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Ann Intern Med. 2017 Sep 19;167(6):365-374. doi: 10.7326/M16-2855. Epub 2017 Aug 22.

Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial.

Author information

1
From Jaeb Center for Health Research, Tampa, Florida; Oregon Health & Science University, Portland, Oregon; Diabetes & Glandular Disease Clinic, San Antonio, Texas; Henry Ford Medical Center, Detroit, Michigan; Washington University in St. Louis, St. Louis, Missouri; Behavioral Diabetes Institute and Dexcom, San Diego, California; Research Institute of Dallas, Dallas, Texas; LMC Diabetes & Endocrinology, Toronto, Ontario, Canada; Joslin Diabetes Center, Boston, Massachusetts; and Park Nicollet International Diabetes Center, St. Louis Park, Minnesota.

Abstract

Background:

Continuous glucose monitoring (CGM), which studies have shown is beneficial for adults with type 1 diabetes, has not been well-evaluated in those with type 2 diabetes receiving insulin.

Objective:

To determine the effectiveness of CGM in adults with type 2 diabetes receiving multiple daily injections of insulin.

Design:

Randomized clinical trial. (The protocol also included a type 1 diabetes cohort in a parallel trial and subsequent second trial.) (ClinicalTrials.gov: NCT02282397).

Setting:

25 endocrinology practices in North America.

Patients:

158 adults who had had type 2 diabetes for a median of 17 years (interquartile range, 11 to 23 years). Participants were aged 35 to 79 years (mean, 60 years [SD, 10]), were receiving multiple daily injections of insulin, and had hemoglobin A1c (HbA1c) levels of 7.5% to 9.9% (mean, 8.5%).

Intervention:

Random assignment to CGM (n = 79) or usual care (control group, n = 79).

Measurements:

The primary outcome was HbA1c reduction at 24 weeks.

Results:

Mean HbA1c levels decreased to 7.7% in the CGM group and 8.0% in the control group at 24 weeks (adjusted difference in mean change, -0.3% [95% CI, -0.5% to 0.0%]; P = 0.022). The groups did not differ meaningfully in CGM-measured hypoglycemia or quality-of-life outcomes. The CGM group averaged 6.7 days (SD, 0.9) of CGM use per week.

Limitation:

6-month follow-up.

Conclusion:

A high percentage of adults who received multiple daily insulin injections for type 2 diabetes used CGM on a daily or near-daily basis for 24 weeks and had improved glycemic control. Because few insulin-treated patients with type 2 diabetes currently use CGM, these results support an additional management method that may benefit these patients.

Primary Funding Source:

Dexcom.

PMID:
28828487
DOI:
10.7326/M16-2855
[Indexed for MEDLINE]

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