The majority of people with type 1 diabetes and multiple daily insulin injections benefit from using continuous glucose monitoring: An analysis based on the GOLD randomized trial (GOLD‐5). Issue 2 (10th December 2020)

• Record Type: Journal Article
• Authors: Ólafsdóttir, Arndís F.; Bolinder, Jan; Heise, Tim; Polonsky, William; Ekelund, Magnus; Wijkman, Magnus; Pivodic, Aldina; Ahlén, Elsa; Schwarcz, Erik; Nyström, Thomas; Hellman, Jarl; Hirsch, Irl B.; Lind, Marcus
• Is Part Of: Diabetes, obesity & metabolism. Volume 23:Issue 2(2021)
• Page Start: 619
• Page End: 630
• Publication Date: 2020-12-10
• Subjects: clinical trial, CGM, randomized trial, type 1 diabetes; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.14257
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract: Aim: To identify responders to continuous glucose monitoring (CGM) in relation to reductions in HbA1c and percentage of time spent in hypoglycaemia after initiation of CGM for individuals with type 1 diabetes treated with multiple daily insulin injections. Materials and Methods: We analysed data from 142 participants in the GOLD randomized clinical trial. We evaluated how many lowered their HbA1c by more than 0.4% (>4.7 mmol/mol) or decreased the time spent in hypoglycaemia over 24 hours by more than 20 or 30 minutes, and which baseline variables were associated with those improvements. Results: Lower reduction of HbA1c was associated with greater reduction of hypoglycaemia (r = −0.52; P < .0001). During CGM, 47% of participants lowered their HbA1c values by more than 0.4% (>4.7 mmol/mol) than with self‐measurement of blood glucose, and 47% decreased the time spent in hypoglycaemia by more than 20 minutes over 24 hours. Overall, 78% either reduced their HbA1c by more than 0.4% (>4.7 mmol/mol) or the time spent in hypoglycaemia by more than 20 minutes over 24 hours, but only 14% improved both. Higher HbA1c, a lower percentage of time at less than 3.0 or 3.9 mmol/L, a lower coefficient of variation (CV) and a higher percentage of time above 13.9 mmol/L ( P = .016) were associated with greater HbA1c reduction during CGM. The variables associated with a greater reduction of time in hypoglycaemia were female sex, greater time with glucose levels at less than 3.0 mmol/L, higher CV, and higher hypoglycaemia confidence as evaluated by a hypoglycaemic confidence questionnaire. Conclusion: The majority of people with type 1 diabetes managed by multiple daily insulin injections benefit from CGM; some experienced reduced HbA1c while others reduced the time spent in hypoglycaemia. These factors need to be considered by healthcare professionals and decision‐makers for reimbursement and diabetes guidelines.