Effect Of Continuous Glucose Monitoring Research Articles

Continuous glucose monitoring: A cost-effective tool to reduce pre-term birth rates in women with type one diabetes.

Women with type one diabetes experience poorer obstetric outcomes than normoglycaemic women in pregnancy. To investigate the cost and clinical effectiveness of continuous glucose monitoring (GCM) compared to self-monitoring of blood glucose in improving obstetric outcomes in women with type one diabetes during pregnancy. This retrospective cohort study included women with type one diabetes referred to a state-wide tertiary obstetric centre before and after the introduction of government-funded CGMs in Australia in March 2019. Forty-nine women using CGMs were propensity matched on a range of clinical features with a historical group of 49 women with type one diabetes who exclusively used intermittent self-monitoring of blood in the year prior to the introduction of funding of sensors. Medical records and administrative cost data were audited to quantify cost and clinical effectiveness. There were significantly lower pre-term (95% CI 0.39-0.922; P=0.026) and very pre-term birth rates (95% CI 1.002-1.184; P=0.041) in the CGM group. There was a significant reduction in the length of antenatal inpatient hospital stay (P < 0.01) and adult special care unit stay (P=0.013) and neonatal admission to the neonatal intensive care unit (P=0.0262) in the continuous glucose monitoring group. CGMs represented a net cost saving to the health care sector of $12 063 per pregnancy where the device was used, with an incremental cost-effectiveness ratio of $3275 per prevented pre-term birth. CGM use in pregnancy is a cost-effective intervention for reducing the risk of pre-term birth in women with type one diabetes, resulting in a net cost benefit to the health sector.

Does Continuous Glucose Monitoring Help in Pregnant Women?

Background: Diabetes is present in approximately 7% of all pregnancies. Maternal glucose control is a crucial issue. Evidence had demonstrated that optimal glycemic control during the first trimester could reduce congenital anomalies and perinatal mortality; likewise, during second and third trimester, it is also associated with reduced rates of pre-eclampsia, preterm delivery, large for gestational age and neonatal intensive care unit admissions. The aim of this review is to evaluate the current evidences about the glycemic control effects of continuous glucose monitoring (CGM) in pregnant women. Methods: We searched the PubMed database from January 1, 2011 to July 20, 2021, for English-language studies related to CGM uses in pregnancy. We mainly focused on randomized clinical trials (RCTs) and secondary analyses of RCT data. Results: After filtering, 14 researches were adopted by this study. We analyzed the results and sorted them into 4 main aspects, including difference between the outcomes of CGM users verses self-monitored blood glucose (SMBG) users, comparison of different modes of CGM, satisfaction of CGM, and using CGM to monitor glycemic levels in pregnant women under antenatal corticosteroids or ritodrine treatment. Conclusions: There is adequate evidence showing that CGM is effective at monitoring glycemic levels, improving maternal glycemia control as well as aiding with the insulin treatment, with more precise insulin dose.

Association between hypoglycaemic glucose variability and autonomic function in type1 diabetes with impaired hypoglycaemia awareness

Cardiovascular autonomic neuropathy (CAN) is suggested to underlie hypoglycaemic risk in impaired awareness of hypoglycaemia (IAH). We assessed the prevalence of CAN and the association between glucose variability (GV) and cardiovascular autonomic function in patients with type 1 diabetes (T1DM) and IAH.This study is a post-hoc-analysis of results obtained with the IN-CONTROL-trial, designed to assess the effects of continuous glucose monitoring (CGM) on glycaemia. Forty participants (aged 46.4 ± 11.4 years, diabetes duration 29.1 ± 13.5 years, HbA1c 7.5 ± 0.8%(58.2 ± 8.8 mmol/mol)) underwent 2-week blinded CGM measurements to obtain GV indices. Standardized cardiovascular reflex tests were used to determine the presence of CAN. Cardiovascular autonomic function was assessed with heart rate variability (HRV) measures.14(35%) participants were classified as having CAN. Participants with CAN had lower percentage time spent in hypoglycaemic range and low blood glucose index(LBGI). After correction for confounders, a significant positive association was found between the coefficient of variation (CV) or time spent in hypoglycaemic range and HRV measures SDRR or RMSSD, and between LBGI and RMSSD.In patients with T1DM and IAH, hypoglycaemic parameters were associated with better cardiovascular autonomic function and lower prevalence of CAN. This suggests that autonomic neuropathy does not seem to further deteriorate hypoglycaemic risk in patients with IAH.

