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Evolving Benefits of Using Continuous Monitoring Blood Glucose Devices 

Mar 17, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Chardae Whitner, 2020 PharmD. Candidate, Lake Erie College of Osteopathic Medicine

A roundup of studies shows both young and older patients with type 1 can benefit from continuous monitoring blood glucose devices. 

Continuous monitoring blood glucose devices (CGM) have, in recent years, revolutionized the care of patients with type 1 diabetes.  Many of the youth patients with type 1 diabetes are not meeting their hemoglobin A1c (HbA1c) level goals. The ability of patients with type 1 diabetes and physicians of patients with type 1 diabetes to have a knowledge base of real-time glycemic patterns allows for better management of type 1 diabetes.  A compilation of several articles was reviewed to demonstrate how the use of CGM in patients with type 1 diabetes can be beneficial in an array of clinical decisions. 

The use of CGM devices in the younger population of patients with type 1 diabetes has gained tremendous popularity based on Miller et al. study. The T1D Exchange in the U.S. and the Diabetes Patienten Velaufdocumentation (DPV) in Germany reported that the use of these devices in patients < 18 years old increased from <5% in 2011 to 31% in the T1D Exchange and 44% in the DPV in 2017.  There was not much of an increase in the use of CGM devices reported in adult patients with type 1 diabetes.   

Prahald et al. examined the feasibility of using CGM in newly diagnosed patients with type 1 diabetes in a young population. The study began with 41 participants with a mean age of 9.7 years old who started CGM shortly after diagnosis.  After three months of CGM, 38 patients remained and their mean time in blood glucose range (70-180 mg/dL) was monitored at 70%.  

Dov et al. measured the pharmacodynamic outcome of CGM; the glycemic patterns were observed with the use of faster insulin aspart compared to the use of regular insulin aspart formulation. Twenty young participants of a double-masked, randomized, cross over study received each insulin dose from a close-loop dosing algorithm based on a 27-h inpatient stay. Results showed that the time in range (70-180 mg/dL) didn’t differ between the two different insulin aspart formulations. However, the glycemic increments post-prandial were slightly higher with the faster insulin aspart.     

The long-term effects of CGM were also evaluated as well. Soupal et al. report a follow -up of the Comparison of Sensor Augmented Insulin Regimens (COMISAIR) study which had 65 participants with type 1 diabetes enrolled, who were currently using multiple-dose injections (MDI).  Participants were placed in groups based on the following categories: pump therapy augmented with CGM, continued MDI with CGM, pump therapy with SMBG (self-monitoring blood glucose), and continued MDI with SMBG.  After one year, HbA1c improved more with participants who were using CGM versus SMBG; a 3 year follow-up was conducted from 88 of the 94 participants.  Results showed that glycemic control was optimal with groups who used CGM (HbA1c of 6.9% (pump therapy) and 7.0%(MDI)).  However, HbA1c was higher for participants using SMBG (HbA1c of 8.0% (pump therapy) and 7.7%(MDI)).   

Another long-term study is comparing the use of CGM with SMBG and MDI with pump therapy in patients with type 1 diabetes and impaired hypoglycemic awareness.  The study’s goal was to find ways to minimize hypoglycemic episodes in this patient population. Following the intervention period, participants’ knowledge of hypoglycemic events was heightened through glucose monitoring; a 2-year follow-up study found that 61% of the participants no longer experienced severe hypoglycemia. Oliver et al. also analyzed the data of 300 patients with type 1 diabetes who had participated in the DIAMOND (Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes) and HypoDE studies; this follow-up study found that there was lower hypoglycemic episode risk for patients who have achieved a lower in-target glucose value when using CGM versus a patient who was using SMBG. Unlike many of the other studies, which focus on the use of CGM in youth, this supports the use of CGM in the older population of patients with type 1 diabetes as these patients regularly use basal-bolus insulin therapies.   

The collections of these articles presented above show how CGM could be beneficial in the management of patients with type 1 diabetes.  Management of meantime blood glucose range, HbA1c, effective insulin therapies, and preventing hypoglycemic episodes are all major concerns of type 1 diabetes patients and their providers. CGM provides effective real-time monitoring and can provide successful outcomes of patients with type 1 diabetes.   

Practice Pearls: 

  • The use of CGM monitoring through studies has shown better endpoint outcomes of the HbA1c. 
  • The use of CGM monitoring will help providers with clinical decisions regarding pharmaceutical therapies of patients with type 1 diabetes.  
  • The use of CGM monitoring has been shown to reduce the number of hypoglycemic episodes in patients with type 1 diabetes. 

 

References for “Evolving Benefits of Using Continuous Monitoring Blood Glucose Devices”:

Faster compared with standard insulin aspart during day-and-night fully closed-loop insulin therapy in type 1 diabetes: a double-blind randomized crossover trial. Diabetes Care 2020;43: 29–36 

Longitudinal changes in continuous glucose monitoring use among individuals with type 1 diabetes: Diabetes Care 2020;43: e1–e2 

Continuous glucose monitoring in people with type 1 diabetes on multiple-dose injection therapy: Diabetes Care 2020; 43:53–58 

 

Chardae Whitner, 2020 PharmD. Candidate, Lake Erie College of Osteopathic Medicine