked with outcomes. Not just glucose-lowering, but they appear to be associated with outcomes such as mortality,” Reaven said during a presentation. “The relationships seen were relatively linear with many of the CGM device metrics, and they were more closely linked with mortality than HbA1c values.”
Reaven discussed data from 719 adults with type 1 diabetes and 1,449 adults with type 2 diabetes using a Dexcom CGM from 2015 through 2020. Follow-up data were available through March 2023.
Researchers found more frequent use of CGM for both the type 1 diabetes and type 2 diabetes group was linked to a lower increase in estimated blood glucose over 3 years, with the greatest benefits seen among those using a CGM for more than 75% of the day.
Additionally, estimated blood glucose and time in range fluctuated among participants based on the time of year and day of the week. Estimated blood glucose increased and time in range decreased during winter months. Participants tended to have lower time in range and higher estimated blood glucose on the weekends compared with weekdays. Some of the patterns varied based on the region of the U.S. each person lived in, according to Reaven.
“[Increased glucose] is much worse for those coming from the Northeast with colder weather,” he said.
CGM metrics tied to mortality risk
Data from 2,665 adults with type 1 or type 2 diabetes also showed CGM metrics in the 6 months after device initiation may predict future mortality risk. Of the group, 368 died during follow-up.
After adjusting for age and mortality, higher time in range lowered the risk for all-cause mortality (HR = 0.83; 95% CI, 0.72-0.92), while higher estimated blood glucose (HR = 1.18; 95% CI, 1.06-1.32), higher time above range (HR = 1.2; 95% CI, 1.07-1.34), higher glycemia risk index (HR = 1.23; 95% CI, 1.1-1.38) and higher coefficient of variation (HR = 1.18; 95% CI, 1.05-1.33) were tied to increased mortality risk.
After an additional adjustment for coefficient of variation, all the CGM metrics as well as HbA1c were significantly associated with future mortality risk. Compared with adults who had an estimated blood glucose and coefficient of variation below the median value for the study group, those who had a below median estimated blood glucose and above median coefficient of variation (HR = 1.59; 95% CI, 1.11-2.26), those with an above median estimated blood glucose and below median coefficient of variation, (HR = 1.61; 95% CI, 1.18-2.2) and adults with both estimated blood glucose and coefficient of variation above the median (HR = 1.81; 95% CI, 1.33-2.46) had a higher mortality risk.
CGM benefits type 1 and type 2 diabetes
A reduced risk for mortality has been observed with CGM use in both type 1 and type 2 diabetes. In findings published in Diabetes Care, CGM users with type 1 diabetes had a lower all-cause mortality risk than those not using CGM (HR = 0.53; 95% CI, 0.43-0.65) and those with type 2 diabetes using CGM had a reduced risk for death than non-CGM users with type 2 diabetes (HR = 0.79; 95% CI, 0.73-0.86).
“The implications can be quite powerful,” Reaven said. “Giving patients and providers that additional information and immediate access to this type of information can help patients and providers make better decisions and change their behavior. All of this may not only improve glucose control, it may save lives as well.”
References:
Reaven PD, et al. Diabetes Care. 2023;doi:10.2337/dc22-2189.
Zhou J, et al. Poster #0065. Presented at: World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease; Dec. 12-14, 2024; Los Angeles.
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Reaven PD. Session 5: Technology impact on health. Presented at: World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease; Dec. 12-14, 2024; Los Angeles.
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