Factors Predictive of Use and of Benefit From Continuous Glucose Monitoring in Type 1 Diabetes

Abstract

OBJECTIVETo evaluate factors associated with successful use of continuous glucose monitoring (CGM) among participants with intensively treated type 1 diabetes in the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Randomized Clinical Trial.RESEARCH DESIGN AND METHODSThe 232 participants randomly assigned to the CGM group (165 with baseline A1C ≥7.0% and 67 with A1C <7.0%) were asked to use CGM on a daily basis. The associations of baseline factors and early CGM use with CGM use ≥6 days/week in the 6th month and with change in A1C from baseline to 6 months were evaluated in regression models.RESULTSThe only baseline factors found to be associated with greater CGM use in month 6 were age ≥25 years (P < 0.001) and more frequent self-reported prestudy blood glucose meter measurements per day (P < 0.001). CGM use and the percentage of CGM glucose values between 71 and 180 mg/dl during the 1st month were predictive of CGM use in month 6 (P < 0.001 and P = 0.002, respectively). More frequent CGM use was associated with a greater reduction in A1C from baseline to 6 months (P < 0.001), a finding present in all age-groups.CONCLUSIONSAfter 6 months, near-daily CGM use is more frequent in intensively treated adults with type 1 diabetes than in children and adolescents, although in all age-groups near-daily CGM use is associated with a similar reduction in A1C. Frequency of blood glucose meter monitoring and initial CGM use may help predict the likelihood of long-term CGM benefit in intensively treated patients with type 1 diabetes of all ages.

Progress in Diabetes Technology: Developments in Insulin Pumps, Continuous Glucose Monitors, and Progress towards the Artificial Pancreas

“…30 Factors associated with greater rates of CGM use were patient age and frequency of blood glucose monitoring before beginning CGM and that frequency of CGM use predicted improvement in HbA1c. 31 Among those patients in the younger age groups who used CGM frequently (≥6 d/wk) benefits were similar to those in the older age groups. 32 Over an additional year, CGM use decreased with time in all age-groups, although frequent use of CGM was still associated with better HbA1c and reduced hypoglycemia in this cohort.…”

A New Horizon for Glucose Monitoring

“…Only regular and widespread use of RT-CGM in the paediatric population together with adequate clinical expertise will provide a realistic assessment of its comprehensive role in paediatric T1D management. Studies identifying factors predictive of adherence to CGM use are warranted because the existing data do not clarify this important issue [28,31,36]. Patients, families and care-givers need adequate and continuous training and support from diabetes care teams [45,46].…”

“…CGM use of at least 6 days per week has proven to be effective in lowering HbA1c level and avoiding biochemical hypoglycaemia [28]. For this reason, it is important that the CGM system is fully adopted by young people and their parents, in order to promote a more regular and frequent use, as consistent usage is hard to achieve in routine care [41].…”

“…When the RT-CGM in the patients was compared to the controls, the number who attained HbA1c levels <7% was significantly greater in the younger group of children (8-14 years of age; n = 15 vs. 7; p = 0.02) but not in the other group (14-24 years of age; n = 8 vs. 9; p = 0.8). Subsequent post hoc analysis of frequent RT-CGM users (at least 6 days/week on average) demonstrated a significant improvement in HbA1c level compared to those who did not make use of RT-CGM as often (p < 0.001 in the group that was 8-14 years old, p = 0.002 in the group that was 15-24 years old and p = 0.02 in the group that was ≥25 years old) [28]. …”

Current Application of Continuous Glucose Monitoring in the Treatment of Diabetes

“…CGM use for 26 weeks significantly reduced HbA 1c by 0.5% in adult patients (13). Although the intention-to-treat analyses did not show a significant HbA 1c reduction in children and adolescents, it was demonstrated among all age groups that there was a significant HbA 1c reduction in patients who used CGM for ≥6 days/week (14). The adolescents were the most infrequent users of CGM devices.…”