Format

Send to

Choose Destination
JAMA. 2017 Jan 24;317(4):379-387. doi: 10.1001/jama.2016.19976.

Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in Adults With Type 1 Diabetes Treated With Multiple Daily Insulin Injections: The GOLD Randomized Clinical Trial.

Author information

1
Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden2Department of Medicine, NU Hospital Group, Uddevalla, Sweden.
2
University of California, San Diego, La Jolla.
3
University of Washington, School of Medicine, Seattle.
4
Profil, Neuss, Germany.
5
Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
6
Department of Medicine, NU Hospital Group, Uddevalla, Sweden.
7
Department of Internal Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
8
Division of Endocrinology, Department of Clinical Sciences, Skåne University Hospital, Malmö9Lund University, Lund, Sweden.
9
Health Metrics Sahlgrenska Academy at University of Gothenburg, Sweden.
10
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
11
Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden.

Erratum in

Abstract

Importance:

The majority of individuals with type 1 diabetes do not meet recommended glycemic targets.

Objective:

To evaluate the effects of continuous glucose monitoring in adults with type 1 diabetes treated with multiple daily insulin injections.

Design, Setting, and Participants:

Open-label crossover randomized clinical trial conducted in 15 diabetes outpatient clinics in Sweden between February 24, 2014, and June 1, 2016 that included 161 individuals with type 1 diabetes and hemoglobin A1c (HbA1c) of at least 7.5% (58 mmol/mol) treated with multiple daily insulin injections.

Interventions:

Participants were randomized to receive treatment using a continuous glucose monitoring system or conventional treatment for 26 weeks, separated by a washout period of 17 weeks.

Main Outcomes and Measures:

Difference in HbA1c between weeks 26 and 69 for the 2 treatments. Adverse events including severe hypoglycemia were also studied.

Results:

Among 161 randomized participants, mean age was 43.7 years, 45.3% were women, and mean HbA1c was 8.6% (70 mmol/mol). A total of 142 participants had follow-up data in both treatment periods. Mean HbA1c was 7.92% (63 mmol/mol) during continuous glucose monitoring use and 8.35% (68 mmol/mol) during conventional treatment (mean difference, -0.43% [95% CI, -0.57% to -0.29%] or -4.7 [-6.3 to -3.1 mmol/mol]; P < .001). Of 19 secondary end points comprising psychosocial and various glycemic measures, 6 met the hierarchical testing criteria of statistical significance, favoring continuous glucose monitoring compared with conventional treatment. Five patients in the conventional treatment group and 1 patient in the continuous glucose monitoring group had severe hypoglycemia. During washout when patients used conventional therapy, 7 patients had severe hypoglycemia.

Conclusions and Relevance:

Among patients with inadequately controlled type 1 diabetes treated with multiple daily insulin injections, the use of continuous glucose monitoring compared with conventional treatment for 26 weeks resulted in lower HbA1c. Further research is needed to assess clinical outcomes and longer-term adverse effects.

Trial Registration:

clinicaltrials.gov Identifier: NCT02092051.

PMID:
28118454
DOI:
10.1001/jama.2016.19976
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center