Abstract
Aim: Assess the impact of switching from intermittently scanned (FreeStyle Libre [FSL]) to real-time (Dexcom G4 platinum [DG4]) continuous glucose monitoring systems on glycemia control in type 1 diabetes (T1D) patients with high risk of hypoglycemia and/or elevated glycated hemoglobin (HbA1c).Methods: We conducted an observational study in 18 T1D adults with poor glycemic control on FSL. Ambulatory glucose profile data were collected during the last 3 months of FSL use before inclusion (M0 period), during the first 3 months (M3 period) and the last 3 months (M6 period) of DG4 use. Data were then expressed as 24-h averages. Biological HbA1c was measured for all three periods. Patients were their own-controls and statistics were performed using paired t-test or Wilcoxon for matched-pairs.Results: The switch to DG4 at M3 resulted in a higher time-in-range (TIR) 70–180 mg/dL (median [Q1;Q3], 53.1 [44.5;67.3] vs. 41.5 [28.5;62.0], P = 0.0008), and a lower time-below-range <70 mg/dL (TBR mean ± standard deviation (SD), 5.4 ± 3.7 vs. 10.9 ± 7.1, P = 0.0009) and in the glucose % coefficient of variation (%CV mean ± SD, 40.1 vs. 46.9, P = 0.0001). Mean (SD) changes were +10.3 (8.0) percentage points for TIR, −5.5 (5.8) percentage points for TBR, and −6.8 (5.8) percentage points for %CV. These results were confirmed at the M6 period.Conclusions: Switching from FSL to DG4 appears to provide a beneficial therapeutic option without changing insulin delivery systems, regardless of the origin of the patient's initial glycemic issue.
Highlights
The main management goal for type 1 diabetes (T1D) is glycemic control.[1]
This is routinely assessed by the measurement of capillary blood glucose by self-monitoring (SMBG) practice providing a single ‘‘point-in-time’’ value, and of glycated hemoglobin (HbA1c), a reliable biomarker of chronic hyperglycemia events over the last 2–3 months, which is positively correlated with the risk of vascular complications.[2,3]. These measurements are limitative as not indicative of the intra- and interdaily glycemic excursions that lead to acute hypoglycemia and postprandial hyperglycemia of different amplitudes and durations, both linked to microvascular and macrovascular complications.[4,5]. This limitation can be resolved by using continuous glucose monitoring (CGM) systems, which enable a dynamic follow-up of interstitial glucose
To improve glycemic control in these patients who are already treated by continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDI) without changing the insulin delivery systems, one alternative in our department is proposing a switch from isCGM (FreeStyle Libre [FSL]; Abbott Diabetes Care, Inc., Alameda, CA) to the rtCGM Dexcom G4 platinum (DG4; Dexcom, San Diego, CA), a device approved for reimbursement by the French health insurance system since June 2018
Summary
The main management goal for type 1 diabetes (T1D) is glycemic control.[1]. This is routinely assessed by the measurement of capillary blood glucose by self-monitoring (SMBG) practice providing a single ‘‘point-in-time’’ value, and of glycated hemoglobin (HbA1c), a reliable biomarker of chronic hyperglycemia events over the last 2–3 months, which is positively correlated with the risk of vascular complications.[2,3] these measurements are limitative as not indicative of the intra- and interdaily glycemic excursions that lead to acute hypoglycemia and postprandial hyperglycemia of different amplitudes and durations, both linked to microvascular and macrovascular complications.[4,5] This limitation can be resolved by using continuous glucose monitoring (CGM) systems, which enable a dynamic follow-up of interstitial glucose.
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