Continuous Glucose Monitoring Positive for Type 2 Diabetes Patients

AUGUST 24, 2017
Matt Hoffman
Continuous glucose monitoring (CGM) could benefit some, but not all, adults who utilize multiple daily insulin inoculations for type 2 diabetes (T2D).

According to recent research, although very few insulin-treated adults use CGM, those who employ CGM on a daily or near-daily basis for a 24-week period saw improved glycemic control. These findings support the benefit of an additional method of management for T2D.

Led by Roy Beck (pictured), MD, PhD, executive director of the Jaeb Center for Health Research in Tampa, Florida, the randomized trial studied 158 adults (average age of 60 years; SD, 10) with T2D for a median of 17 years.

All 158 subjects were receiving daily insulin injections and had hemoglobin A1C (HbA1C) levels of 7.5% to 9.9% (mean 8.5%), and were assigned either CGM (n=79) or their standard care (n=79). The primary outcome was HbA1C reduction at the 24-week mark.

The study authors highlighted a need to examine CGM further for T2D patients, writing that “[c]ontinuous 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.”

At the 24-week point, the mean HbA1C levels for the CGM arm decreased to 7.7%, while the control arm registered 8.0% (-0.3% adjusted difference in mean change [95% CI, -0.5% to 0.0%]). Between the 2 groups, the quality-of-life outcomes and hyperglycemia measurements did not differ significantly, the authors noted.

CGM was used for an average of 6.7 days (SD, 0.9) by the 79 CGM patients.

In an editorial that accompanied the study, Vanessa Arguello, MD, and Matthew Freeby, MD, from the David Geffen School of Medicine at the University of California, wrote that Beck’s study showed that CGM improved diabetes control compared with meter testing, though moderately.

Arguello and Freeby wrote that real-time CGM candidates should be carefully chosen by clinicians, keeping in mind those “who may achieve maximum clinical utility, such as those who have [type 1 diabetes], high risk for hypoglycemia, and high medical literacy; those who adhere to medical device instructions; and now patients with [type 2 diabetes] receiving multiple daily injections of insulin.”

They did note that the invasive nature of CGM devices and the requirement for daily calibration of blood glucose meter readings could be restrictive in allowing wider use of CGM.

According to Beck and colleagues, the HbA1C reduction for the CGM arm was “a meaningful improvement on a patient level, particularly because it was achieved without a pharmacologic change.”

The secondary outcomes for the study, which included the proportion of patients with HbA1C <7.0% or 7.5% or a reduction of at least 10%, were not statistically significant, but they did favor the CGM arm.

Beck and the authors concluded that future CGM randomized trials should include the impact on T2D health care outcomes and the financial impact on the health care system.

The study, "Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial," was published in the Annals of Internal Medicine and online, as well as the editorial.

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