Bruce Soloway, MD reviewing Heinemann L et al. Lancet 2018 Feb 16.
rtCGM might be a valid less-expensive alternative to insulin pumps for type 1 diabetics.
Hypoglycemia, a barrier to glycemic control in patients with type 1 diabetes, is more likely to occur in patients with impaired hypoglycemia awareness or past severe hypoglycemia. Real-time continuous glucose monitoring (rtCGM) helps prevent hypoglycemia in patients with excess hypoglycemic risk; however, until now, this effect has not been studied in patients who use multiple daily insulin injections (MDI) rather than more-expensive, continuous subcutaneous insulin infusion pumps.
German researchers randomized 149 MDI-treated patients with type 1 diabetes (glycosylated hemoglobin level, ≤9.0%) and risk factors for hypoglycemia. First, all patients wore masked rtCGM devices for 4 weeks to assess baseline glycemic control. Next, patients were randomized to use rtCGM or continued fingerstick self-monitoring to make insulin adjustments for the next 22 weeks. Then, during a final 4-week follow-up period, rtCGM patients continued to use their devices to make treatment decisions, whereas fingerstick patients again wore masked rtCGM devices (but only to collect data).
Between baseline and follow-up periods, mean hypoglycemic episodes per 28 days declined from 10.8 to 3.5 in rtCGM patients but were essentially unchanged (14.4 vs. 13.7) in fingerstick patients. Mean HbA1c values were unchanged in both groups.
The lower incidence of hypoglycemia seen in this study with rtCGM and MDI was similar to that seen in other studies using rtCGM and insulin infusion pumps, which suggests that rtCGM plus MDI provides an equally effective and less costly alternative. The authors suggest that future studies should be designed to compare these two strategies directly.
Heinemann L et al. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): A multicentre, randomised controlled trial. Lancet 2018 Feb 16; [e-pub]. (https://doi.org/10.1016/S0140-6736(18)30297-6)
Bergenstal RM. Continuous glucose monitoring: Transforming diabetes management step by step. Lancet 2018 Feb 16; [e-pub]. (https://doi.org/10.1016/S0140-6736(18)30290-3)