medwireNews: The results of two studies published in JAMA indicate that real-time continuous glucose monitoring (CGM) benefits people with type 1 or type 2 diabetes on a range of insulin regimens and a wide variety of backgrounds.
In an editorial published alongside the randomized trial and observational study, Monica Peek and Celeste Thomas, both of the University of Chicago in Illinois, USA, observe that the randomized trial recruited participants with type 2 diabetes “who had disproportionate barriers to fully accessing healthcare and healthcare-related technologies and also had disproportionately lower rates of adherence to diabetes treatment plans.”
Just over half (53%) of the 175 American trial participants were Hispanic or Latino, African American, Asian, or some other minority group; a similar proportion had less than a college diploma; and less than half had private health insurance.
All participants used basal insulin to control their blood sugar, and other diabetes medications were allowed, except mealtime insulin. Studies such as the DIAMOND trial have previously demonstrated the benefits of CGM in people with type 2 diabetes using basal bolus insulin.
At baseline, mean glycated hemoglobin (HbA1c) levels were 9.1% and 9.0% in 116 and 59 participants randomized to use CGM or continue self-monitoring of blood glucose (SMBG), respectively . But after 8 months, there was a significant improvement in favor of the CGM group, with corresponding levels of 8.0% and 8.4%.
Time in range was also significantly higher in participants using CGM, at 59% versus 43% in the SMBG group (the latter measured using blind CGM). Roy Beck (Jaeb Center for Health Research Foundation, Tampa, Florida, USA) and study co-authors note that the difference equates to 3.6 overtime hours per day within the recommended range.
There were no significant differences between groups in insulin dose or drug changes, leading editorial writers to attribute improvements in blood sugar readings to increased patient engagement.
“Activated patients are a powerful element in achieving diabetes control,” they write.
Peek and Thomas also observe that trial participants rated the use of CGM positively in terms of high benefits and low problems, “suggesting a willingness of this diverse patient population to engage with the technology.” .
In the observational study, Andrew Karter (Kaiser Permanente, Oakland, California, USA) and colleagues found similar significant benefits in a study of 41,753 people with type 1 or type 2 diabetes in primary care , of which 3,806 initiated the SCG. Their average HbA1c levels fell from 8.17% to 7.76%, compared to 8.28% to 8.19% in 37,947 people who had not initiated CMS, giving a weighted and adjusted difference of 0.4% in favor of using CMS, which was statistically significant.
The majority of study participants were Caucasian and followed a variety of insulin regimens, with about two-thirds using long-acting insulins.
Nine percent of CGM initiators had type 2 diabetes, and they appeared to derive the greatest benefit from initiating CGM, achieving a 0.56% reduction in HbA1c compared to non-initiators with diabetes. type 2, which was significantly greater than the 0.39% reduction observed for CGM initiators versus non-initiators with type 1 diabetes.
Of note, 97% of participants with type 2 diabetes were on a basal-bolus insulin regimen, which Peek and Thomas note is consistent with current recommendations for the use of CGM in this group. But they point out that the combined studies indicate that people on an insulin treatment regimen might benefit from CGM.
Taken together, these studies “provide a powerful narrative that CGM may be a useful technology that helps control diabetes among multiple patient groups,” the columnists say.
They conclude: “The time has come to expand access to CGM for patients with type 2 diabetes.”
The results of the randomized trial were also presented at the ATTD 2021 virtual conference, by study lead author Thomas Martens (Park Nicollet Internal Medicine, Minneapolis, Minnesota, USA).
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