Assessment of Patient-Led or Physician-Driven Continuous Glucose Monitoring in Patients With Poorly Controlled Type 1 Diabetes Using Basal-Bolus Insulin Regimens

Abstract

OBJECTIVEThe benefits of real-time continuous glucose monitoring (CGM) have been demonstrated in patients with type 1 diabetes. Our aim was to compare the effect of two modes of use of CGM, patient led or physician driven, for 1 year in subjects with poorly controlled type 1 diabetes.RESEARCH DESIGN AND METHODSPatients with type 1 diabetes aged 8–60 years with HbA1c ≥8% were randomly assigned to three groups (1:1:1). Outcomes for glucose control were assessed at 1 year for two modes of CGM (group 1: patient led; group 2: physician driven) versus conventional self-monitoring of blood glucose (group 3: control).RESULTSA total of 257 subjects with type 1 diabetes underwent screening. Of these, 197 were randomized, with 178 patients completing the study (age: 36 ± 14 years; HbA1c: 8.9 ± 0.9%). HbA1c improved similarly in both CGM groups and was reduced compared with the control group (group 1 vs. group 3: −0.52%, P = 0.0006; group 2 vs. group 3: −0.47%, P = 0.0008; groups 1 + 2 vs. group 3: −0.50%, P < 0.0001). The incidence of hypoglycemia was similar in the three groups. Patient SF-36 questionnaire physical health score improved in both experimental CGM groups (P = 0.004). Sensor consumption was 34% lower in group 2 than in group 1 (median [Q1–Q3] consumption: group 1: 3.42/month [2.20–3.91] vs. group 2: 2.25/month [1.27–2.99], P = 0.001).CONCLUSIONSBoth patient-led and physician-driven CGM provide similar long-term improvement in glucose control in patients with poorly controlled type 1 diabetes, but the physician-driven CGM mode used fewer sensors.

Real-time continuous glucose monitoring (CGM) integrated into the treatment of type 1 diabetes: Consensus of experts from SFD, EVADIAC and SFE

“…A recent meta-analysis confirms these results [27] and a Cochrane review appeared a short while ago [28]. The improvement is observed at 3 months [23] and maintained at 6 months [24], 12 months [26,29,30] and 18 months [24], the maximum follow-up of the studies to date. The improvement is observed whatever the initial level of HbA 1c is, whether the patient uses a pump or multiple daily injections [21] and however long a pump has previously been used by a particular patient.…”

“…The improvement is observed whatever the initial level of HbA 1c is, whether the patient uses a pump or multiple daily injections [21] and however long a pump has previously been used by a particular patient. In the EVADIAC Sensor study [30], the reduction of HbA 1c at 12 months is greater in patients on a pump than in those on multiple injections.…”

“…Careful initial training of patients [21,32,33] and educational reinforcement [30] are also key elements in the improvement of HbA 1c .…”

“…The improvement lasts between the 6th and the 12th month in the follow-up of the adult group in the JDRF study with a reduction of severe hypoglycaemias (from 21.8 to 7.1 events per 100 personyears) -a reduction more pronounced in patients having HbA 1c <7% -and a reduced glucose variability (standard deviation of glucose values, P = 0.02, and MAGE, P = 0.03) [29]. The Real trend [25] and EVADIAC Sensor [30] studies find a reduction in the glycaemic variability (standard deviation of glucose values respectively P = 0.005 and P = 0.018) with no change in the number of hypoglycaemias (Table 3).…”

“…Some data are available in the literature. They show no degradation of QoL with CGM in adult type 1 diabetics [30,39,40], children [41] or children and adults [42]. Two studies have found no difference in QoL between CGM and traditional self-monitoring [40].…”