Clinical Use of Continuous Glucose Monitoring in Adults with Type 1 Diabetes

Slattery, David; Choudhary, Pratik

doi:10.1089/dia.2017.0051

Cited by 67 publications

(61 citation statements)

References 40 publications

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“…Of note, we showed that patients who used CGMS (N = 4) had better glycaemic control, compared with those who did not, which was consistent with prior data from observational and randomized trial in patients aged >60 (65) years [15][16][17].…”

Section: Discussionsupporting

confidence: 88%

Efficacy and safety of long-term insulin pump treatment in patients with type 1 diabetes aged over 50 years

et al. 2020

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Continuous subcutaneous insulin infusion (CSII) therapy using insulin pumps has become widely used in the treatment of type 1 diabetes mellitus (T1DM). This retrospective study aimed to assess the efficacy and safety of long-term insulin pump treatment in patients with T1DM aged ≥50 years. The study included patients aged ≥50 years, who had a diagnosis of T1DM based on clinical criteria and/or presence of autoantibodies characteristic of autoimmune diabetes, and had received ≥5 years of recent and uninterrupted treatment with a personal insulin pump. We analyzed records on HbA1c levels across the entire observation period. The cohort comprised 17 patients, of whom 6 (35%) were men and 11 (65%) were women. The mean duration of observation was 6.6 years, during which patients had a mean of 8.4 HbA1c measurements. Mean HbA1c level over the entire observation period was 6.7% (range, 5.3-7.4%). Overall, 11 patients (65%) had mean HbA1c levels at the ADA-recommended target of <7% and 5 patients (29%) had mean HbA1c <6.5%. Mean HbA1c level was significantly lower at the end of the observation period than at the start (6.52% versus 6.91%; difference, -0.39%; p < 0.01), indicating an improvement in glycaemic control over time. On average, patients experienced one level 1 hypoglycaemia episode every 2.4 days. This retrospective analysis of at least 5 years of follow-up of selected patients with T1DM aged ≥50 years at the start of observation, showed that CSII is a safe and effective treatment option in this age group.

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Section: Discussionsupporting

confidence: 88%

Efficacy and safety of long-term insulin pump treatment in patients with type 1 diabetes aged over 50 years

et al. 2020

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“…Fourthly, as previously mentioned, CGM devices are often less accurate in the hypoglycaemia range and have a high false‐detection rate for nocturnal hypoglycaemia . Additionally, mean absolute relative differences between CGM readings and blood glucose readings remain between 9% and 14% . As well as the limiting impact of the accuracy of CGM devices, the patients in our study wore a CGM device for a relatively short period of time (seven days), while recent CGM guidelines call for two weeks of CGM data collection for analysis .…”

Section: Discussionmentioning

confidence: 75%

“…18 Additionally, mean absolute relative differences between CGM readings and blood glucose readings remain between 9% and 14%. 19 As well as the limiting impact of the accuracy of CGM devices, the patients in our study wore a CGM device for a relatively short period of time (seven days), while recent CGM guidelines call for two weeks of CGM data collection for analysis. 13 Despite these limitations, the major strength of the study is that it is one of the largest CGM-based studies of insulin treatment in T1D to date.…”

Section: Safetymentioning

confidence: 99%

Efficacy and safety of a morning injection of insulin glargine 300 units/mL versus insulin glargine 100 units/mL in adult patients with type 1 diabetes: A multicentre, randomized controlled trial using continuous glucose monitoring

