scholarly journals Benefits of a Switch from Intermittently Scanned Continuous Glucose Monitoring (isCGM) to Real-Time (rt) CGM in Diabetes Type 1 Suboptimal Controlled Patients in Real-Life: A One-Year Prospective Study

Sensors ◽  
2021 ◽  
Vol 21 (18) ◽  
pp. 6131
Author(s):  
Yannis Préau ◽  
Sébastien Galie ◽  
Pauline Schaepelynck ◽  
Martine Armand ◽  
Denis Raccah
Keyword(s):  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Therapeutic Option ◽  
Real Life ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Long Term Study ◽  
Average Glucose

The switch from intermittently scanned continuous glucose monitoring (isCGM) to real-time (rt) CGM could improve glycemic management in suboptimal controlled type 1 diabetes patients, but long-term study is lacking. We evaluated retrospectively the ambulatory glucose profile (AGP) in such patients after switching from Free Style Libre 1 (FSL1) to Dexcom G4 (DG4) biosensors over 1 year. Patients (n = 21, 43 ± 15 years, BMI 25 ± 5, HbA1c 8.1 ± 1.0%) had severe hypoglycemia and/or HbA1c ≥ 8%. AGP metrics (time-in-range (TIR) 70–180 mg/dL, time-below-range (TBR) <70 mg/dL or <54 mg/dL, glucose coefficient of variation (%CV), time-above-range (TAR) >180 mg/dL or >250 mg/dL, glucose management indicator (GMI), average glucose) were collected the last 3 months of FSL1 use (M0) and of DG4 for 3, 6 (M6) and 12 (M12) months of use. Values were means ± standard deviation or medians [Q1;Q3]. At M12 versus M0, the higher TIR (50 ± 17 vs. 45 ± 16, p = 0.036), and lower TBR < 70 mg/dL (2.5 [1.6;5.5] vs. 7.0 [4.5;12.5], p = 0.0007), TBR < 54 mg/dL (0.7 [0.4;0.8] vs. 2.3 [0.8;7.0], p = 0.007) and %CV (39 ± 5 vs. 45 ± 8, p = 0.0009), evidenced a long-term effectiveness of the switch. Compared to M6, TBR < 70 mg/dL decreased, %CV remained stable, while the improvement on hyperglycemia exposure decreased (higher GMI, TAR and average glucose). This switch was a relevant therapeutic option, though a loss of benefit on hyperglycemia stressed the need for optimized management of threshold alarms. Nevertheless, few patients attained the recommended values for AGP metrics, and the reasons why some patients are “responders” vs. “non-responders” warrant to be investigated.

scholarly journals Benefits of a Switch From Intermittently Scanned Continuous Glucose Monitoring (isCGM) to Real-time (rt) CGM in Diabetes Type 1 Suboptimal Controlled Patients in Real-life: A One-year Prospective Study

2021 ◽  
Author(s):  
Yannis Préau ◽  
Sébastien Galie ◽  
Pauline Schaepelynck ◽  
Martine Armand ◽  
Denis Raccah
Keyword(s):  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Therapeutic Option ◽  
Real Life ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Long Term Study ◽  
Average Glucose

The switch from intermittently scanned continuous glucose monitoring (isCGM) to real-time (rt) CGM could improve glycemic management in suboptimal controlled type 1 diabetes patients, but long-term study is lacking. We evaluated retrospectively the ambulatory glucose profile (AGP) in such patients after switching from Free Style libre 1 (FSL1) to Dexcom G4 (DG4) over 1 year. Patients (n=21, 43&plusmn;15 years, BMI 25&plusmn;5, HbA1c 8.1&plusmn;1.0%) had severe hypoglycemia and/or HbA1c&ge;8%. AGP metrics (time-in-range (TIR) 70-180 mg/dL, time-below-range (TBR)&lt;70 mg/dL or &lt;54 mg/dL, glucose coefficient of variation (%CV), time-above-range (TAR) &gt;180 mg/dL or &gt;250 mg/dL, glucose management indicator (GMI), average glucose) were collected the last 3 months of FSL1 use (M0) and of DG4 for 3, 6 (M6) and 12 (M12) months of use. Values were means &plusmn; standard deviation or medians [Q1;Q3]. At M12 versus M0, the higher TIR (50&plusmn;17 vs. 45&plusmn;16, P=0.036), and lower TBR&lt;70 mg/dL (2.5 [1.6;5.5] vs. 7.0 [4.5;12.5], P=0.0007), TBR&lt;54 mg/dL (0.7 [0.4;0.8] vs. 2.3 [0.8;7.0], P=0.007) and %CV (39&plusmn;5 vs. 45&plusmn;8, P=0.0009), evidenced a long-term effectiveness of the switch. Compared to M6, TBR&lt;70mg/dL decreased, %CV remained stable, while the improvement on hyperglycemia exposure decreased (higher GMI, TAR and average glucose). This switch was a relevant therapeutic option, though a loss of benefit on hyperglycemia stressed the need for optimized management of threshold alarms. Nevertheless, few patients attained the recommended values for AGP metrics, and the reasons why some patients are &ldquo;responders&rdquo; vs &ldquo;non-responders&rdquo; warrant to be investigated.

