Continuous glucose monitoring improves glycaemic control versus finger-prick

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Continuous glucose monitoring substantially improves blood sugars levels and decreasing the risks of hypoglycaemia compared with the usual finger-prick, found a US study.

15-centre study of 175 patients with poorly controlled type 2 diabetes by the University of Michigan and published in JAMA found that continuous glucose monitoring, compared to blood glucose meter monitoring, or finger-pricking, significantly decreased their haemoglobin A1C over eight months (-1.1% versus -0.16%, respectively.)

Although the benefits of continuous glucose monitoring for patients with diabetes has been demonstrated before, the benefits have only been well studied in patients with type 1 diabetes or patients with type 2 treated with multiple daily insulin injections, referred to as prandial insulin.

Study author Professor Rodica Busui, also the vice chair of clinical research in the Department of Internal Medicine at University of Michigan Health, says this work is one of the first to thoroughly understand the impact of having access to and using a continuous glucose monitor in adults with poorly controlled type 2 diabetes who are only treated with basal insulin, a long-acting insulin designed to be injected once or twice daily to provide an adequate level of insulin throughout the day and night

“Not only does this trial demonstrate the benefits of continuous glucose monitoring for these patients, a technology that hasn't been covered by many insurers for those with type 2 diabetes, but these benefits were seen across a broad spectrum of socio-economic status and racial backgrounds,” said Busui. Approximately half of the study's participants were of a racial or ethnic minority.

The randomised clinic trial began enrolling patients in mid-2018 to late-2019, with follow up in mid-2020. The participants received one or two daily injections of long-acting basal insulin, with or without non-insulin medications to help lower blood sugar levels.

“This work wouldn't have been possible without the partnership between endocrinologists and primary care physicians, as all the patients were recruited and treated by our primary care teams,” said Busui, who is also associate director for clinical research in the Elizabeth Weiser Caswell Diabetes Institute.

Aside from testing the efficacy of continuous glucose monitoring paired with basal insulin in the study participants, Busui and her team sought to better understand how the impact of this diabetes treatment approach affected patients' adherence to managing their disease as well as their overall life satisfaction.

To the researchers' delight, the 175 study participants exhibited better adherence to managing their diabetes, and their life satisfaction was higher.

“What's most exciting is that this work demonstrates that using continuous glucose monitoring is effective in substantially improving blood sugars levels and decreasing the risks of hypoglycaemia in those who were randomised to use a continuous glucose monitor compared with the usual finger-prick,” said Busui.

“This may open the door for broader coverage of this game-changing technology for all patients with diabetes. More patients can manage their diabetes if they have access to this resource and their primary care physicians are educated on the benefits of their patients utilising it.”

Study details

Effect of Continuous Glucose Monitoring on Glycaemic Control in Patients With Type 2 Diabetes Treated With Basal InsulinA Randomised Clinical Trial

Thomas Martens, Roy W. Beck, Ryan Bailey, Katrina J. Ruedy, Peter Calhoun, Anne L. Peters, Rodica Pop-Busui, Athena Philis-Tsimikas, Shichun Bao, Guillermo Umpierrez, Georgia Davis, Davida Kruger, Anuj Bhargava, Laura Young, Janet B. McGill, Grazia Aleppo, Quang T. Nguyen, Ian Orozco, William Biggs, K. Jean Lucas, William H. Polonsky,  John B. Buse, David Price, Richard M. Bergenstal

Published in JAMA, 2 June 2021

Key points
Question For adults with poorly controlled type 2 diabetes treated with basal insulin without prandial insulin in primary care practices, does continuous glucose monitoring improve haemoglobin A1c (HbA1c) levels compared with blood glucose meter monitoring?

Findings In a randomised clinical trial including 175 adults with type 2 diabetes, there was a significantly greater decrease in HbA1c level over 8 months with continuous glucose monitoring than with blood glucose meter monitoring (−1.1% vs −0.6%).

Meaning Continuous glucose monitoring resulted in better glycaemic control compared with blood glucose meter monitoring in adults with poorly controlled type 2 diabetes treated with basal insulin without prandial insulin.

Abstract
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 Participants This randomised 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 Measures The primary outcome was haemoglobin A1c (HbA1c) 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 randomised participants (mean [SD] age, 57 [9] years; 88 women [50%]; 92 racial/ethnic minority individuals [53%]; mean [SD] baseline HbA1c level, 9.1% [0.9%]), 165 (94%) completed the trial. Mean HbA1c 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 hypoglycaemic 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 HbA1c levels at 8 months.

 

Full JAMA article – Effect of Continuous Glucose Monitoring on Glycaemic Control in Patients With Type 2 Diabetes Treated With Basal InsulinA Randomized Clinical Trial (Open access)

 

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New drug weekly as safe and efficacious as insulin daily — NRI diabetes trial

 

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MSF: Only half of those needing insulin have access to it 100 years after its discovery

 


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