Type 1 diabetes

More evidence for CGM but funding remains a barrier


The federal government’s election promise of $54 million for continuous glucose monitoring (CGM) should not be limited to children and adolescents given the growing evidence for CGM in other patient populations, an expert says.

Commenting on new research showing the benefits of CGM in adults with type 1 diabetes and impaired awareness of hypoglycaemia, paediatric endocrinologist Professor Maria Craig said the cost of CGM remained a major barrier to its wider use.

“We are moving towards CGM being a part of routine practice but we’re not quite there due to the cost and the previous lack of evidence,” she said.

Professor Craig, from Westmead Children’s Hospital, said the Dutch study confirmed clinically important and multiple benefits of CGM.

The crossover designed study found patients using CGM had significantly more time with normal blood sugar levels than when self-monitoring (65 v 55.4%).

They also had significantly less time in either hyperglycaemia or hypoglycaemia, across 24 hours or at night, and less within-day variability in glucose concentrations.

“Impaired awareness of hypoglycaemia and the associated risks can be debilitating for patients and reduce their quality of life. It’s also hard to reverse, which is why it’s one of the criteria for islet transplantation,” Professor Craig said.

“Anything we can do to relieve their hypoglycaemia and improve their awareness is of huge benefit.”

She said the findings suggested the federal government’s election promise of $54 million for CGM should perhaps not be limited to children and adolescents.

Severe hypoglycaemic events were fewer but not statistically different when patients were using CGM rather than self-monitoring.

However the duration of hypoglycaemic events was significantly shorter with CGM than with self monitoring (60 v 90 mins).

“Given 19% of patients using CGM had one or more severe hypoglycaemic events compared to 35% when self-monitoring, it’s likely a larger sample size would have confirmed a significant difference,” Professor Craig said.

“Nevertheless this is an evolving field and this is a positive study in terms of the benefits of CGM – more time in the normal range and less variability.”

An accompanying comment article in The Lancet Diabetes & Endocrinology said a longer study period may have provided the necessary time for hypoglycaemia awareness to improve.

However the author concluded the study strengthened the evidence in favour of CGM use in patients with impaired awareness of hypoglycaemia.

 

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