Nav: Home

Can continuous glucose monitoring improve diabetes control in patients with type 1 diabetes who inject insulin

January 24, 2017

Two studies in the January 24/31 issue of JAMA find that use of a sensor implanted under the skin that continuously monitors glucose levels resulted in improved levels in patients with type 1 diabetes who inject insulin multiple times a day, compared to conventional treatment.

In one study, Roy W. Beck, M.D., Ph.D., of the Jaeb Center for Health Research, Tampa, Fla., and colleagues randomly assigned 158 adults with type 1 diabetes who were using multiple daily insulin injections and had elevated hemoglobin A1c (HbA1c) levels of 7.5 percent to 9.9 percent to continuous glucose monitoring (n = 105) or usual care (control group; n = 53).

Only approximately 30 percent of individuals with type 1 diabetes meet the American Diabetes Association goal of HbA1c level of 7.5 percent for children and 7.0 percent for adults, indicating the need for better approaches to diabetes management. Continuous glucose monitoring (CGM) with glucose measurements as often as every five minutes, plus low and high glucose level alerts and glucose trend information, has the capability of better informing diabetes management decisions than blood glucose meter testing performed several times a day. Only a small proportion of individuals with type 1 diabetes who inject insulin use CGM. Continuous glucose monitoring systems include a sensor underneath the skin with a transmitter attached and continuous reporting of glucose levels and trends to the patient by a handheld monitor.

In this study in the CGM group, 93 percent used CGM six days/week or more in month six. Average HbA1c reduction from baseline was 1.1 percent at 12 weeks and 1.0 percent at 24 weeks in the CGM group and 0.5 percent and 0.4 percent, respectively, in the control group. Median duration of hypoglycemia was 43 minutes/day in the CGM group vs 80 minutes/day in the control group. Severe hypoglycemia events occurred in 2 participants in each group.

"Among adults with type l diabetes who used multiple daily insulin injections, the use of CGM compared with usual care resulted in a greater decrease in HbA1c level during 24 weeks. Further research is needed to assess longer-term effectiveness, as well as clinical outcomes and adverse effects," the authors write.

(doi:10.1001/jama.2016.19975; the study is available pre-embargo at the For the Media website)

Editor's Note: Dexcom Inc. provided funding for the trial to each investigator's institution. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

In another study, Marcus Lind, M.D., Ph.D., of the University of Gothenburg, Sweden, and colleagues randomly assigned 161 individuals with type 1 diabetes and HbA1c of at least 7.5 percent treated with multiple daily insulin injections to receive treatment using a CGM system or conventional treatment for 26 weeks, separated by a washout period of 17 weeks. The goal of the study was to analyze the effect of CGM on glycemic control, hypoglycemia, well-being, and glycemic variability. The researchers found that average HbA1c was 7.92 percent during CGM use and 8.35 percent during conventional treatment. Of 19 other outcomes comprising psychosocial and various glycemic measures, six met statistical significance, favoring CGM compared with conventional treatment. Five patients in the conventional treatment group and one patient in the CGM group had severe hypoglycemia.

"In this crossover study of persons with type 1 diabetes treated with multiple daily insulin injections, CGM was associated with a mean HbA1c level that was 0.43 percent less than conventional treatment. Moreover, glycemic variability was reduced by CGM. Subjective well-being and treatment satisfaction were greater during CGM than conventional therapy," the authors write. "Further research is needed to assess clinical outcomes and longer-term adverse effects."
-end-
(doi:10.1001/jama.2016.19976; the study is available pre-embargo at the For the Media website)

Editor's Note: The trial was sponsored by the NU Hospital Group, Trollhattan and Uddevalla, Sweden. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

Related material: The editorial, "Continuous Glucose Monitoring in Patients With Type 1 Diabetes Taking Insulin Injections, by Mayer B. Davidson, M.D., of the Charles R. Drew University of Medicine and Science, Los Angeles, also is available at the For The Media website.

