Glycaemic profiles of diverse patients with type 2 diabetes using basal insulin: <scp>MOBILE</scp> study baseline data

Peters, Anne L.; Cohen, Nathan; Calhoun, Peter; Ruedy, Katrina J.; Beck, Roy W.; Martens, Thomas W.; Bao, Shichun; Njeru, Nelly; Beck, Stayce E.; Price, David A.

doi:10.1111/dom.14238

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…Participants could be using any other antidiabetic medication in addition to basal insulin, provided the regimen had been stable for at least 3 months, but not prandial insulin. See eTable 1 in Supplement 2 and a prior publication for a complete listing of the inclusion and exclusion criteria. To characterize the cohort with respect to the generalization of the results, race and ethnicity were recorded through self-report by the study participants from a structured list of choices.…”

Section: Methodsmentioning

confidence: 60%

Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin

Martens

Beck

Bailey

et al. 2021

JAMA

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197

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IMPORTANCE Continuous glucose monitoring (CGM) has been shown to be beneficial for adults with type 2 diabetes using intensive insulin therapy, but its use in type 2 diabetes treated with basal insulin without prandial insulin has not been well studied.OBJECTIVE To determine the effectiveness of CGM in adults with type 2 diabetes treated with basal insulin without prandial insulin in primary care practices. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted at 15 centers in the US (enrollment from July 30, 2018, to October 30, 2019; follow-up completed July 7, 2020) and included adults with type 2 diabetes receiving their diabetes care from a primary care clinician and treated with 1 or 2 daily injections of long-or intermediate-acting basal insulin without prandial insulin, with or without noninsulin glucose-lowering medications.INTERVENTIONS Random assignment 2:1 to CGM (n = 116) or traditional blood glucose meter (BGM) monitoring (n = 59). MAIN OUTCOMES AND MEASURESThe primary outcome was hemoglobin A 1c (HbA 1c ) level at 8 months. Key secondary outcomes were CGM-measured time in target glucose range of 70 to 180 mg/dL, time with glucose level at greater than 250 mg/dL, and mean glucose level at 8 months. RESULTS Among 175 randomized participants (mean [SD] age, 57 [9] years; 88 women [50%]; 92 racial/ethnic minority individuals [53%]; mean [SD] baseline HbA 1c level, 9.1% [0.9%]), 165 (94%) completed the trial. Mean HbA 1c level decreased from 9.1% at baseline to 8.0% at 8 months in the CGM group and from 9.0% to 8.4% in the BGM group (adjusted difference, −0.4% [95% CI, −0.8% to −0.1%]; P = .02). In the CGM group, compared with the BGM group, the mean percentage of CGM-measured time in the target glucose range of 70 to 180 mg/dL was 59% vs 43% (adjusted difference, 15% [95% CI, 8% to 23%]; P < .001), the mean percentage of time at greater than 250 mg/dL was 11% vs 27% (adjusted difference, −16% [95% CI, −21% to −11%]; P < .001), and the means of the mean glucose values were 179 mg/dL vs 206 mg/dL (adjusted difference, −26 mg/dL [95% CI, −41 to −12]; P < .001). Severe hypoglycemic events occurred in 1 participant (1%) in the CGM group and in 1 (2%) in the BGM group.CONCLUSIONS AND RELEVANCE Among adults with poorly controlled type 2 diabetes treated with basal insulin without prandial insulin, continuous glucose monitoring, as compared with blood glucose meter monitoring, resulted in significantly lower HbA 1c levels at 8 months.

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Section: Methodsmentioning

confidence: 60%

Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin

Martens

Beck

Bailey

et al. 2021

JAMA

Self Cite

197

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“…Mean (±standard deviation [SD]) baseline HbA1c was 9.1% ± 0.9% and mean (±SD) baseline TIR 70–180 mg/dL was 40% ± 25%. 21 , 22 Potential participants were recruited from primary care practices and were not under the care of an endocrinologist to manage their diabetes. Participants could not have been using prandial insulin at the time of enrollment.…”

Section: Methodsmentioning

confidence: 99%

Magnitude of Glycemic Improvement in Patients with Type 2 Diabetes Treated with Basal Insulin: Subgroup Analyses from the MOBILE Study

Davis

Bailey

Calhoun

et al. 2022

Diabetes Technology & Therapeutics

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Objective: To determine if type 2 diabetes patients using basal insulin without prandial insulin with worse glycemic control at baseline would have the greatest benefit from using real-time continuous glucose monitoring (CGM). Methods: We conducted a post hoc analysis of the MOBILE Study, a multicenter trial examining the impact of CGM versus self-monitoring with a blood glucose meter (BGM) in patients with type 2 diabetes treated with basal insulin without prandial insulin. Participants were divided into subgroups based on baseline hemoglobin A1c (HbA1c) and baseline time-in-range 70–180 mg/dL (TIR). Change in TIR from baseline was calculated within each subgroup. Results: In subgroups based on baseline HbA1c, compared with the BGM group, the CGM group had 14% greater increase in TIR for participants with baseline HbA1c ≥8.5%, 14% greater increase for baseline HbA1c ≥9.0%, 22% greater increase for baseline HbA1c ≥9.5%, and 32% greater increase for baseline HbA1c ≥10.0% ( P -value for interaction = 0.27). The time spent with glucose >250 mg/dL was significantly lower with CGM compared with BGM among participants with higher HbA1c values ( P for interaction = 0.004). Results in subgroups based on baseline TIR paralleled the results in subgroups based on baseline HbA1c. Conclusion: While the benefit of CGM on TIR among patients with type 2 diabetes treated with basal insulin is apparent across the range of baseline glycemic control, the greatest impact of CGM is in those with the worst baseline glycemic control, particularly among those with HbA1c ≥10%. Clinical Trial Registration number: NCT03566693.

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“…Written informed consent was obtained from each participant on entering the initial randomized trial. Methods for the initial 8-month randomized trial have been reported ( 6 , 7 ). Key aspects of the protocol are summarized below.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Discontinuing Continuous Glucose Monitoring in Adults With Type 2 Diabetes Treated With Basal Insulin

et al. 2021

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Glycaemic profiles of diverse patients with type 2 diabetes using basal insulin: MOBILE study baseline data

Cited by 9 publications

References 20 publications

Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin

Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin

Magnitude of Glycemic Improvement in Patients with Type 2 Diabetes Treated with Basal Insulin: Subgroup Analyses from the MOBILE Study

The Effect of Discontinuing Continuous Glucose Monitoring in Adults With Type 2 Diabetes Treated With Basal Insulin

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