Journal Article

The Effect of Continuous Glucose Monitoring in Well-Controlled Type 1 Diabetes

Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group

2009

Overview

The Effect of Continuous Glucose Monitoring in Well-Controlled Type 1 Diabetes Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group * Corresponding author: Roy W. Beck, rbeck{at}jaeb.org . Abstract OBJECTIVE The potential benefits of continuous glucose monitoring (CGM) in the management of adults and children with well-controlled type 1 diabetes have not been examined. RESEARCH DESIGN AND METHODS A total of 129 adults and children with intensively treated type 1 diabetes (age range 8–69 years) and A1C <7.0% were randomly assigned to either continuous or standard glucose monitoring for 26 weeks. The main study outcomes were time with glucose level ≤70 mg/dl, A1C level, and severe hypoglycemic events. RESULTS At 26 weeks, biochemical hypoglycemia (≤70 mg/dl) was less frequent in the CGM group than in the control group (median 54 vs. 91 min/day), but the difference was not statistically significant ( P = 0.16). Median time with a glucose level ≤60 mg/dl was 18 versus 35 min/day, respectively ( P = 0.05). Time out of range (≤70 or >180 mg/dl) was significantly lower in the CGM group than in the control group (377 vs. 491 min/day, P = 0.003). There was a significant treatment group difference favoring the CGM group in mean A1C at 26 weeks adjusted for baseline ( P < 0.001). One or more severe hypoglycemic events occurred in 10 and 11% of the two groups, respectively ( P = 1.0). Four outcome measures combining A1C and hypoglycemia data favored the CGM group in comparison with the control group ( P < 0.001, 0.007, 0.005, and 0.003). CONCLUSIONS Most outcomes, including those combining A1C and hypoglycemia, favored the CGM group. The weight of evidence suggests that CGM is beneficial for individuals with type 1 diabetes who have already achieved excellent control with A1C <7.0%. Footnotes ↵ *The members of the writing committee and the full listing of the members of the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group can be found in the online appendix available at http://care.diabetesjournals.org/cgi/content/full/dc09-0108/DC1 . Clinical trial reg. no. NCT00406133, clinicaltrials.gov . The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Received January 20, 2009. Accepted April 27, 2009. © 2009 by the American Diabetes Association.

• Publisher: American Diabetes Association
• Subject: Adolescent / Adult / Aged / Biological and medical sciences / Blood Glucose - analysis / Child / Dextrose / Diabetes / Diabetes Mellitus, Type 1 - blood / Diabetes. Impaired glucose tolerance / Endocrine pancreas. Apud cells (diseases) / Endocrinopathies / Etiopathogenesis. Screening. Investigations. Target tissue resistance / Fees & charges / Glucose / Humans / Hyperglycemia / Hypoglycemia - epidemiology / Hypoglycemia - prevention & control / Hypoglycemic Agents - adverse effects / Hypoglycemic Agents - therapeutic use / Insulin - adverse effects / Insulin - therapeutic use / Medical sciences / Metabolic diseases / Middle Aged / Miscellaneous / Monitoring, Ambulatory - methods / Original Research / Patient monitoring equipment / Public health. Hygiene / Public health. Hygiene-occupational medicine / Sample size / Statistical methods / Type 1 diabetes / Young Adult