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Effect of ContinuousGlucose Monitoring onGlycemic Control inPatients With Type 2Diabetes Treated WithBasal Insulin Thomas W. MartensRoy W. BeckRyan Bailey2021 год

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

Importance

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.

Objective

To determine the effectiveness of CGM in adults with type 2 diabetes treated with basal insulin without prandial insulin in primary care practices.

Design, Setting, and Participants

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.

Interventions

Random assignment 2:1 to CGM (n = 116) or traditional blood glucose meter (BGM) monitoring (n = 59).

Main Outcomes and Measures

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.

Results

Among 175 randomized participants (mean [SD] age, 57 [9] years; 88 women [50%]; 92 racial/ethnic minority individuals [53%]; mean [SD] baseline HbA1clevel, 9.1% [0.9%]), 165 (94%) completed the trial. Mean HbA1clevel 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.

Conclusions and Relevance

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 HbA1clevels at 8 months.

Trial Registration

ClinicalTrials.gov Identifier:NCT03566693
Год издания: 2021
Авторы: Thomas W. Martens, Roy W. Beck, Ryan Bailey, Katrina J. Ruedy, Peter Calhoun, Anne L. Peters, Rodica Pop‐Busui, Athena Philis‐Tsimikas, Shichun Bao, Guillermo E. Umpierrez, Georgia M. Davis, Davida F. Kruger, Anuj Bhargava, Laura Young, Janet B. McGill, Grazia Aleppo, Quang T. Nguyen, Ian J. Orozco, William Biggs, K. Lucas, William H. Polonsky, John B. Buse, David A. Price, Richard M. Bergenstal, Anders L. Carlson, Sharon Chambers, Shoua Yang, M. Sue Kirkman, Alexander Kass, Rachael Fraser, Terra Cushman, Clementina Ramos, Maria Magar, Martha Walker, Sara Serafin-Dokhan, Maamoun Salam, Stacy Hurst, Mary Jane Clifton, Jelena Kravarusic, Anupam Bansal, Candice Fulkerson, Lynn Ang, Caroline R. Richardson, Kara Mizokami‐Stout, Jake Reiss, Virginia Leone, Kirstie Stifel, George Dailey, Amy Change, James McCallum, María Isabel Ávalos García, Dianne Davis, C. Lovell, Connie Root, Freida Toler, Lori Wilhelm, Robin Eifert, Lorena Murguia, Becky Cota, Loida Nguyen, Randie Lipski, Mary Katherine Lawrence, Adelle Fournier, Matthew Carter, Stephanie Hoover, Nathan Cohen, Thomas Mouse, Jessica Rusnak, Tiffany Campos, Nelly M. Njeru, Tom Arant, Stayce E. Beck, Andrew K. Balo
Издательство: American Medical Association
Источник: JAMA
Ключевые слова: Diabetes Management and Research, Diabetes and associated disorders, Pancreatic function and diabetes
Другие ссылки: JAMA (PDF)
JAMA (HTML)
PubMed Central (HTML)
PubMed (HTML)