Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin: A Randomized Clinical Trial

Authors: 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, MOBILE Study Group

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 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 measures: The primary outcome was hemoglobin 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 randomized 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 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 HbA1c levels at 8 months.

Source: https://pubmed.ncbi.nlm.nih.gov/34077499/

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BDI Monthly Events

June 11Case Consultation
BDI hosts the San Diego-wide, monthly case consultation meeting (for mental health professionals working in the field of diabetes). Contact us at [email protected] if you are in the greater San Diego area and would like further information about this program.
June 20-23ADA 85th Scientific Sessions
It will be a busy time for BDI staff at the American Diabetes Association’s 85th Scientific Sessions (Chicago, IL). Exciting new study results to be presented, new projects to be discussed, and old friends to see.
June 21Above the Bias Panel
At the Abbott Diabetes Care booth at this years ADA Scientific Sessions in Chicago Il, Dr. Guzman, BDI Director of Clinical Education, will be moderating the panel discussion, Above the Bias.
June 22Using CGM in Diabetes Self-Care
At the American Diabetes Association’s 85th Scientific Sessions (Chicago, IL), Dr. Polonsky, BDI President, will be speaking on Tell Me Why—Using CGM to Drive Changes in Diabetes Self-Care. He also serves a co-author on six poster presentations on that day:
June 23EMBARK
At the American Diabetes Association’s 85th Scientific Sessions (Chicago, IL), Dr. Fisher, BDI Research Director, will present Reducing Diabetes Distress Leads to Positive Glycemic Change—Results from the EMBARK Trial
August 8-10TCOYD ONE
August 8 – 10. Taking Control of Your Diabetes (TCOYD) will be hosting the in-person ONE event, an amazing weekend experience here in San Diego for more than 500 people with type 1 diabetes and their loved ones. Dr. Polonsky is honored to be one of the presenters, and we will hope to see many of you there. There are still a few spaces left, so if you’d like to know more, please visit: