CGM improves glucose control in type 1 diabetes
The use of continuous glucose monitoring (CGM) leads to a greater decrease in HbA1c levels compared with usual care, according to a new study.
The DIaMonD study (Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes) was the first of its kind study that demonstrates the impact of CGM on HbA1C and hypoglycaemia in adults with type 1 diabetes on a multiple daily injection insulin regimen.
Dexcom CGM System users on multiple daily injections (MDI) achieved a one per cent average HbA1C reduction after 24 weeks of regular use, compared to baseline, according to the research published in the Journal of the American Medical Association (JAMA) has found.
In the diabetes community, there is a commonly held belief that insulin pump users are better candidates for using CGM
In addition to better glucose control, participants also increased time spent in target range and spent less time in hypoglycaemia and hyperglycaemia when they used a Dexcom CGM System compared to those who used only a standard meter to monitor their glucose.
Dr Roy Beck, from the Jaeb Center for Health Research in Tampa, Florida, who was one of the lead researcher on the study, said: “In the diabetes community, there is a commonly held belief that insulin pump users are better candidates for using CGM, and that patients on an MDI regimen wouldn’t benefit either because they wouldn’t be willing to wear a CGM device or they wouldn’t use the information to make the changes needed for better glucose control. The DIaMonD study makes significant headway in proving that a wide range of diabetes patients taking insulin injections can benefit from CGM use.”
The DIaMonD study included 158 adult participants with type 1 diabetes on MDI. At 24 weeks, the average HbA1c reduction in people assigned to the CGM group (n=105) was one per cent compared to baseline. People in the self monitoring of blood glucose control group showed only a 0.4 per cent reduction (n=53); (p < .001). A subset of people who were considered uncontrolled – an A1C greater than 8.5 per cent – saw a 1.3 per cent reduction in HbA1c from baseline at week 24.
The CGM System used in the study was the Dexcom G4® PLATINUM CGM System with Software 505, made by DexCom, Inc., (NASDAQ:DXCM).
Initially presented at the 76th Annual Meeting of the American Diabetes Association in June 2016, the DIaMonD study also tracked the amount of time patients spent in hypoglycaemia and found a significant reduction in the CGM group compared to baseline:
• 49 per cent reduction in time spent < 70mg/dL(3.9 mmol/L)
• 53 per cent reduction in time spent < 60 mg/dL(3.3 mmol/L)
• 69 per cent reduction in time spent < 50mg/dL (2.8 mmol/L)
CGM users showed a significant reduction in hypoglycaemia during the night, spending only 0.6 per cent of the time in hypoglycaemia vs. 2.9 per cent at baseline. The study also found that CGM patients spent significantly less time (58 minutes) in hyperglycaemia ( > 300mg/dL or 16.6 mmol/L) compared to baseline and demonstrated a substantial increase in time spent “in range” (70-180mg/dL or 3.9-10.0 mmol/L) of 1.3 hours.
People demonstrated significant HbA1c reductions regardless of education level, math ability, or age, the study concluded. A high level of adherence was also achieved with 93 per cent of patients still using the Dexcom CGM System ≥6 days/week at the end of the study.