Pettus

Gill

Paranjape

et al. 2019

Diabetes Obesity Metabolism

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Video abstract: View a video abstract for this article.Aims: This multicentre (N = 104), randomized controlled phase 4 study compared the efficacy and safety of insulin glargine 300 units/mL (Gla-300) with insulin glargine 100 units/mL (Gla-100) in patients with type 1 diabetes (T1D).Materials and methods: Patients were randomized 1:1 to self-perform morning Gla-300 or Gla-100 injections daily for 16 weeks. The primary endpoint was percentage of time blood glucose remained in the target range (70-180 mg/dL) during Week 15/16, measured by blinded continuous glucose monitoring. Secondary endpoints included incidence and rate of nocturnal symptomatic hypoglycaemia (≤70 mg/dL), glycaemic variability parameters and safety assessments. Exploratory analyses were performed in patients with glycated haemoglobin (HbA1c) <7.5% at Week 16.Results: Overall, 638 patients with T1D were included (Gla-300, n = 320; Gla-100, n = 318). In the modified intent-to-treat (mITT) population, no differences between Gla-300 and Gla-100 were observed in time in range, in glycaemic variability, or in incidence or rates of nocturnal symptomatic hypoglycaemia. In exploratory analyses of patients with HbA1c <7.5% at Week 16, Gla-300 recipients had greater improvement in time in range over 24 hours, during the day and at night compared with Gla-100 recipients (P < 0.05), with small increases in overall hypoglycaemia.Conclusions: Time in range and glycaemic variability were similar for Gla-300 and Gla-100 recipients at the end of study in the mITT population of relatively well-controlled patients with T1D. In patients with end-of-study HbA1c <7.5%, exploratory analyses suggested that Gla-300 provided improvements in time in range compared with Gla-100. K E Y W O R D Sbasal insulin, continuous glucose monitoring (CGM), glycaemic control, hypoglycaemia, type 1 diabetes

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“…CGM, including isCGM (hereafter, unless stated, CGM includes both rtCGM and isCGM), is being used by an increasing number of people with type 1 diabetes (T1D). 15,16 The key benefits of CGM include real-time data monitoring for people with T1D and access for them and their HCPs to complete glucose datasets 17 ; both of which help people to achieve their target time spent within the acceptable range (time in range [TIR]: 3.9-10.0 mmol/L [70-180 mg/dL]) and avoid hyper-and hypoglycemia. 18 Reductions in HbA 1c have been reported with CGM use in people on multiple daily injection (MDI) therapy, 19 and continuous subcutaneous insulin infusion therapy, 20 with reduced time spent in hypoglycemia, 20 and improved hypoglycemia awareness.…”

Section: Introductionmentioning

confidence: 99%

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

Adolfsson

Hartvig

Kaas

et al. 2020

Diabetes Technology & Therapeutics

111

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Background: This observational study investigated whether the connected NovoPen Ò 6 could influence insulin regimen management and glycemic control in people with type 1 diabetes (T1D) using a basal-bolus insulin regimen and continuous glucose monitoring in a real-world setting. Methods: Participants from 12 Swedish diabetes clinics downloaded pen data at each visit (final cohort: n = 94). Outcomes included time in range (TIR; sensor glucose 3.9-10.0 mmol/L), time in hyperglycemia (>10 mmol/L), and hypoglycemia (L1: 3.0-<3.9 mmol/L; L2: <3.0 mmol/L). Missed bolus dose (MBD) injections were meals without bolus injection within -15 and +60 min from the start of a meal. Outcomes were compared between the baseline and follow-up periods ( ‡5 health care professional visits). Data were analyzed from the first 14 days following each visit. For the TIR and total insulin dose analyses (n = 94), a linear mixed model was used, and for the MBD analysis (n = 81), a mixed Poisson model was used. Results: TIR significantly increased (+1.9 [0.8; 3.0] 95% CI h/day; P < 0.001) from baseline to follow-up period, with a corresponding reduction in time in hyperglycemia (-1.8 [-3.0; -0.6] 95% CI h/day; P = 0.003) and L2 hypoglycemia (-0.3 [-0.6; -0.1] 95% CI h/day; P = 0.005), and no change in time in L1 hypoglycemia. MBD injections decreased by 43% over the study (P = 0.002). Change in MBD injections corresponded to a decrease from 25% to 14% based on the assumption that participants had three main meals per day. Conclusions: Our study highlights the potential benefit on glycemic control and dosing behavior when reliable insulin dose data from a connected pen contribute to insulin management in people with T1D.

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Clinical Use of Continuous Glucose Monitoring in Adults with Type 1 Diabetes

Cited by 67 publications

References 40 publications

Efficacy and safety of long-term insulin pump treatment in patients with type 1 diabetes aged over 50 years

Efficacy and safety of long-term insulin pump treatment in patients with type 1 diabetes aged over 50 years

Efficacy and safety of a morning injection of insulin glargine 300 units/mL versus insulin glargine 100 units/mL in adult patients with type 1 diabetes: A multicentre, randomized controlled trial using continuous glucose monitoring

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

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