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Real-time glucose research (rtCGM) is effective in people with type 1 diabetes, regardless of how insulin is delivered to the body, researchers said.
The trial compared the use of insulin pumps, multiple daily injections (MDIs), glucose tests and continuous glucose monitoring (CGM). For three years, this study has been the longest to examine the use of CGM so far.
In total, 94 people with type 1 diabetes were invited to participate in one of four treatment regimens.
The four groups consisted of:
- insulin pump and rtCGM – 26 participants
- insulin pump and blood glucose test – 25 participants
- MDI and rtCGM – 22 participants
- MDI and blood glucose test – 21 participants
Participants were allowed to choose the insulin and surveillance option that met their individual needs, which, according to the researchers, "reflects the actual decision-making in most practices".
After three years, HbA1c levels were significantly lower in the groups treated with rtCGM; 52 mmol / mmol (6.9%) for the rtCGM and the insulin pump and 53 mmol / mol (7.0%) for the rtCGM and the MDI. This compared with HbA1c levels of 61 mmol / mol (7.7%) for insulin pump users and glucose test and 64 mmol / mol (8.0%) for users of insulin pump and blood glucose test.
A key measure in controlling type 1 diabetes is time in the interval, which is the proportion of time that blood glucose remains within target limits. The results showed that only rtCGM users experienced significant improvement in this regard. In addition, the time spent in hypoglycemia decreased only for users of rtCGM and not for groups testing blood glucose.
The main author, Jan Šoupal, said: "The way insulin is delivered does not matter, but the most important is how patients with diabetes mellitus type 1 monitor their blood glucose.
"The individualization of treatment is important, but according to the results of our trial, in the vast majority of cases CGM is what makes the difference."
The findings were published in the journal Diabetes Care and were also unveiled at the 2019 annual meeting of the European Association for the Study of Diabetes (EASD) in Barcelona.
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