Continuous glucose monitoring pilot in low-income type 1 diabetes patients

Abstract

Background: Continuous glucose monitoring (CGM) has been shown to be a valuable tool to improve glycemic control in patients with diabetes. The objective of this pilot study was to develop and implement CGM in an existing diabetes clinic for low-income patients on multiple daily injections.

Subjects and methods: This was a single-center, prospective, randomized controlled, crossover pilot study. Initial focus groups were held to create low-literacy, Spanish and English guides to the use of carbohydrate counting and CGM. These tools were implemented to train participants on carbohydrate counting and insulin adjustments participants. Subjects were then randomized to start in Group A (CGM) or Group B (self-monitoring blood glucose and then switched after 28 weeks). Hemoglobin A1c (HbA1c) was obtained at baseline and at the end of both study phases.

Results: Twenty-five economically challenged, primarily Latino participants with minimal prior education on intensive diabetes management completed the study. No significant reduction in HbA1c or decrease in time spent in parameters of low and high blood glucose was shown. However, eighty percent of participants who completed the study wanted to continue to use CGM once the research study was over. The participants also felt that the CGM made adjusting insulin easier.

Conclusions: CGM can be implemented in patients from a low-income public clinic; however, HbA1c reduction was not achieved. Given the underlying lack of baseline self-management knowledge, a longer trial might be necessary to see benefit with CGM in this population.

FIG. 1.

Box plots of hemoglobin A1c (HbA1c) at three time points (baseline, Period 1, and Period 2) by treatment for all the subjects who completed both phases of the study. The open box denotes the 25^th, 75^th percentile, the solid line in the box denotes the median, and solid circle denotes the mean HbA1c level. CGM, continuous glucose monitoring; SMBG, self-monitoring of blood glucose.