scholarly journals Real-Time Continuous Glucose Monitoring Significantly Reduces Severe Hypoglycemia in Hypoglycemia-Unaware Patients With Type 1 Diabetes

Diabetes Care ◽  
2013 ◽  
Vol 36 (12) ◽  
pp. 4160-4162 ◽  
Author(s):  
P. Choudhary ◽  
S. Ramasamy ◽  
L. Green ◽  
G. Gallen ◽  
S. Pender ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia

scholarly journals Sustained impact of real-time continuous glucose monitoring in adults with type 1 diabetes on insulin pump therapy: Results after 24 months RESCUE study

2020 ◽  
Author(s):  
Sara Charleer ◽  
Christophe De Block ◽  
Frank Nobels ◽  
Régis P. Radermecker ◽  
Ine Lowyck ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Acute Hypoglycemia

<b>Objective:</b> In recent years, a growing number of people with type 1 diabetes have access to real-time continuous glucose monitoring (rtCGM). Long-term benefits of rtCGM are unclear due to lack of large studies of long duration. We evaluated whether real-world rtCGM-use up to 24 months offered benefits, in particular to those living with impaired awareness of hypoglycemia (IAH). <p><b>Research Design and Methods:</b> This 24-month, prospective, observational, cohort study followed 441<b> </b>adults with insulin pumps receiving full reimbursement for rtCGM. Forty-two percent had IAH. Primary endpoint was evolution of HbA<sub>1c</sub>, with secondary endpoints change in acute hypoglycemia complications, diabetes-related work absenteeism, and quality of life (QOL) scores. Additionally, we evaluated if people could achieve glycemic consensus targets during follow-up.</p> <p><b>Results:</b> After 24 months, HbA<sub>1c</sub> remained significantly lower compared to baseline (7.64% [60 mmol/mol] vs 7.37% [57 mmol/mol], p<0.0001). Sustained benefits were also observed for the score on the hypoglycemia fear survey and hypoglycemia-related acute complications irrespective of hypoglycemia awareness level. People with IAH had the strongest improvement, especially for severe hypoglycemia (862 events year before vs 119 events per 100 patient-years in second year, p<0.0001). Over 24 months, more people were able to meet hypoglycemia consensus targets at the expense of slightly less people achieving hyperglycemia consensus targets. Furthermore, the number of people with HbA<sub>1c</sub> <7% (<53 mmol/mol) without severe hypoglycemia events more than doubled (11.0% vs 25.4%, p<0.0001).</p> <p><b>Conclusion:</b> Use of rtCGM led to sustained improvements in hypoglycemia-related glucose control over 24 months. Lower fear of hypoglycemia, less acute hypoglycemia-related events and diabetes-related days off work were observed, particularly in those with IAH.</p>

scholarly journals Sustained impact of real-time continuous glucose monitoring in adults with type 1 diabetes on insulin pump therapy: Results after 24 months RESCUE study

2020 ◽  
Author(s):  
Sara Charleer ◽  
Christophe De Block ◽  
Frank Nobels ◽  
Régis P. Radermecker ◽  
Ine Lowyck ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Acute Hypoglycemia

<b>Objective:</b> In recent years, a growing number of people with type 1 diabetes have access to real-time continuous glucose monitoring (rtCGM). Long-term benefits of rtCGM are unclear due to lack of large studies of long duration. We evaluated whether real-world rtCGM-use up to 24 months offered benefits, in particular to those living with impaired awareness of hypoglycemia (IAH). <p><b>Research Design and Methods:</b> This 24-month, prospective, observational, cohort study followed 441<b> </b>adults with insulin pumps receiving full reimbursement for rtCGM. Forty-two percent had IAH. Primary endpoint was evolution of HbA<sub>1c</sub>, with secondary endpoints change in acute hypoglycemia complications, diabetes-related work absenteeism, and quality of life (QOL) scores. Additionally, we evaluated if people could achieve glycemic consensus targets during follow-up.</p> <p><b>Results:</b> After 24 months, HbA<sub>1c</sub> remained significantly lower compared to baseline (7.64% [60 mmol/mol] vs 7.37% [57 mmol/mol], p<0.0001). Sustained benefits were also observed for the score on the hypoglycemia fear survey and hypoglycemia-related acute complications irrespective of hypoglycemia awareness level. People with IAH had the strongest improvement, especially for severe hypoglycemia (862 events year before vs 119 events per 100 patient-years in second year, p<0.0001). Over 24 months, more people were able to meet hypoglycemia consensus targets at the expense of slightly less people achieving hyperglycemia consensus targets. Furthermore, the number of people with HbA<sub>1c</sub> <7% (<53 mmol/mol) without severe hypoglycemia events more than doubled (11.0% vs 25.4%, p<0.0001).</p> <p><b>Conclusion:</b> Use of rtCGM led to sustained improvements in hypoglycemia-related glucose control over 24 months. Lower fear of hypoglycemia, less acute hypoglycemia-related events and diabetes-related days off work were observed, particularly in those with IAH.</p>

The impact of real-time continuous glucose monitoring on metabolic control in children with type 1 diabetes

2020 ◽  
Author(s):  
Ruxandra Calapod Ioana ◽  
Irina Bojoga ◽  
Duta Simona Gabriela ◽  
Ana-Maria Stancu ◽  
Amalia Arhire ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Metabolic Control ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
The Impact
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