Type 1 diabetes

CGM proving its worth in high-risk T1D groups

More evidence has emerged of the benefits of CGM use in the high-risk populations of adolescent and young adults (AYA) and older adults with type 1 diabetes.

A US study, published in JAMA, randomised 153 young people 14-24 years with sub-optimal glycaemic control (HbA1c 7.5-10.9%, 58-96 mmol/mol) to either CGM or to remaining on standard blood glucose monitoring (BGM).

Over six-months from baseline, HbA1c in the CGM users had dropped from 8.9 to 8.5% (74-69 mmol/mol) while remained the same (74 mmol/mol) in BGM users.

There was also an improvement in time-in-target glucose range with CGM use from 37% to 43%, which was not seen with BGM (36% to 35%).

CGM use was initially high in the new users (82%) but dropped to 68% by the end of the study period; however satisfaction with glucose monitoring was higher with CGM than BGM.

The study authors said the small but significant improvement in glycaemic control with CGM supported the need for expanded reimbursement for the technology.

Another US study of 203 people over 60 years with type 1 diabetes compared rates of hypoglycaemia over six months in patients randomised to CGM or remaining on standard BGM.

The study found the time spent in hypoglycaemia (<70 mg/dL [3.9mmol/L]) in patients using CGM dropped from 5.1% at baseline to 2.7% but increased marginally from 4.7% to 4.9% in patients using BGM.

The small but significant benefit of CGM in reducing time in hypoglycaemia was observed during day and night and was present for both insulin pump and injection users.

The results were consistent across the age range of 60-86 years, baseline HbA1c range of 5.6%-10.8% [38-40 mmol/mol], the presence or absence of cognitive impairment and education levels.

However there was a greater reduction in hypoglycaemia associated with CGM use in the patients most at risk for severe hypoglycaemia due to their higher baseline hypoglycemia and glycemic variability.

Despite that, patients in the CGM group had similar levels of fear about hypoglycemia and diabetes distress as the BGM group.

“One possible explanation is that the baseline scores on these measures were quite low, indicating already good adjustment to managing diabetes,” the study authors said.

An accompanying editorial in JAMA said both trials demonstrate the benefit of CGM to populations at high risk of complications.

“Together, the data support CGM as an important component of care in individuals with type 1 diabetes.”

“With CGM innovation happening at a rapid pace and the imminent commercial release of artificial pancreas systems, CGM offers a new outlook for patients with type 1 diabetes and for the clinicians and communities caring for them. More effort is needed to overcome current barriers and provide better access to this beneficial technology,” it concluded.

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