Recent study results suggest that insulin pumps with CGM outperforms traditional monitoring in adolescents and young adults with type 1 diabetes for greater short-term outcomes.
Therapy for patients with severe enough forms of type 1 diabetes typically includes the infusion of insulin through pumps and monitoring of blood glucose through continuous meters. Continuous blood glucose monitors are worn by the patients at all times. Insulin administration technology has improved to the point of Bluetooth synchronization between the pump and the continuous monitor, ultimately reducing the burden of self-care. Pump synchronization allows insulin to be administered based on real time blood glucose values and prevents inappropriate insulin doses. In hindsight, such accurate insulin administration could lead to a reduction in risk of developing hypoglycemic events and promote improved overall glycemic outcomes.
A recent study that was published at the 2019 79th annual Scientific Sessions of the American Diabetes Association (ADA) aimed to determine which specific outcomes may be improved with the initiation of insulin pumps and continuous glucose monitors compared to traditional monitoring of blood glucose with finger pricks in adolescents and young adults with recently diagnosed type 1 diabetes. Patients with type 1 diabetes were enrolled if they were between 14 and 24 years old, were diagnosed within the past year, and had an HbA1c between 7.5% and 11%. The primary outcome observed in this study was net effect on HbA1c between the two treatment groups.
A total of 153 adolescents and young adults with an average age of 17 years were enrolled into this study, and had type 1 diabetes for an average of 8 years and an average HbA1c of 8.9%. Patients were randomized in a 1:1 fashion to monitor blood glucose traditionally with finger pricks or to continuously monitor blood glucose with a Dexcom reader. Intervention with a continuous glucose monitor also included advocacy for its use in the form of social marketing in order to promote adherence as well as seamless use in everyday life; no such advocacy was provided to those who traditionally monitored. After 6 months of follow up, 142 patients total (71 per treatment group) remained within the study and were included in analysis of the primary outcome.
Significantly superior HbA1c reductions were observed in the continuous glucose monitoring group when compared to the traditional finger prick group. Adolescents with type 1 diabetes who used continuous monitoring saw a 0.4% greater decrease in average HbA1c than those who had used traditional monitoring with finger pricks at 6 months (95% CI -0.7% to -0.1%). HbA1c reductions of greater than 1% were observed in about 25% of the study population randomized to continuous monitors, while the same reductions were observed in only 6% of patients that were randomized to traditional monitoring with finger pricks.
Analysis of secondary outcomes demonstrated similar results in favor of continuous monitoring of blood glucose. Patients with type 1 diabetes randomized to use continuous monitoring spent less total time in both hyper- and hypoglycemic states than those randomized to monitor traditionally with finger pricks over the course of 6 months (-1.4 hours, 95% CI -10 to -2 hours). Similar figures were reported for total time in a target glucose range of between 70 and 180 mg/dL. At the end of the follow up period, the researchers of the trials surveyed study participants to determine overall satisfaction with their randomized method of monitoring blood glucose. On average, patients were significantly more satisfied with their continuous monitors than patients who had to traditionally monitor with finger sticks.
In conclusion, the results of this study demonstrate the profound benefits of intensive glucose control through insulin pumps and continuous blood glucose meters. Technological advancements have only improved the precision and specificity of insulin administration, leading to greater time spent in target glucose ranges and reduced incidence of hyper- and hypoglycemic events. Providers of adolescents and young adults with type 1 diabetes should consider the results of this newly published study when determining insulin therapy plans.
Practice Pearls — CGM Outperforms Traditional Monitoring:
- Technological advancements have allowed synchronization between insulin pumps and continuous glucose monitors.
- Continuous monitoring of glucose resulted in greater HbA1c reductions than traditional monitoring with finger pricks in adolescents and young adults with type 1 diabetes at 6 months.
- Adolescents and young adults preferred monitoring with continuous blood glucose readers over traditional monitoring, based on an end-of-study survey.
Reference for “CGM Outperforms Traditional Monitoring for Type 1 Diabetes”:
Laffel L, et al. Continuous glucose monitoring intervention in teens and young adults (CITY): primary study results. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, San Francisco.
Adam Chalela B.S., PharmD Candidate, USF College of Pharmacy Class of 2020