Glycemic Outcomes in Adults With T1D Are Impacted More by Continuous Glucose Monitoring Than by Insulin Delivery Method: 3 Years of Follow-Up From the COMISAIR Study
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu klinické zkoušky, časopisecké články, práce podpořená grantem
PubMed
31530663
DOI
10.2337/dc19-0888
PII: dc19-0888
Knihovny.cz E-zdroje
- MeSH
- diabetes mellitus 1. typu krev farmakoterapie MeSH
- dospělí MeSH
- glykovaný hemoglobin analýza metabolismus MeSH
- hypoglykemie krev chemicky indukované MeSH
- hypoglykemika aplikace a dávkování škodlivé účinky MeSH
- injekce subkutánní MeSH
- inzulin aplikace a dávkování škodlivé účinky MeSH
- inzulinové infuzní systémy MeSH
- krevní glukóza analýza účinky léků metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- longitudinální studie MeSH
- mladý dospělý MeSH
- následné studie MeSH
- selfmonitoring glykemie metody MeSH
- výsledek terapie MeSH
- způsoby aplikace léků MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
- Názvy látek
- glykovaný hemoglobin MeSH
- hypoglykemika MeSH
- inzulin MeSH
- krevní glukóza MeSH
OBJECTIVE: This study assessed the clinical impact of four treatment strategies in adults with type 1 diabetes (T1D): real-time continuous glucose monitoring (rtCGM) with multiple daily insulin injections (rtCGM+MDI), rtCGM with continuous subcutaneous insulin infusion (rtCGM+CSII), self-monitoring of blood glucose with MDI (SMBG+MDI), and SMBG with CSII (SMBG+CSII). RESEARCH DESIGN AND METHODS: This 3-year, nonrandomized, prospective, real-world, clinical trial followed 94 participants with T1D (rtCGM+MDI, n = 22; rtCGM+CSII, n = 26; SMBG+MDI, n = 21; SMBG+CSII, n = 25). The main end points were changes in A1C, time in range (70-180 mg/dL [3.9-10 mmol/L]), time below range (<70 mg/dL [<3.9 mmol/L]), glycemic variability, and incidence of hypoglycemia. RESULTS: At 3 years, the rtCGM groups (rtCGM+MDI and rtCGM+CSII) had significantly lower A1C (7.0% [53 mmol/mol], P = 0.0002, and 6.9% [52 mmol/mol], P < 0.0001, respectively), compared with the SMBG+CSII and SMBG+MDI groups (7.7% [61 mmol/mol], P = 0.3574, and 8.0% [64 mmol/mol], P = 1.000, respectively), with no significant difference between the rtCGM groups. Significant improvements in percentage of time in range were observed in the rtCGM subgroups (rtCGM+MDI, 48.7-69.0%, P < 0.0001; and rtCGM+CSII, 50.9-72.3%, P < 0.0001) and in the SMBG+CSII group (50.6-57.8%, P = 0.0114). Significant reductions in time below range were found only in the rtCGM subgroups (rtCGM+MDI, 9.4-5.5%, P = 0.0387; and rtCGM+CSII, 9.0-5.3%, P = 0.0235). Seven severe hypoglycemia episodes occurred: SMBG groups, n = 5; sensor-augmented insulin regimen groups, n = 2. CONCLUSIONS: rtCGM was superior to SMBG in reducing A1C, hypoglycemia, and other end points in individuals with T1D regardless of their insulin delivery method. rtCGM+MDI can be considered an equivalent but lower-cost alternative to sensor-augmented insulin pump therapy and superior to treatment with SMBG+MDI or SMBG+CSII therapy.
1st Faculty of Medicine Charles University Prague Czech Republic
3rd Department of Internal Medicine 1st Faculty of Medicine Charles University Prague Czech Republic
CGParkin Communications Inc Henderson NV
Department of Internal Medicine William Beaumont School of Medicine Oakland University Rochester MI
Department of Paediatrics 2nd Faculty of Medicine Charles University Prague Czech Republic
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