Continuous glucose monitoring to assess glucose variability in type 3c diabetes.

AimThe effectiveness of continuous glucose monitoring (CGM) in maintaining glycaemic control in type 1 diabetes mellitus and type 2 diabetes mellitus has been well demonstrated. However, the degree of glycaemic variability (GV) in people with type 3c diabetes mellitus has not been fully explored using CGM. This study aims to evaluate GV in type 3c diabetes mellitus participants and compare it to type 1 diabetes mellitus and type 2 diabetes mellitus.MethodsParticipants were grouped according to type of diabetes. GV, defined as percentage coefficient of variation (%CV), and other glycaemic indices were obtained using CGM (FreeStyle Libre, Abbott, Australia) from 82 participants across all three cohorts over a 14‐day period. Comparison of baseline characteristics and GV were performed across all groups. Correlation of GV with C‐peptide values, and whether pancreatic supplementation had an effect on GV were also assessed in the type 3c diabetes mellitus cohort.ResultsGV of type 3c diabetes mellitus participants was within the recommended target of less than %CV 36% (p = 0.004). Type 3c diabetes mellitus participants had the lowest GV among the three groups (p = 0.001). There was a trend for lower C‐peptide levels to be associated with higher GV in type 3c diabetes mellitus participants (p = 0.22). Pancreatic enzyme supplementation in type 3c diabetes mellitus participants did not have an effect on GV (p = 0.664).ConclusionsAlthough type 3c diabetes mellitus participants were the least variable, they had the highest mean glucose levels and estimated HbA1c, which suggests that the concept of ‘brittle’ diabetes in type 3c diabetes mellitus is not supported by the results of CGM in this study and may be leading to poorer glycaemic control.

Acceptance and Effect of Continuous Glucose Monitoring on Discharge From Hospital in Patients With Type 2 Diabetes: Open-label, Prospective, Controlled Study.

BackgroundContinuous glucose monitors (CGM) can provide detailed information on glucose excursions. There is little information on safe transitioning from hospital back to the community for patients who have had diabetes therapies adjusted in hospital and it is unclear whether newer technologies may facilitate this process.ObjectiveOur aim was to determine whether offering CGM on discharge would be acceptable and if CGM initiated on hospital discharge in people with type 2 diabetes (T2DM) would reduce hospital re-presentations at 1 month.MethodsThis was an open-label study. Adult inpatients with T2DM, who were to be discharged home and required postdischarge glycemic stabilization, were offered usual care consisting of clinic review at 2 weeks and at 3 months. In addition to usual care, participants in the intervention arm were provided with a Libre flash glucose monitoring system (Abbott Australia). An initial run-in phase for the first 20 participants was planned, where all consenting participants were enrolled in an active arm. Subsequently, all participants were to be randomized to the active arm or usual care control group.ResultsOf 237 patients screened during their hospital admission, 34 had comorbidities affecting cognition that prevented informed consent and affected their ability to learn to use the CGM device. In addition, 21 were not able to be approached as the material was only in English. Of 101 potential participants who fulfilled eligibility criteria, 19 provided consent and were enrolled. Of the 82 patients who declined to participate, 31 advised that the learning of a new task toward discharge was overwhelming or too stressful and 26 were not interested, with no other details. Due to poor recruitment, the study was terminated without entering the randomization phase to determine whether CGM could reduce readmission rate.ConclusionsThese results suggest successful and equitable implementation of telemedicine programs requires that any human factors such as language, cognition, and possible disengagement be addressed. Recovery from acute illness may not be the ideal time for introduction of newer technologies or may require more novel implementation frameworks.

