The effect of continuous glucose monitoring in well-controlled type 1 diabetes

TitleThe effect of continuous glucose monitoring in well-controlled type 1 diabetes
Publication TypeJournal Article
Year of Publication2009
AuthorsBeck, R. W., Hirsch I. B., Laffel L., Tamborlane W. V., Bode B. W., Buckingham B., Chase P., Clemons R., Fiallo-Scharer R., Fox L. A., Gilliam L. K., Huang E. S., Kollman C., Kowalski A. J., Lawrence J. M., Lee J., Mauras N., O'Grady M., Ruedy K. J., Tansey M., Tsalikian E., Weinzimer S. A., Wilson D. M., Wolpert H., Wysocki T., & Xing D.
Corporate AuthorsJuvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
JournalDiabetes Care
Volume32
Issue8
Pagination1378-83
Date Published2009 Aug
ISSN1935-5548
KeywordsAdolescent; Adult; Aged; Blood Glucose; Child; Diabetes Mellitus, Type 1; Humans; Hypoglycemia; Hypoglycemic Agents; Insulin; Middle Aged; Monitoring, Ambulatory; Young Adult
Abstract

OBJECTIVE The potential benefits of continuous glucose monitoring (CGM) in the management of adults and children with well-controlled type 1 diabetes have not been examined. RESEARCH DESIGN AND METHODS A total of 129 adults and children with intensively treated type 1 diabetes (age range 8-69 years) and A1C <7.0% were randomly assigned to either continuous or standard glucose monitoring for 26 weeks. The main study outcomes were time with glucose level < or =70 mg/dl, A1C level, and severe hypoglycemic events. RESULTS At 26 weeks, biochemical hypoglycemia (< or =70 mg/dl) was less frequent in the CGM group than in the control group (median 54 vs. 91 min/day), but the difference was not statistically significant (P = 0.16). Median time with a glucose level < or =60 mg/dl was 18 versus 35 min/day, respectively (P = 0.05). Time out of range (< or =70 or >180 mg/dl) was significantly lower in the CGM group than in the control group (377 vs. 491 min/day, P = 0.003). There was a significant treatment group difference favoring the CGM group in mean A1C at 26 weeks adjusted for baseline (P < 0.001). One or more severe hypoglycemic events occurred in 10 and 11% of the two groups, respectively (P = 1.0). Four outcome measures combining A1C and hypoglycemia data favored the CGM group in comparison with the control group (P < 0.001, 0.007, 0.005, and 0.003). CONCLUSIONS Most outcomes, including those combining A1C and hypoglycemia, favored the CGM group. The weight of evidence suggests that CGM is beneficial for individuals with type 1 diabetes who have already achieved excellent control with A1C <7.0%.

DOI10.2337/dc09-0108
Alternate JournalDiabetes Care
Refereed DesignationRefereed