To place an electronic embedded link to these studies in your story These links will be live at the embargo time. This is the link to the 1st study: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.19975 This is the link to the 2nd study: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.19976

The JAMA Network Journals

Related Diabetes Articles:

The role of vitamin A in diabetes
There has been no known link between diabetes and vitamin A -- until now.
Can continuous glucose monitoring improve diabetes control in patients with type 1 diabetes who inject insulin
Two studies in the Jan. 24/31 issue of JAMA find that use of a sensor implanted under the skin that continuously monitors glucose levels resulted in improved levels in patients with type 1 diabetes who inject insulin multiple times a day, compared to conventional treatment.
Complications of type 2 diabetes affect quality of life, care can lead to diabetes burnout
T2D Lifestyle, a national survey by Health Union of more than 400 individuals experiencing type 2 diabetes (T2D), reveals that patients not only struggle with commonly understood complications, but also numerous lesser known ones that people do not associate with diabetes.
Type 2 diabetes and obesity -- what do we really know?
Social and economic factors have led to a dramatic rise in type 2 diabetes and obesity around the world.
A better way to predict diabetes
An international team of researchers has discovered a simple, accurate new way to predict which women with gestational diabetes will develop type 2 diabetes after delivery.
The Lancet Diabetes & Endocrinology: Older Americans with diabetes living longer without disability, US study shows
Older Americans with diabetes born in the 1940s are living longer and with less disability performing day to day tasks than those born 10 years earlier, according to new research published in The Lancet Diabetes & Endocrinology journal.
Reverse your diabetes -- and you can stay diabetes-free long-term
A new study from Newcastle University, UK, has shown that people who reverse their diabetes and then keep their weight down remain free of diabetes.
New cause of diabetes
Although insulin-producing cells are found in the endocrine tissue of the pancreas, a new mouse study suggests that abnormalities in the exocrine tissue could cause cell non-autonomous effects that promotes diabetes-like symptoms.
The Lancet Diabetes & Endocrinology: Reducing sugar content in sugar-sweetened drinks by 40 percent over 5 years could prevent 1.5 million cases of overweight and obesity in the UK and 300,000 cases of diabetes
A new study published in The Lancet Diabetes & Endocrinology journal suggests that reducing sugar content in sugar sweetened drinks (including fruit juices) in the UK by 40 percent over five years, without replacing them with any artificial sweeteners, could prevent 500,000 cases of overweight and 1 million cases of obesity, in turn preventing around 300,000 cases of type 2 diabetes, over two decades.
Breastfeeding lowers risk of type 2 diabetes following gestational diabetes
Women with gestational diabetes who consistently and continuously breastfeed from the time of giving birth are half as likely to develop type 2 diabetes within two years after delivery, according to a study from Kaiser Permanente published today in Annals of Internal Medicine.

Related Diabetes Reading:

The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally
by Jason Fung (Author), Nina Teicholz (Foreword)

The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes
by Joel Fuhrman M.D. (Author)

The Complete Diabetes Cookbook: The Healthy Way to Eat the Foods You Love
by America's Test Kitchen (Editor), Dariush Mozaffarian M.D. (Editor)

Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars
by Richard K. Bernstein (Author)

Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me
by Adam Brown (Author), Kelly L. Close (Foreword)

Mayo Clinic The Essential Diabetes Book
by Mayo Clinic (Author)

Dr. Neal Barnard's Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes Without Drugs
by Neal Barnard (Author)

Diabetes For Dummies
by Alan L. Rubin (Author)

Diabetic Living Diabetes Meals by the Plate: 90 Low-Carb Meals to Mix & Match
by Diabetic Living Editors (Author)

American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Reference from the Diabetes Experts
by American Diabetes Association (Author)

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Circular
We're told if the economy is growing, and if we keep producing, that's a good thing. But at what cost? This hour, TED speakers explore circular systems that regenerate and re-use what we already have. Guests include economist Kate Raworth, environmental activist Tristram Stuart, landscape architect Kate Orff, entrepreneur David Katz, and graphic designer Jessi Arrington.
Now Playing: Science for the People

#504 The Art of Logic
How can mathematics help us have better arguments? This week we spend the hour with "The Art of Logic in an Illogical World" author, mathematician Eugenia Cheng, as she makes her case that the logic of mathematics can combine with emotional resonance to allow us to have better debates and arguments. Along the way we learn a lot about rigorous logic using arguments you're probably having every day, while also learning a lot about our own underlying beliefs and assumptions.