Running with Type 1 Diabetes: A Case Report on the Benefit of Sensor Technology

Technological advances in the management and treatment of type 1 diabetes have afforded some patients the resources to better manage their condition and live full, healthy lives. One of these technologies is continuous glucose monitoring which allows patients and medical practitioners alike to receive real-time blood glucose readings, evaluate trends, and tailor insulin dosing to avoid both hyper- and hypoglycemic events. The benefit of such technology during exercise, particularly running or cycling, is invaluable. In this case report, we describe the effect of using a continuous glucose monitoring technology in a 38-year-old, brittle, type 1 diabetic female runner over two years. The combined effect of continuous glucose monitoring and exercise, primarily running, resulted in an almost two-fold reduction in HbA1C, a 21% reduction in total daily insulin usage from diagnosis approximately 20 years ago. The patient recorded an over 100% improvement in running capacity.

Measuring the Impact of Flash Glucose Monitoring in a Pediatric Population in Saudi Arabia: A Retrospective Cohort Study.

IntroductionMeasurement of glucose levels is the mainstay method of ensuring good glycemic control and preventing complications associated with uncontrolled diabetes. Continuous glucose monitoring enables easy and effective monitoring of interstitial glucose around the clock and hence improves glycemic control.ObjectivesThis study aimed to measure the effect of continuous glucose monitoring on glycated hemoglobin (HbA1c) at 3, 6, and 9 months following sensor insertion.MethodsA retrospective cohort study of pediatric and adolescent type 1 diabetes mellitus patients randomly sampled from 32 Ministry of Health diabetes centers across Saudi Arabia was performed. Patients were subjected to flash glucose monitoring using the FreeStyle® Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, UK), an intermittently scanned continuous glucose monitoring device approved by the Conformité Européenne in 2014. These patients were first-time users of any kind of continuous glucose monitoring system, aged 4–18 years, and received insulin via multiple dose injection or continuous subcutaneous insulin infusion for at least 6 months prior to study start. Patients were excluded if they had used flash glucose monitoring or other interstitial glucose monitoring systems in the past 3 months, were pregnant, or had existing hemoglobinopathies. The flash glucose monitoring sensor was attached to the back of the upper arm at the baseline visit. HbA1c (%) was measured at baseline and 3, 6, and 9 months. Patient demographics were collected from electronic health records.Results1,307 patients were included, with a mean age of 11.1 years (standard deviation 3.6 years). Where specified, 51.4% were female. Mean HbA1c significantly reduced from baseline (10.8%) to 3 months (9.8%, p < 0.001), 6 months (9.2%, p < 0.001), and 9 months (9.1%, p < 0.001). For individuals with baseline HbA1c > 9%, mean HbA1c was significantly reduced from baseline (11.7%) to 3 months (10.3%, p < 0.001), 6 months (9.6%, p < 0.001), and 9 months (9.5%, p < 0.001).ConclusionsFlash glucose monitoring significantly reduced HbA1c levels at 3, 6, and 9 months following sensor insertion. This reduction was greatest in those patients with higher HbA1c at baseline (> 9%).

IDF21-0487 Effects of continuous glucose monitoring versus self-monitoring of blood glucose among adults with type 2 diabetes

Background: Type 2 diabetes is a common global health problem and leads to severe damage and complications to the heart, kidneys, nerves, blood vessels, and eyes over time. The use of continuous glucose monitoring (CGM) in the management of type 2 diabetes has shown its effectiveness in reducing blood glucose levels and the time spent in hypoglycemia.

Effectiveness of continuous glucose monitoring in maintaining glycaemic control among people with type 1 diabetes mellitus: a systematic review of randomised controlled trials and meta-analysis.

