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Continuous glucose monitoring may benefit patients with type 2 diabetes

Adults with type 2 diabetes who had more than one insulin injection daily and continuous glucose monitoring for 24 hours experienced improved glycemic control, suggesting that this addition to diabetes management can potentially help patients, according to recent findings.

“Whether [continuous glucose monitoring (CGM)] could also benefit adults with type 2 diabetes receiving insulin has not been well-studied, although substantially more insulin users have type 2 than type 1 diabetes, and glycemic control often remains suboptimal even with the use of insulin,” Roy W. Beck, MD, PhD, executive director of the Jaeb Center for Health Research, and colleagues wrote in Annals of Internal Medicine. “Few data assess the benefit of CGM in persons with poorly controlled type 2 diabetes receiving insulin.”

Researchers performed a 24-week, randomized clinical trial to examine the effectiveness of CGM in adults with type 2 diabetes who receive multiple daily injections of insulin. They enrolled 158 adults aged 35 to 79 years from 25 endocrinology practices in the U.S. and Canada who had type 2 diabetes for a median of 17 years, were receiving multiple daily injections of insulin and had HbA1c levels between 7.5% and 9.9%. Participants were randomly assigned to either CGM or usual care to determine HbA1c reduction at 24 weeks.

Analysis showed that mean HbA1c levels decreased to 7.5% in the CGM group and 7.9% in the usual care group (–0.3%; 95% CI, –0.6 to –0.1; P = .005) at 12 weeks, and 7.7% in the CGM group and 8% in the usual care group (–0.3%; 95% CI, –0.5 to 0; P = .022) at 24 weeks. In exploratory analyses, Beck and colleagues found that HbA1c results favored the CGM patients across all subgroups including age, education level and diabetes numeracy score. There were no significant differences in CGM-measured hypoglycemia or quality-of-life outcomes between groups. Per week, patients in the CGM group averaged 6.7 days of CGM use.

“Use of CGM was associated with a high degree of patient satisfaction, reduced hyperglycemia and consequently HbA1c levels, and increased time in the target glucose range,” Beck and colleagues wrote. “Because few insulin-treated patients with type 2 diabetes are currently prescribed CGM, the study results indicate an additional management method that may be beneficial for these patients.”

In an accompanying commentary, Vanessa Arguello, MD, and Matthew Freeby, MD, from the David Geffen School of Medicine at UCLA, wrote that these findings have the potential to help manage patients with poorly controlled type 2 diabetes who receive multiple insulin injections each day, but further research is still needed.

“With these data, we should seek to further understand patient populations that will benefit most from CGM intervention, such as those with the skills to address glucose variability,” they wrote. “Future RT-CGM studies must also assess whether this approach improves health care outcomes for T2DM [type 2 diabetes]; its financial effects on the health care system; and further generalizability in T2DM [type 2 diabetes] subgroups, such as those with higher risk for hypoglycemia.” – by Savannah Demko

Disclosures: Beck reports support from Dexcom and Abbott Diabetes Care. Please see the study for all other authors’ relevant financial disclosures. Arguello and Freeby report no relevant financial disclosures.