Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May;11(3):522-528.
doi: 10.1177/1932296817693253. Epub 2017 Feb 1.

Continuous Glucose Monitoring Use in Type 1 Diabetes: Longitudinal Analysis Demonstrates Meaningful Improvements in HbA1c and Reductions in Health Care Utilization

Christopher G Parkin  1 , Claudia Graham  2 , John Smolskis  3
Affiliations

Continuous Glucose Monitoring Use in Type 1 Diabetes: Longitudinal Analysis Demonstrates Meaningful Improvements in HbA1c and Reductions in Health Care Utilization

Christopher G Parkin et al. J Diabetes Sci Technol. 2017 May.

Abstract

Background: Real-time continuous glucose monitoring (rtCGM) improves glycemic control in type 1 diabetes (T1D) patients treated with continuous subcutaneous insulin infusion (CSII). However, the benefits of rtCGM in T1D patients treated with multiple daily insulin injection (MDI) therapy has not been well studied. We explored the effects of rtCGM versus self-monitoring of blood glucose (SMBG) on clinical outcomes within a large T1D population treated with either CSII or MDI therapy.

Methods: This retrospective, longitudinal analysis utilized datasets from T1D patients enrolled in a commercial health plan to assess changes in HbA1c in 187 naïve to rtCGM users and 6260 SMBG users. Propensity score modeling was used to assess inpatient admissions, emergency room (ER) visits in 1130 patients (565 rtCGM, 565 SMBG). Differences in HbA1c reduction (rtCGM+MDI vs rtCGM+CSII) were evaluated.

Results: Larger, clinically meaningful HbA1c reductions were seen among rtCGM versus SMBG users: -0.5% ( P = .004) versus -0.2% ( P < .0001); 0.3% diff in diff, P = .03. All-cause inpatient admissions were lower for rtCGM users: -42%, P = .013. Emergency room visits coded for diabetic ketoacidosis (DKA) were four times higher for SMBG patients than rtCGM patients: 17 versus 4, P = .0318. HbA1c reductions were most notable with rtCGM+MDI versus rtCGM+CSII treatment: -0.6% ( P = .01) versus -0.3% ( P = .16).

Conclusions: Use of rtCGM in T1D patients facilitates greater HbA1c improvements and reduced health care system utilization compared with traditional SMBG use regardless of insulin administration method. Treatment with rtCGM in conjunction with MDI confers similar or greater glycemic benefits without the additional costs associated with CSII therapy.

Keywords: CSII; SMBG; continuous glucose monitoring; insulin pump; rtCGM; type 1 diabetes.

PubMed Disclaimer

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: CGP has received consulting fees from Dexcom, Inc, Insulet Corporation, Roche Diabetes Care, and Sanofi. CG is an employee of Dexcom, Inc. JS has received consulting fees from Dexcom, Inc.

Figures

Figure 1.
Figure 1.
Percentage distribution of baseline HbA1c values.
Figure 2.
Figure 2.
Changes in HbA1c from baseline: CGM vs SMBG (A) and CGM with MDI versus CGM with CSII (B).
Figure 3.
Figure 3.
Utilization of health services and costs: Inpatient admissions (A) and ER admissions (B).
See this image and copyright information in PMC

References

    1. Bailey TS, Grunberger G, Bode BW, et al. American Association of Clinical Endocrinologists and American College of Endocrinology 2016 outpatient glucose monitoring consensus statement. Endocr Pract. 2016;22:231-261. - PubMed
    1. Pettus J, Edelman SV. Use of glucose rate of change arrows to adjust insulin therapy among individuals with type 1 diabetes who use continuous glucose monitoring. Diabetes Technol Ther. 2016;18(suppl 20):S234-S242. - PMC - PubMed
    1. Pettus J, Price DA, Edelman SV. How patients with type 1 diabetes translate continuous glucose monitoring data into diabetes management decisions. Endocr Pract. 2015;21:613-620. - PubMed
    1. Kovatchev BP, Patek SD, Ortiz EA, Breton MD. Assessing sensor accuracy for non-adjunct use of continuous glucose monitoring. Diabetes Technol Ther. 2015;17:177-186. - PMC - PubMed
    1. Vettoretti M, Facchinetti A, Sparacino G, Cobelli C. Simulation of patient decision-making to test safety and effectiveness of CGM sensor for non-adjunctive use in type 1 diabetes: SMBG vs CGM-based therapies. Paper presented at: 15th Annual Diabetes Technology Meeting; 22–24 October 2015; Bethesda, MD.

Publication types