The aim of this work was to assess the effectiveness of continuous glucose monitoring (CGM) vs self-monitoring of blood glucose (SMBG) in maintaining glycaemic control among people with type 1 diabetes mellitus. Cochrane Library, PubMed, Embase, CINAHL, Scopus, trial registries and grey literature were searched from 9 June 2011 until 22 December 2020 for RCTs comparing CGM intervention against SMBG control among the non-pregnant individuals with type 1 diabetes mellitus of all ages and both sexes on multiple daily injections or continuous subcutaneous insulin infusion with HbA1c levels, severe hypoglycaemia and diabetic ketoacidosis (DKA) as outcomes. Studies also included any individual or caregiver-led CGM systems. Studies involving GlucoWatch were excluded. Risk of bias was appraised with Cochrane risk of bias tool. Meta-analysis and meta-regression were performed using Review Manager software and R software, respectively. Heterogeneity was evaluated using χ2 and I2 statistics. Overall effects and certainty of evidence were evaluated using Z statistic and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) software. Twenty-two studies, involving 2188 individuals with type 1 diabetes, were identified. Most studies had low risk of bias. Meta-analysis of 21 studies involving 2149 individuals revealed that CGM significantly decreased HbA1c levels compared with SMBG (mean difference -2.46mmol/mol [-0.23%] [95% CI -3.83, -1.08], Z = 3.50, p=0.0005), with larger effects experienced among higher baseline HbA1c >64mmol/mol (>8%) individuals (mean difference -4.67mmol/mol [-0.43%] [95% CI -6.04, -3.30], Z = 6.69, p<0.00001). However, CGM had no influence on the number of severe hypoglycaemia (p=0.13) and DKA events (p=0.88). Certainty of evidence was moderate. CGM is superior to SMBG in improving glycaemic control among individuals with type 1 diabetes in the community, especially in those with uncontrolled glycaemia. Individuals with type 1 diabetes with HbA1c >64mmol/mol (>8%) are most likely to benefit from CGM. Current findings could not confer a concrete conclusion on the effectiveness of CGM on DKA outcome as DKA incidences were rare. Current evidence is also limited to outpatient settings. Future research should evaluate the accuracy of CGM and the effectiveness of CGM across different age groups and insulin regimens as these remain unclear in this paper. Registration no. CRD42020207042. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Protocol for a feasibility randomised control trial for continuous glucose monitoring in patients with type 1 diabetes at first-level hospitals in rural Malawi

IntroductionThe majority of people living with type 1 diabetes (PLWT1D) struggle to access high-quality care in low-income countries (LICs), and lack access to technologies, including continuous glucose monitoring (CGM), that...

Use of Continuous Glucose Monitoring in Older Adults: A Review of Benefits, Challenges and Future Directions.

Many new technologies have been developed over the past decade, and these have substantially changed the way diabetes is managed. Continuous glucose monitoring is now the standard of care for many people living with diabetes, and among its numerous benefits, it has been shown to improve glycaemic outcomes and enhance quality of life. Older adults carry a high burden of diabetes and have a high risk of hypo-glycaemia and hypo-glycaemic unawareness, and continuous glucose monitoring can help to improve glycaemic management in this vulnerable population. Unfortunately, only a few trials have evaluated the effectiveness of continuous glucose monitoring in older adults. Certainly, the implementation of continuous glucose monitoring in older adults can come with many challenges, including logistical, educational and reimbursement barriers. This article will discuss the benefits of continuous glucose monitoring in older adults with diabetes, the clinical studies that support its use and the barriers to its optimal implementation in this population.

Effectiveness of Continuous Glucose Monitoring in Older Adults with Type 2 Diabetes Treated with Basal Insulin.

Objective: To evaluate the effectiveness and safety of real-time continuous glucose monitoring (CGM) in adults 65 years old and older with type 2 diabetes (T2D) using basal without bolus insulin. Research Design and Methods: Using data from the MOBILE randomized trial comparing CGM versus blood glucose meter (BGM) monitoring for T2D treated with basal insulin, the treatment effect in participants ≥65 years (range: 65-79 years, N = 42) was compared with the treatment effect in participants <65 years (range: 33-64 years, N = 133). Results: For participants ≥65 years old, mean change in hemoglobin A1c (HbA1c) was -1.08% in the CGM group and -0.38% in the BGM group (adjusted mean difference = -0.65% [95% confidence interval (CI) -1.49 to 0.19]). In contrast, the adjusted mean difference in HbA1c between treatment groups was -0.35% [95% CI -0.77 to 0.07] in the <65 years age group. For time in range 70-180 mg/dL (TIR), mean adjusted treatment group difference was 19% (95% CI 4 to 35, P = 0.01) in ≥65 years old participants and 12% (95% CI 4 to 19, P = 0.003) in those <65 years old. Comparable treatment group differences favoring the CGM group were observed in both the ≥65 and <65 years age groups for mean glucose and less time >180, 250, and 300 mg/dL. Hypoglycemia was low in both groups with little difference between treatment groups in both age groups. Conclusions: In this study of adults with T2D treated with basal insulin without bolus insulin, participants ≥65 years old using CGM had a greater increase in TIR and a reduction in hyperglycemia than those using BGM and the benefit appeared to be at least as great as that observed in younger adults.

