Multicenter Randomized Trial of Intermittently Scanned Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Individuals With Type 2 Diabetes and Recent-Onset Acute Myocardial Infarction: Results of the LIBERATES Trial

Ajjan, Ramzi; Heller, Simon; Everett, Colin; Vargas-Palacios, Armando; Higham, Ruchi; Sharples, Linda; Gorog, Diana A.; Rogers, Alice; Reynolds, Catherine; Fernandez, Catherine; Rodrigues, Pedro; Sathyapalan, Thozhukat; Storey, Robert F.; Stocken, Deborah

doi:10.2337/dc22-1219

Cited by 12 publications

(20 citation statements)

References 36 publications

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“…Finally, 12 RCTs were included. Corresponding authors of the publications of all 12 RCTs were contacted to obtain any missing data, and the investigators of five RCTs [ 21 – 25 ] provided additional data.…”

Section: Resultsmentioning

confidence: 99%

“…The baseline HbA 1c ranged from a mean of 61.1 mmol/mol (7.83%) to 77.9 mmol/mol (9.27%) (Table 1 ). Eleven trials had a two-arm open-label parallel group design [ 21 – 31 ]. One trial had a three-arm parallel group design [ 32 ], including arms with 1 week of CGM use at baseline only (first arm), 1 week of CGM use at both baseline and at the end of the study period after 12 weeks (second arm) and a control arm that did not use CGM (third arm) [ 32 ].…”

Section: Resultsmentioning

confidence: 99%

“…We only included data of the intervention arm with CGM use at both the start and study endpoint and control. Eight trials compared rtCGM to SMBG [ 22 , 26 – 32 ] and four trials compared isCGM to SMBG [ 21 , 23 – 25 ]. No studies compared rtCGM to isCGM.…”

Section: Resultsmentioning

confidence: 99%

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Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis

Jancev,

Vissers,

Visseren

et al. 2024

Diabetologia

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Aims/hypothesis Continuous glucose monitoring (CGM) is increasingly used in the treatment of type 2 diabetes, but the effects on glycaemic control are unclear. The aim of this systematic review and meta-analysis is to provide a comprehensive overview of the effect of CGM on glycaemic control in adults with type 2 diabetes. Methods We performed a systematic review using Embase, MEDLINE, Web of Science, Scopus and ClinicalTrials.gov from inception until 2 May 2023. We included RCTs investigating real-time CGM (rtCGM) or intermittently scanned CGM (isCGM) compared with self-monitoring of blood glucose (SMBG) in adults with type 2 diabetes. Studies with an intervention duration <6 weeks or investigating professional CGM, a combination of CGM and additional glucose-lowering treatment strategies or GlucoWatch were not eligible. Change in HbA1c and the CGM metrics time in range (TIR), time below range (TBR), time above range (TAR) and glycaemic variability were extracted. We evaluated the risk of bias using the Cochrane risk-of-bias tool version 2. Data were synthesised by performing a meta-analysis. We also explored the effects of CGM on severe hypoglycaemia and micro- and macrovascular complications. Results We found 12 RCTs comprising 1248 participants, with eight investigating rtCGM and four isCGM. Compared with SMBG, CGM use (rtCGM or isCGM) led to a mean difference (MD) in HbA1c of −3.43 mmol/mol (−0.31%; 95% CI −4.75, −2.11, p<0.00001, I2=15%; moderate certainty). This effect was comparable in studies that included individuals using insulin with or without oral agents (MD −3.27 mmol/mol [−0.30%]; 95% CI −6.22, −0.31, p=0.03, I2=55%), and individuals using oral agents only (MD −3.22 mmol/mol [−0.29%]; 95% CI −5.39, −1.05, p=0.004, I2=0%). Use of rtCGM showed a trend towards a larger effect (MD −3.95 mmol/mol [−0.36%]; 95% CI −5.46 to −2.44, p<0.00001, I2=0%) than use of isCGM (MD −1.79 mmol/mol [−0.16%]; 95% CI −5.28, 1.69, p=0.31, I2=64%). CGM was also associated with an increase in TIR (+6.36%; 95% CI +2.48, +10.24, p=0.001, I2=9%) and a decrease in TBR (−0.66%; 95% CI −1.21, −0.12, p=0.02, I2=45%), TAR (−5.86%; 95% CI −10.88, −0.84, p=0.02, I2=37%) and glycaemic variability (−1.47%; 95% CI −2.94, −0.01, p=0.05, I2=0%). Three studies reported one or more events of severe hypoglycaemia and macrovascular complications. In comparison with SMBG, CGM use led to a non-statistically significant difference in the incidence of severe hypoglycaemia (RR 0.66, 95% CI 0.15, 3.00, p=0.57, I2=0%) and macrovascular complications (RR 1.54, 95% CI 0.42, 5.72, p=0.52, I2=29%). No trials reported data on microvascular complications. Conclusions/interpretation CGM use compared with SMBG is associated with improvements in glycaemic control in adults with type 2 diabetes. However, all studies were open label. In addition, outcome data on incident severe hypoglycaemia and incident microvascular and macrovascular complications were scarce. Registration This systematic review was registered on PROSPERO (ID CRD42023418005). Graphical Abstract

