Use of factory calibrated real-time continuous glucose monitoring improves time in target and HbA1c in a multiethnic cohort of adolescents and young adults with type 1 diabetes: the MILLENNIALS Study

Abstract

<b>Objective: </b>International type 1 diabetes registries have shown that HbA1c levels are highest in young people with type 1 diabetes, however improving their glycaemic control remains a challenge. We propose that use of factory-calibrated Dexcom G6 CGM system would improve glycaemic control in this cohort. <p><b>Research Design and Methods: </b>We conducted a randomized crossover trial in young people with type 1 diabetes (16 – 24 years old), comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded CGM was worn by each participant for 10 days at the start, week-4 and week-7 of the control period. HbA1c measurements were drawn after enrolment, before and after each treatment period. The primary outcome was time in range 70–180mg/dl.</p> <p><b>Results: </b>Time in range was significantly higher during CGM compared to control [35.7±13.5% vs. 24.6±9.3%, mean difference 11.1% (95% CI 7.0 to 15.2, p<0.001)]. CGM use reduced mean sensor glucose [219.7±37.6mg/dl vs. 251.9±36.3mg/dl, mean difference -32.2mg/dl (95% CI -44.5 to -20.0, p<0.001)] and time above range [61.7±15.1% vs. 73.6±10.4%, mean difference 11.9% (95% CI -16.4 to -7.4, p<0.001)]. HbA1c level was reduced by 0.76% (95% CI -1.1 to -0.4) [-8.5mmol/mol (95% CI -12.4 to -4.6, p<0.001)]. Times spent below range (<70mg/dl and <54mg/dl) were low and comparable during both study periods. Sensor wear was 84% during the CGM period.</p> <p><b>Conclusion: </b>CGM use in young people with type 1 diabetes improves time in target and HbA1c levels compared to SMBG.<b> </b></p>

Real‐world performance of hybrid closed loop in youth, young adults, adults and older adults with type 1 diabetes: Identifying a clinical target for hybrid closed‐loop use

“…Use of factory‐calibrated CGMs with HCL systems is increasing and may help to increase CGM use, especially for youth, by eliminating the need to complete fingerstick BG checks for sensor calibration, 28 ultimately increasing success with HCL. The t:slim X2 Control‐IQ HCL system (Tandem Diabetes), which is commercially available as of January 2020, and the Omnipod 5 HCL system (Insulet Corporation), which is expected to be commercially available in 2021, both use the Dexcom G6 CGM, which is factory‐calibrated 29‐32 .…”

“…Many youth become frustrated with CGMs after a while and perceive that CGMs interfere with their lives,27 therefore, setting goals that build in scheduled breaks in CGM use (e.g. wearing a CGM for 6 days, with a 1-day break in CGM use each week) may help to prevent CGM burnout and increase the likelihood of sustaining 80% CGM use across time26,27 ; however, research is needed to confirm if scheduled breaks in use are an effective strategy to increase CGM use.Use of factory-calibrated CGMs with HCL systems is increasing and may help to increase CGM use, especially for youth, by eliminating the need to complete fingerstick BG checks for sensor calibration,28 ultimately increasing success with HCL. The t:slim X2 Control-IQ HCL system (Tandem Diabetes), which is commercially available as of January 2020, and the Omnipod 5 HCL system (Insulet Corporation), which is expected to be commercially available in 2021, both use the Dexcom G6 CGM, which is factory-calibrated [29][30][31][32].…”

Racial Disparities in Diabetes Technology Use and Outcomes in Type 1 Diabetes in a Safety-Net Hospital

“…For individuals living with type 1 diabetes mellitus (T1D), diabetes technologies—defined as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitor (CGM)—are associated with improved glycemic control, reduced rates of severe hypoglycemia, and improved quality of life. 1-6 Diabetes technologies, in particular CGM and sensor-augmented pump therapy, provide benefit at the individual and societal level through increase in quality-adjusted life years, reduction in complications, and a suggestion of extending the life expectancy of patients with T1D. Furthermore, they have been shown to be cost-effective, decreasing the future economic burden of T1D.…”

Flash Glucose Monitoring in the Netherlands: Increased monitoring frequency is associated with improvement of glycemic parameters

“…Continuous Glucose Monitoring (CGM), either by real time Continuous Glucose Monitoring (rt-CGM) or by Flash Glucose Monitoring (FLASH), allows a more frequent assessment of glucose concentrations in the interstitial fluid and also provides information on glucose trends. CGM is changing diabetes management and often contributes to increased quality of life, treatment satisfaction, better and more stable glycemic control and improved short term outcomes [4][5][6][7][8][9][10][11].…”