CGM leads to greater improvement in type 1 control than with insulin pumps, study suggests

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Real-time continuous glucose monitoring (rtCGM) is effective among those with type 1 diabetes, irrespective of how insulin is delivered to the body, researchers have said.

The trial compared usage of insulin pumps, multiple daily injections (MDI), blood glucose testing and continuous glucose monitoring (CGM). At three years long, this study is the longest to review use of CGM to date.

A total of 94 people with type 1 diabetes were asked to participate by using one of four treatment regimens.

The four groups consisted of:

  • insulin pump and rtCGM – 26 participants
  • insulin pump and blood glucose testing – 25 participants
  • MDI and rtCGM – 22 participants
  • MDI and blood glucose testing – 21 participants

The participants were allowed to choose the insulin and monitoring option that met their individual needs, which the researchers said, “reflects real-life decision-making in most practices”.

After three years, HbA1c levels were noticeably lower in the rtCGM groups; 52 mmol/mmol (6.9%) for rtCGM and insulin pump and 53 mmol/mol (7.0%) for rtCGM and MDI. This compared to HbA1c levels of 61 mmol/mol (7.7%) for users of insulin pump and blood glucose testing, and 64 mmol/mol (8.0%) for users of insulin pump and blood glucose testing.

A key measure of type 1 diabetes control is time in range, which is the proportion of time that blood glucose levels stay within a target range. The results showed that it was only the users of rtCGM that experienced significant improvement in this. Furthermore, time in hypoglycemia decreased only for the users of rtCGM and not for the groups using blood glucose testing.

Lead author Jan Šoupal said: “It is not so important how insulin is delivered, but more important is how patients with type 1 diabetes monitor their glucose.

“Individualisation of treatment is important. However, according to the results of our trial, in the vast majority of cases, CGM is what makes the difference.”

The findings have been published in the journal Diabetes Care and were also unveiled at last week’s European Association for the Study of Diabetes (EASD) 2019 Annual Meeting in Barcelona.





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