Glycemic Outcomes in Adults With T1D Are Impacted More by Continuous Glucose Monitoring Than by Insulin Delivery Method: 3 Years of Follow-Up From the COMISAIR Study

Sep 19, 2019Diabetes care

Blood Sugar Control in Adults with Type 1 Diabetes Is More Influenced by Continuous Glucose Monitoring Than by How Insulin Is Delivered: 3-Year Follow-Up

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Abstract

At 3 years, the rtCGM groups achieved A1C levels of 7.0% and 6.9%, significantly lower than the SMBG+MDI and SMBG+CSII groups, which had A1C levels of 8.0% and 7.7%, respectively.

Real-time continuous glucose monitoring (rtCGM) is associated with lower A1C levels compared to self-monitoring of blood glucose (SMBG).
The rtCGM+MDI and rtCGM+CSII groups showed significant improvements in time spent within target glucose range (70-180 mg/dL).
Reductions in time spent below the target glucose range were significant in the rtCGM subgroups but not in the SMBG groups.
Seven episodes of severe hypoglycemia were observed, with more occurring in the SMBG groups.
RtCGM+MDI is suggested as a cost-effective alternative to sensor-augmented insulin pump therapy.

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OBJECTIVE: This study assessed the clinical impact of four treatment strategies in adults with type 1 diabetes (T1D): real-time continuous glucose monitoring (rtCGM) with multiple daily insulin injections (rtCGM+MDI), rtCGM with continuous subcutaneous insulin infusion (rtCGM+CSII), self-monitoring of blood glucose with MDI (SMBG+MDI), and SMBG with CSII (SMBG+CSII).

RESEARCH DESIGN AND METHODS: This 3-year, nonrandomized, prospective, real-world, clinical trial followed 94 participants with T1D (rtCGM+MDI,= 22; rtCGM+CSII,= 26; SMBG+MDI,= 21; SMBG+CSII,= 25). The main end points were changes in A1C, time in range (70-180 mg/dL [3.9-10 mmol/L]), time below range (<70 mg/dL [<3.9 mmol/L]), glycemic variability, and incidence of hypoglycemia. n n n n

RESULTS: At 3 years, the rtCGM groups (rtCGM+MDI and rtCGM+CSII) had significantly lower A1C (7.0% [53 mmol/mol],= 0.0002, and 6.9% [52 mmol/mol],< 0.0001, respectively), compared with the SMBG+CSII and SMBG+MDI groups (7.7% [61 mmol/mol],= 0.3574, and 8.0% [64 mmol/mol],= 1.000, respectively), with no significant difference between the rtCGM groups. Significant improvements in percentage of time in range were observed in the rtCGM subgroups (rtCGM+MDI, 48.7-69.0%,< 0.0001; and rtCGM+CSII, 50.9-72.3%,< 0.0001) and in the SMBG+CSII group (50.6-57.8%,= 0.0114). Significant reductions in time below range were found only in the rtCGM subgroups (rtCGM+MDI, 9.4-5.5%,= 0.0387; and rtCGM+CSII, 9.0-5.3%,= 0.0235). Seven severe hypoglycemia episodes occurred: SMBG groups,= 5; sensor-augmented insulin regimen groups,= 2. P P P P P P P P P n n

CONCLUSIONS: rtCGM was superior to SMBG in reducing A1C, hypoglycemia, and other end points in individuals with T1D regardless of their insulin delivery method. rtCGM+MDI can be considered an equivalent but lower-cost alternative to sensor-augmented insulin pump therapy and superior to treatment with SMBG+MDI or SMBG+CSII therapy.

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Glycemic Outcomes in Adults With T1D Are Impacted More by Continuous Glucose Monitoring Than by Insulin Delivery Method: 3 Years of Follow-Up From the COMISAIR Study

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