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
Language English Country United States Media print-electronic
Document type Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't
PubMed
31530663
DOI
10.2337/dc19-0888
PII: dc19-0888
Knihovny.cz E-resources
- MeSH
- Diabetes Mellitus, Type 1 blood drug therapy MeSH
- Adult MeSH
- Glycated Hemoglobin analysis metabolism MeSH
- Hypoglycemia blood chemically induced MeSH
- Hypoglycemic Agents administration & dosage adverse effects MeSH
- Injections, Subcutaneous MeSH
- Insulin administration & dosage adverse effects MeSH
- Insulin Infusion Systems MeSH
- Blood Glucose analysis drug effects metabolism MeSH
- Middle Aged MeSH
- Humans MeSH
- Longitudinal Studies MeSH
- Young Adult MeSH
- Follow-Up Studies MeSH
- Blood Glucose Self-Monitoring methods MeSH
- Treatment Outcome MeSH
- Drug Administration Routes MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Glycated Hemoglobin A MeSH
- Hypoglycemic Agents MeSH
- Insulin MeSH
- Blood Glucose 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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