Continuous glucose monitoring for the prevention of morbidity and mortality in preterm infants.

Preterm infants are susceptible to hyperglycaemia and hypoglycaemia, which may lead to adverse neurodevelopment. The use of continuous glucose monitoring (CGM) devicesmight help in keeping glucose levels in the normal range, and reduce the need for blood sampling. However, the use of CGM might be associated with harms in the preterm infant. To assess the benefits and harms of CGM versus intermittent modalities to measure glycaemia in preterm infants 1. at risk of hypoglycaemia or hyperglycaemia; 2. with proven hypoglycaemia; or 3. with proven hyperglycaemia. We searched CENTRAL (2021, Issue 4); PubMed; Embase; and CINAHL in April2021. We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomized controlled trials (RCTs) and quasi-RCTs. We included RCTs and quasi-RCTs comparing the use of CGM versus intermittent modalities to measure glycaemia in preterm infants at risk of hypoglycaemia or hyperglycaemia; with proven hypoglycaemia; or with proven hyperglycaemia. We assessed the methodological quality of included trials using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria (assessing randomization, blinding, loss to follow-up, and handling of outcome data). We evaluated treatment effects using a fixed-effect model with risk ratio (RR) with 95% confidence intervals (CI) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to assess the certainty of the evidence. We included four trials enrolling 300infants in our updated review. We included one new study and excluded another previously included study (because the inclusion criteria of the review have been narrowed). Wecomparedthe use ofCGM to intermittent modalities in preterm infantsat risk of hypoglycaemia or hyperglycaemia; however, one of these trialswas analyzedseparately because CGMwas used as a standalone device, without being coupled to a control algorithm as in the other trials.We identified no studies in preterm infants with provenhypoglycaemia orhyperglycaemia. None of the four included trials reported the neurodevelopmental outcome (i.e. the primary outcome of this review), or seizures. The effect of the use of CGM on mortality during hospitalization is uncertain (RR 0.59,95% CI 0.16 to 2.13; RD -0.02, 95% CI -0.07to 0.03; 230 participants; 2studies; very low-certainty evidence). The certaintyof the evidence was very low for all outcomesbecause of limitations in study design, and imprecision of estimates. One studyisongoing (estimated sample size 60 infants) and planned to be completed in 2022. There is insufficient evidence to determine if CGM affects preterm infant mortality or morbidities. We are very uncertain of the safety of CGM and the available management algorithms, and many morbidities remain unreported. Preterminfants at risk of hypoglycaemia or hyperglycaemiawere enrolled in all four included studies. No studies have been conducted in preterm infants with provenhypoglycaemia orhyperglycaemia. Long-term outcomeswerenot reported.Events of necrotizing enterocolitis,reported in the study published in 2021, were lower in the CGM group. However, the effect of CGM on this outcome remains very uncertain. Clinical trials are required to determine the most effective CGM and glycaemic management regimens in preterm infants before larger studies can be performed to assess the efficacy of CGM for reducing mortality, morbidity, and long-term neurodevelopmental impairments.

Continuous glucose monitoring systems for monitoring cystic fibrosis-related diabetes.

