Sustained Intensive Treatment and Long-term Effects on HbA1c Reduction (SILVER Study) by CGM in People With Type 1 Diabetes Treated With MDI

Authors: Marcus Lind, Arndís F Ólafsdóttir, Irl B Hirsch, Jan Bolinder, Sofia Dahlqvist, Aldina Pivodic, Jarl Hellman, Magnus Wijkman, Erik Schwarcz, Henrik Albrektsson, Tim Heise, William Polonsky

Abstract

Objective: Continuous glucose monitoring (CGM) reduces HbA_1c and time spent in hypoglycemia in people with type 1 diabetes (T1D) treated with multiple daily insulin injections (MDI) when evaluated over shorter time periods. It is unclear to what extent CGM improves and helps to maintain glucose control, treatment satisfaction, diabetes distress, hypoglycemic concerns, and overall well-being over longer periods of time.

Research design and methods: The GOLD trial was a randomized crossover trial performed over 16 months of CGM treatment in people with T1D treated with MDI. People completing the trial (n = 141) were invited to participate in the current SILVER extension study in which 107 patients continued CGM treatment over 1 year along with the support of a diabetes nurse every 3 months.

Results: The primary end point of the change in HbA_1c over 1.0-1.5 years of CGM use compared with previous self-monitoring of blood glucose during GOLD showed a decrease in HbA_1c of 0.35% (95% CI 0.19-0.50, P < 0.001). Time spent in hypoglycemia <3.0 mmol/L (54 mg/dL) and <4.0 mmol/L (72 mg/dL) decreased from 2.1% to 0.6% (P < 0.001) and from 5.4% to 2.9% (P < 0.001), respectively. Overall well-being (World Health Organization 5-item well-being index, P = 0.009), treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire, P < 0.001), and hypoglycemic confidence (P < 0.001) increased, while hypoglycemic fear (Hypoglycemia Fear Survey-Worry, P = 0.016) decreased and diabetes distress tended to decrease (Problem Areas in Diabetes Scale, P = 0.06). From randomization and screening in GOLD, HbA_1c was lowered by 0.45% (P < 0.001) and 0.68% (P < 0.001) after 2.3 and 2.5 years, respectively.

Conclusions: The SILVER study supports beneficial long-term effects from CGM on HbA_1c, hypoglycemia, treatment satisfaction, well-being, and hypoglycemic confidence in people with T1D managed with MDI.

Source: https://pubmed.ncbi.nlm.nih.gov/33199470/

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BDI Monthly Events

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.

July 18: Time for another T1D meet-up! GrownupT1Ds, a wonderful nonprofit here in southern California, is teaming up with TCOYD and BDI for a special Friday afternoon (3 pm - 6 pm) you won’t want to miss. Dr. Edelman (famed endocrinologist, TCOYD Founder and living with T1D) and Dr. Polonsky (BDI President) will be speaking, and it will be a chance to hang out with other adults with T1D. The event will be held at TCOYD, 5720 Oberlin Drive, Suite 150, San Diego, CA 92121. While the event is free, space is limited, so please RSVP https://grownupt1ds.org/.

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: https://tcoyd.org/one-2025/