Responses to Continuous Glucose Monitoring in Subjects with Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion or Multiple Daily Injections

Abstract

We compared changes in response to unmasking of continuous glucose monitoring (CGM) in subjects with type 1 diabetes who use multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Use of real-time CGM (DexCom [San Diego, CA] SEVEN was studied in 38 subjects using CSII and 26 using MDI. CGM output was masked during Week 1 and unmasked during Weeks 2 and 3. We evaluated changes in 16 criteria for quality of glycemic control and eight criteria for glycemic variability. All 24 criteria showed highly statistically significant improvement when considered simultaneously (P < 0.000001). For subjects using CSII, 18 of 24 criteria improved significantly (nominal P < 0.05); for subjects using MDI, 16 of 24 criteria improved significantly (P < 0.05). Twelve of the comparisons remained significant (P < 0.05) after applying the overconservative Bonferroni correction for multiple comparisons. The percentage of glucose values within the range 80-140 mg/dL increased by 19% and 17% relative to their control values (Week 1) for subjects using MDI and CSII, respectively. Mean glucose, overall SD (SD(T)), SD between daily means (SD(dm)), mean amplitude of glycemic excursion (MAGE), and mean of daily differences (MODD) improved significantly. Responses to CGM display were not significantly different between the MDI and CSII subject groups for any of the 24 criteria considered individually or in groups of eight, 16, or 24. CGM has similar effectiveness in subjects with type 1 diabetes using either CSII or MDI.