Cystic fibrosis(CF) is one of the most common life-shortening autosomal-recessive genetic conditions with around 100,000 people affected globally. CF mainly affects the respiratory system, but cystic fibrosis-related diabetes(CFRD) is a common extrapulmonary co-morbidity and causes excess morbidity and mortality in this population. Continuous glucose monitoring systems(CGMS) are a relatively new technology and, as yet, the impact of these on the monitoring and subsequent management of CFRD remains undetermined. To establish the impact of insulin therapy guided by continuous glucose monitoring compared to insulin therapy guided by other forms of glucose data collection on the lives of people with CFRD. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of latest search: 23 September 2021. We also searched the reference lists of relevant articles and reviews and online trials registries.Date of last search: 23 September 2021. Randomised controlled studies comparing insulin regimens led bydata from CGMS (including real-time or retrospective data, orboth) with insulin regimens guided by abnormal blood glucose measurements collected through other means of glycaemic data collection in people with CFRD. Studies with a cross-over design, even with a washout period between intervention arms, are not eligible for inclusion due to the potential long-term impact of each of the interventions and the potential to compromise the outcomes of the second intervention. No studies were included in the review, meaning that no data were available to be collected for analysis. Review authors screened 14 studies at the full-text stage against the review'sinclusion criteria. Consequently, seven were excluded due to the study type being ineligible (not randomised), two studies were excluded due to their cross-over design, and two studies was excluded since theintervention used was not eligible and one was a literature review. One study in participants hospitalised for a pulmonary exacerbation is ongoing. Investigators are comparing insulin dosing via insulin pump with blood sugar monitoring by a CGMS to conventional diabetes management with daily insulin injections (or on an insulin pump if already on an insulin pump in the outpatient setting) and capillary blood glucose monitoring. The participants in the control arm will wear a blinded continuous glucose monitoring system for outcome assessment. In addition to this, one further study is still awaiting classification, and will be screened to determine whether it is eligible for inclusion, or is to be excluded, in an update of this review. No studies were included in the review, indicating that there is currently insufficient evidence to determine the impact of insulin therapy guided by CGMS compared to insulin therapy guided by other forms of glucose data collection on the lives of people with CFRD, nor on potential adverse effects of continuous glucose monitoring in this context. Randomised controlled studies are needed to generate evidence on the efficacy and safety of continuous glucose monitoring in people with CFRD. There is one relevant ongoing study that may be eligible for inclusion in a future update of this Cochrane Review, and whose results may help answer the review question.

Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials.

This systematic review aims to evaluate the effect of continuous glucose monitoring (CGM) on maternal and neonatal outcomes in gestational diabetes mellitus (GDM). Two authors conducted a systematic search using PubMed, Embase, CENTRAL, CINAHL, Scopus, Web of Science, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. The inclusion criteria for the systematic review were randomized clinical trials that compared the effects of CGM and blood glucose monitoring (BGM) in women with GDM. A restricted maximum likelihood random-effects model was used for the meta-analysis. The measures of effect were risk ratios for categorical data and mean differences for continuous data. Of the 457studies reviewed, six randomized clinical trials met the inclusion criteria. A total of 482 patients were included in the meta-analysis. The use of CGM was associated with lower HbA1c levels at the end of pregnancy (mean difference: -0.22; 95%CI -0.42 to -0.03) compared to BGM. Women using CGM also had less gestational weight gain (mean difference: -1.17, 95%CI -2.15 to -0.19), and their children had lower birth weight (mean difference: -116.26, 95%CI -224.70 to -7.81). No differences were observed in the other outcomes evaluated. Women with GDM using CGM may achieve lower average blood glucose levels, lower maternal weight gain and infant birth weight than women using BGM. Nevertheless, current evidence is limited by the low number of studies and the small sample sizes of these studies. Larger clinical trials are needed to better understand the effects of CGM in GDM. PROSPERO registration ID CRD42021225651.

Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin

Continuous glucose monitoring (CGM) has been shown to be beneficial for adults with type 2 diabetes using intensive insulin therapy, but its use in type 2 diabetes treated with basal insulin without prandial insulin has not been well studied. To determine the effectiveness of CGM in adults with type 2 diabetes treated with basal insulin without prandial insulin in primary care practices. This randomized clinical trial was conducted at 15 centers in the US (enrollment from July 30, 2018, to October 30, 2019; follow-up completed July 7, 2020) and included adults with type 2 diabetes receiving their diabetes care from a primary care clinician and treated with 1 or 2 daily injections of long- or intermediate-acting basal insulin without prandial insulin, with or without noninsulin glucose-lowering medications. Random assignment 2:1 to CGM (n = 116) or traditional blood glucose meter (BGM) monitoring (n = 59). The primary outcome was hemoglobin A1c (HbA1c) level at 8 months. Key secondary outcomes were CGM-measured time in target glucose range of 70 to 180 mg/dL, time with glucose level at greater than 250 mg/dL, and mean glucose level at 8 months. Among 175 randomized participants (mean [SD] age, 57 [9] years; 88 women [50%]; 92 racial/ethnic minority individuals [53%]; mean [SD] baseline HbA1c level, 9.1% [0.9%]), 165 (94%) completed the trial. Mean HbA1c level decreased from 9.1% at baseline to 8.0% at 8 months in the CGM group and from 9.0% to 8.4% in the BGM group (adjusted difference, -0.4% [95% CI, -0.8% to -0.1%]; P = .02). In the CGM group, compared with the BGM group, the mean percentage of CGM-measured time in the target glucose range of 70 to 180 mg/dL was 59% vs 43% (adjusted difference, 15% [95% CI, 8% to 23%]; P < .001), the mean percentage of time at greater than 250 mg/dL was 11% vs 27% (adjusted difference, -16% [95% CI, -21% to -11%]; P < .001), and the means of the mean glucose values were 179 mg/dL vs 206 mg/dL (adjusted difference, -26 mg/dL [95% CI, -41 to -12]; P < .001). Severe hypoglycemic events occurred in 1 participant (1%) in the CGM group and in 1 (2%) in the BGM group. Among adults with poorly controlled type 2 diabetes treated with basal insulin without prandial insulin, continuous glucose monitoring, as compared with blood glucose meter monitoring, resulted in significantly lower HbA1c levels at 8 months. ClinicalTrials.gov Identifier: NCT03566693.

CONTINUOUS GLUCOSE MONITORING AND TYPE 1 DIABETES MELLITUS CONTROL IN CHILD, ADOLESCENT AND YOUNG ADULT POPULATION - ARGUMENTS FOR ITS USE AND EFFECTS.

SUMMARYSensors for continuous glucose monitoring (CGM) in intercellular fluid are used as a contemporary method to achieve better control in type 1 diabetes mellitus (DM), which is best shown through lower glycated hemoglobin (HbA1c) levels.The aim of this study was to assess how many of our patients used CGM (parents were solely financing all the cost of the device) and what was the effect of CGM on the control of DM. Data were retrospectively collected from medical records of patients actively treated at the Division of Endocrinology, Diabetology, Pulmonology and Allergology, Department of Pediatrics, Sestre milosrdnice University Hospital Center. The t-test was used for independent samples to compare the mean levels of HbA1c before and after the inclusion of CGM. CGM was used by 81 (32.1%) of our patients with type 1 DM, of which 43 met the inclusion criteria. The mean HbA1c level 6 months before the introduction of CGM was 8.2%±1.9 and after 12 months of CGM use it was 7.4%±1.2, which was a statistically significant improvement (p=0.026). Furthermore, our results demonstrated that the greatest improvement in HbA1c level was recorded in the groups of young adults (18-25 years) and youngest children (<12 years). We confirmed the efficacy of CGM in achieving better control of type 1 DM by significantly improving HbA1c levels in a population of highly motivated patients.

A Randomized Clinical Trial Assessing Continuous Glucose Monitoring (CGM) Use With Standardized Education With or Without a Family Behavioral Intervention Compared With Fingerstick Blood Glucose Monitoring in Very Young Children With Type 1 Diabetes.

