Sensor and software use for the glycaemic management of insulin-treated type 1 and type 2 diabetes patients

Abstract

Lowering glucose levels, while avoiding hypoglycaemia, can be challenging in insulin-treated patients with diabetes. We evaluated the role of ambulatory glucose profile in optimising glycaemic control in this population. Insulin-treated patients with type 1 and type 2 diabetes were recruited into a prospective, multicentre, 100-day study and randomised to control (n = 28) or intervention (n = 59) groups. The intervention group used ambulatory glucose profile, generated by continuous glucose monitoring, to assess daily glucose levels, whereas the controls relied on capillary glucose testing. Patients were reviewed at days 30 and 45 by the health care professional to adjust insulin therapy. Comparing first and last 2 weeks of the study, ambulatory glucose profile-monitored type 2 diabetes patients (n = 28) showed increased time in euglycaemia (mean ± standard deviation) by 1.4 ± 3.5 h/day (p = 0.0427) associated with reduction in HbA 1c from 77 ± 15 to 67 ± 13 mmol/ mol (p = 0.0002) without increased hypoglycaemia. Type 1 diabetes patients (n = 25) showed reduction in hypoglycaemia from 1.4 ± 1.7 to 0.8 ± 0.8 h/day (p = 0.0472) associated with a marginal HbA 1c decrease from 75 ± 10 to 72 ± 8 mmol/mol (p = 0.0508). Largely similar findings were observed comparing intervention and control groups at end of study. In conclusion, ambulatory glucose profile helps glycaemic management in insulin-treated diabetes patients by increasing time spent in euglycaemia and decreasing HbA 1c in type 2 diabetes patients, while reducing hypoglycaemia in type 1 diabetes patients.

Three European Retrospective Real-World Chart Review Studies to Determine the Effectiveness of Flash Glucose Monitoring on HbA1c in Adults with Type 2 Diabetes

“…However, in contrast to Beck et al, the demonstrated HbA1c improvement was achieved without the use of alarms. Glycaemic benefit from real-time CGM use without alarms has been reported previously in type 2 diabetes [10].…”

“…There are some limitations including minimal characteristic and demographic data and other variables such as socio-economic status, education level, ethnicity, duration of diabetes, previous CGM use and the reason for use of the study device. However, usual exclusion criteria such as renal disease [10], planned dialysis [3] or recent myocardial infarction were also not applied, adding to the generalisability of the primary endpoint.…”

Glucose monitoring in diabetes: from clinical studies to real‐world practice

“…Until recently, we have lacked accurate measures of GV; CGM or FCGM now allow measurement of glucose levels 24 hours/day, which led to the development of a number of GV measures . Glycaemic coefficient of variation (CV) has been increasingly used as a simple yet reliable measure of GV and has shown correlations with diabetes complications . One difficulty with GV is the documented association with hypoglycaemia, making disentangling its direct role in diabetes complications problematic.…”

“…One difficulty with GV is the documented association with hypoglycaemia, making disentangling its direct role in diabetes complications problematic. Further CGM studies will provide more accurate and standardised information on GV, helping to fully understand the role of this glycaemic variable in diabetic vascular disease …”

“…In general, studies comparing real‐time CGM with SMBG in T1DM demonstrated a 0.26% reduction in HbA 1c with no additional hypoglycaemia . In contrast to T1DM, CGM studies in patients with T2DM have been limited and, although these show potential benefit, more work is required before robust recommendations can be made on the routine use of CGM in T2DM individuals …”