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Randomized Controlled Trial
. 2017 Nov;11(6):1138-1146.
doi: 10.1177/1932296817704445. Epub 2017 Apr 28.

Continuous Glucose Monitoring in Older Adults With Type 1 and Type 2 Diabetes Using Multiple Daily Injections of Insulin: Results From the DIAMOND Trial

Katrina J Ruedy  1 , Christopher G Parkin  2 , Tonya D Riddlesworth  1 , Claudia Graham  3 ; DIAMOND Study Group
Affiliations
Randomized Controlled Trial

Continuous Glucose Monitoring in Older Adults With Type 1 and Type 2 Diabetes Using Multiple Daily Injections of Insulin: Results From the DIAMOND Trial

Katrina J Ruedy et al. J Diabetes Sci Technol. 2017 Nov.

Abstract

Objective: The objective was to determine the effectiveness of real-time continuous glucose monitoring (CGM) in adults ≥ 60 years of age with type 1 (T1D) or type 2 (T2D) diabetes using multiple daily insulin injections (MDI).

Methods: A multicenter, randomized trial was conducted in the United States and Canada in which 116 individuals ≥60 years (mean 67 ± 5 years) with T1D (n = 34) or T2D (n = 82) using MDI therapy were randomly assigned to either CGM (Dexcom™ G4 Platinum CGM System® with software 505; n = 63) or continued management with self-monitoring blood glucose (SMBG; n = 53). Median diabetes duration was 21 (14, 30) years and mean baseline HbA1c was 8.5 ± 0.6%. The primary outcome, HbA1c at 24 weeks, was obtained for 114 (98%) participants.

Results: HbA1c reduction from baseline to 24 weeks was greater in the CGM group than Control group (-0.9 ± 0.7% versus -0.5 ± 0.7%, adjusted difference in mean change was -0.4 ± 0.1%, P < .001). CGM-measured time >250 mg/dL ( P = .006) and glycemic variability ( P = .02) were lower in the CGM group. Among the 61 in the CGM group completing the trial, 97% used CGM ≥ 6 days/week in month 6. There were no severe hypoglycemic or diabetic ketoacidosis events in either group.

Conclusion: In adults ≥ 60 years of age with T1D and T2D using MDI, CGM use was high and associated with improved HbA1c and reduced glycemic variability. Therefore, CGM should be considered for older adults with diabetes using MDI.

Keywords: CGM; MDI; glucose monitoring; insulin; older; type 1 diabetes; type 2 diabetes.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: One author (CG) is employed by Dexcom and CP received consulting fees from Dexcom. The other authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Participant disposition.
Figure 2.
Figure 2.
HbA1c values at baseline and 24 weeks, by group. (A) Scatterplot of 24-week HbA1c levels by baseline HbA1c level. The horizontal line at 7.0% represents the American Diabetes Association HbA1c goal for nonpregnant adults with diabetes. Points below the diagonal line represent cases in which the 24-week HbA1c level was lower than the baseline HbA1c level, points above the diagonal line represent cases in which the 24-week HbA1c level was higher than the baseline HbA1c level, and points on the diagonal line represent cases in which the 24-week and baseline HbA1c values were the same. (B) Cumulative distribution of 24-week HbA1c values. For any given 24-week HbA1c level, the percentage of cases in each treatment group with an HbA1c value at that level or lower can be determined from the figure.
See this image and copyright information in PMC

References

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