This study evaluated the effects of continuous glucose monitoring (CGM) combined with family behavioral intervention (CGM+FBI) and CGM alone (Standard-CGM) on glycemic outcomes and parental quality of life compared with blood glucose monitoring (BGM) in children ages 2 to <8 years with type 1 diabetes. This was a multicenter (N = 14), 6-month, randomized controlled trial including 143 youth 2 to <8 years of age with type 1 diabetes. Primary analysis included treatment group comparisons of percent time in range (TIR) (70-180 mg/dL) across follow-up visits. Approximately 90% of participants in the CGM groups used CGM ≥6 days/week at 6 months. Between-group TIR comparisons showed no significant changes: CGM+FBI vs. BGM 3.2% (95% CI -0.5, 7.0), Standard-CGM vs. BGM 0.5% (-2.6 to 3.6), CGM+FBI vs. Standard-CGM 2.7% (-0.6, 6.1). Mean time with glucose level <70 mg/dL was reduced from baseline to follow-up in the CGM+FBI (from 5.2% to 2.6%) and Standard-CGM (5.8% to 2.5%) groups, compared with 5.4% to 5.8% with BGM (CGM+FBI vs. BGM, P < 0.001, and Standard-CGM vs. BGM, P < 0.001). No severe hypoglycemic events occurred in the CGM+FBI group, one occurred in the Standard-CGM group, and five occurred in the BGM group. CGM+FBI parents reported greater reductions in diabetes burden and fear of hypoglycemia compared with Standard-CGM (P = 0.008 and 0.04) and BGM (P = 0.02 and 0.002). CGM used consistently over a 6-month period in young children with type 1 diabetes did not improve TIR but did significantly reduce time in hypoglycemia. The FBI benefited parental well-being.

Continuous glucose monitoring in diabetes patients with chronic kidney disease on dialysis: a meta-analysis

This study evaluates the effectiveness of continuous glucose monitoring (CGM) in diabetes patients who were on routine dialysis.Literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate a) correlations of CGM with other indicators including glycated hemoglobin A1c (HbA1c), glycated albumin and mean amplitude of glucose excursions (MAGE), and b) mean differences (MDs) in CGM and MAGE values between dialysis and off-dialysis days or during vs before dialysis.There was a good correlation between CGM and self-monitoring of blood glucose values (r=0.837 [95% confidence interval (CI): 0.67, 0.92]. Correlation coefficient between CGM and HbA1c was 0.523 [95% CI: 0.422, 604] in diabetes patients on dialysis and 0.592 [95% CI: 0.354, 0.757] in diabetes patients without renal failure. Correlation coefficient between CGM and glycated albumin in diabetes patients on dialysis was 0.544 [95% CI: 0.254, 0.744]. Average CGM and MAGE values on dialysis day were not significantly different from those of offdialysis day in diabetes patients (MDs: -0.40 millimole/liter (mmol/L) [95% CI: -1.06, 0.26]; p=0.23) and MAGE 0.50 mmol/L [95% CI: -0.01, 1.00]; p=0.05, respectively). Compared to predialysis values, average CGM and MAGE values were significantly lower during dialysis in diabetes patients (MDs: -2.11 mmol/L [95% CI: -3.25, -0.97]; p=0.0003 and MAGE -2.24 mmol/L [95% CI: -3.99, -0.50]; p=0.01, respectively).CGM is an efficient method of glycemic monitoring in diabetes patients on dialysis. CGM had similar correlations with HbA1c and glycated albumin.

Effect of CGM in the HbA1c and Coefficient of Variation of glucose in a pediatric sample

Aim of the studyPrevious studies have found no significant improvements in glycated hemoglobin (HbA1c), while using Continuous Glucose Monitoring (CGM), with children and adolescents. The aim of this paper is to measure the change in HbA1c, and the Coefficient of Variation in glucose levels, when using CGM, once the effect of other relevant variables, such as gender, actual age, the years the patient has had diabetes, use of an insulin pump, the presence of autoimmune disease, other associated pathologies, and weekly hours of exercise, are controlled for. MethodsThis is a retrospective study that uses a linear regression model. Data was collected from Type 1 Diabetes Mellitus (T1DM), children diagnosed between 2003 and 2017 in the Pediatric Unit for Diabetes in Zaragoza, Spain. We used a linear regression and the method of estimation is Ordinary Least Squares. ResultsResults show that the use of CGM decreased the HbA1c value by 3.5% and the Coefficient of Variation by 14%. ConclusionsThe implication of these results is that this device helped in the management of diabetes, although more research is needed to distinguish between different devices in terms of their efficacy.