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis

Jancev,

Vissers,

Visseren

et al. 2024

Diabetologia

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“…Five studies evaluating the use of the fCGM in patients undergoing treatment with non-insulin antidiabetic agents or the combination with basal insulin reported statistically significant decreases in HbA1c levels compared to standard blood glucose self-monitoring. One of these studies also reported significant improvements in the Diabetes Self-Management Questionnaire (DSMQ) subscales, which include glucose management (p = 0.042), dietary control (p = 0.048), physical activity (p = 0.043), use of healthcare (p = 0.001), and self-care (p = 0.001), compared to baseline values [ 18 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

Type 2 diabetes in latin America: recommendations on the flash glucose monitoring system

Krakauer,

Gómez,

Almeda-Valdes

et al. 2024

Diabetol Metab Syndr

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Objective To establish recommendations through the consensus of a Latin American experts panel on the use of the flash glucose monitoring system (fCGM) in people living with type 2 diabetes mellitus (T2DM) regarding the benefits and challenges of using the fCGM. Methods An executive committee of experts was created, comprised by a panel of fifteen physicians, including endocrinologists and internal medicine physicians, with expertise in management of adult patients with T2DM. The experts were from various countries: Colombia, Chile, Peru, Mexico, Argentina, and Brazil. The modified Delphi method was used, considering a consensus level of at least 80% of the participants. A seventeen-item instrument was developed to establish recommendations on the use of fCGM in patients with T2DM in Latin American. Results The number of glucose scans recommended per day with the fCGM for patients managed with oral antidiabetic drugs or basal insulin was a median of 6 scans per day, and for those managed with multiple insulin doses, a median of 10 scans per day was recommended. Additionally, a holistic and individualized management approach was recommended, taking into account new treatment directions and identifying patients who would benefit from the use of the fCGM. Conclusion Continuous use of the fCGM is recommended for people living with T2DM, regardless of their type of treatment. These metrics must be evaluated individually for each patient profile.

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“…In addition to significant reductions in hypoglycemia, there has also been a demonstrable cost-effectiveness to utilizing CGM instead of FSBG in older adults. 25 The available data are promising, and trends of CGM use in older adults assessed from the Diabetes Prospective Follow-up Registry indicate that utilization of CGM in older adults is increasing. 26…”

Section: Overview Of Cgm Use In Older Adultsmentioning

confidence: 99%

Continuous Glucose Monitoring in Older Adults: What We Know and What We Have Yet to Learn

Price,

Callahan,

Aloi

et al. 2024

J Diabetes Sci Technol

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Objective: To assess the growing use of continuous glucose monitoring (CGM) systems by older adults and explore additional areas integration that could benefit adults with frailty. Background: The use of CGM devices has expanded rapidly in the last decade. This has been supported by substantial data showing significant benefit in glycemic metrics: hemoglobin A1c improvements, less hypoglycemia, and improved quality of life. However, sub-populations, such as older persons, exist where available data are limited. Furthermore, frail older adults represent a heterogeneous population with their own unique challenges to the management of diabetes. This group has some of the poorest outcomes related to the sequela of diabetes. For example, hypoglycemia resulting in significant morbidity and mortality is more frequent in older person with diabetes than in younger persons with diabetes. Method: We present a concise literature review on CGM use in the older adult as well as expand upon glycemic and non-glycemic benefits of CGM for patients, caregivers, and providers. Retrospective analysis of inpatient glycemic data of 16,935 older adults with Type 2 diabetes mellitus at Atrium Health Wake Forest Baptist indicated those with fraility managed with insulin or sulfonylurea had the highest rates of delirium (4.8%), hypoglycemia (3.5%), cardiovascular complications (20.2%) and ED visits/hospitalizatoins (49%). In addition, we address special consideration of specific situations including inpatient, palliative and long term care settings. Conclusion: This review article summarizes the available data for CGM use in older adults, discusses the benefits and obstacles with CGM use in this population, and identifies areas of future research needed for improved delivery of care to older persons with diabetes.

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Multicenter Randomized Trial of Intermittently Scanned Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Individuals With Type 2 Diabetes and Recent-Onset Acute Myocardial Infarction: Results of the LIBERATES Trial

Cited by 12 publications

References 36 publications

Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis

Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis

Type 2 diabetes in latin America: recommendations on the flash glucose monitoring system

Continuous Glucose Monitoring in Older Adults: What We Know and What We Have Yet to Learn

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