Clinical Outcomes
Source: Diabetes Technology & Therapeutics
Key Takeaway: CGM initiated within the first year of T1D diagnosis was effective in lowering and maintaining A1C for 2.5 years and reduced the frequency of ED visits related to hypoglycemia and hyperglycemia irrespective of insulin delivery method.
Source: The Journal of Clinical Endocrinology & Metabolism
Key Takeaway: Nationwide reimbursement of real-time CGM improved HbA1c, fear of hypoglycemia, and QOL as well as economic indicators including work absenteeism and hospital admissions for acute diabetes complications.
The Value of rtCGM: Reduction in Hospitalizations and Work Absenteeism
| Pre-Reimbursement for rtCGM | Post-Reimbursement for rtCGM | P Value | |
| (n = 496) | (n = 379) | ||
| Patients with | |||
| Hospitalizations due to hypoglycemia and/or ketoacidosis | 77 (16%) | 14 (4%) | <0.0005 |
| Hospitalizations due to hypoglycemia | 59 (11%) | 12 (3%) | <0.0005 |
| Hospitalizations due to ketoacidosis | 23 (5%) | 4 (1%) | 0.092 |
| Work absenteesim* | 123 (25%) | 36 (9%) | <0.0005 |
| Days (per 100 patient years) of | |||
| Hospitalizations due to hypoglycemia and/or ketoacidosis | 53.5 | 17.8 | <0.0005 |
| Hospitalizations due to hypoglycemia | 38.5 | 12.5 | 0.001 |
| Hospitalizations due to ketoacidosis | 14.9 | 5.3 | 0.220 |
| Work absenteeism | 494.5 | 233.8 | 0.001 |
Data are n (%).
*Work absenteeism of at least half a day. Patient-reported hospital admissions were validated by clinicians.
Reference: Charleer S, et al. Clin Endocrinol Metab. 2018;103(3):1224–1232
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Reference: Charleer S, Mathieu C, Nobels F, et al. J Clin Endocrinol Metab. 2018;103(3):1224-1232.
LEARN MORESource: Journal of the American Medical Association
Key Takeaway: In the DIAMOND RCT, patients using multiple daily injections of insulin with type 1 diabetes who were randomly assigned to real-time CGM (rtCGM) had improved glycemic control vs. the SMBG group. This benefit was seen across patient groups regardless of baseline A1C, age, education level, or math ability. In addition, the rtCGM group spent 79% less time in nocturnal hypoglycemia, and also demonstrated a greater increase in hypoglycemic confidence and a greater decrease in diabetes distress vs. the SMBG group.
Learn MoreSource: Journal of the American Medical Association
Key Takeaway: In the GOLD trial, glycemic control was improved with use of rtCGM compared with conventional treatment; however, increases in A1C and hypoglycemic events occurred when patients reverted back to SMBG during the crossover/washout period, suggesting that the effectiveness of CGM depends on uninterrupted use during treatment with MDI. Additionally, the study showed reductions in severe and nocturnal hypoglycemia as well as in glycemic variability and improved hypoglycemic confidence for rtCGM users.
Source: Diabetes Care
Key Takeaway: The COMISAIR study is the longest running real-world real-time CGM (rtCGM) study performed to date. In this study, the continuous use of rtCGM had a sustained and durable benefit with regards to glycemic control over a 3-year time period, with rtCGM being superior to self-monitoring of blood glucose in reducing A1C, hypoglycemia, and glycemic variability in individuals with type 1 diabetes regardless of their insulin delivery method.
Observational COMISAIR Study in Patients With T1D Who Chose Insulin Delivery Method (MDI or Pump) and Monitoring Method (SMBG or CGM), Staying on Chosen Therapy for 3 Years
Source: The New England Journal of Medicine
Key Takeaway: This 6 month randomized trial showed use of a closed-loop system using the t:slim X2 insulin pump with Control-IQ Technology, (Tandem Diabetes Care) and a continuous glucose monitor (Dexcom G6, Dexcom) was safe and effective compared to sensor-augmented pump therapy (SAP). Participants in the closed-loop group achieved 70% time in range overall which meets the International Consensus Guidelines for people with diabetes. The closed-loop group also achieved significant improvements in hyperglycemia, HbA1c, mean glucose, and hypoglycemia (< 70 mg/dL < 54 mg/dL) as compared with the SAP group. Glycemic benefits were seen in the first month of the trial and were sustained over the entire 6-month period. Over 90% of participants said they trusted the device and found Control-IQ technology easy to use.
*Full article available for a fee
Learn MoreSource: The Lancet
Key Takeaway: This study conducted in Europe with over 300 participants found novel flash glucose testing reduced the time adults with well controlled type 1 diabetes spent in hypoglycaemia. Future studies are needed to assess the effectiveness of this technology in patients with less well controlled diabetes and in younger age groups.
Learn MoreSource: American Association of Clinical Endocrinologists
Conclusion: CGM improves glycemic control, reduces hypoglycemia, and may reduce overall costs of diabetes management. Expanding CGM coverage and utilization is likely to improve the health outcomes of people with diabetes.
LEARN MORESource: IQVIA
Key Takeaway: This webinar presented the first estimation of reduction in complications and costs associated with improving time-in-range per research found in the Advancing Glycemic Management in People with Diabetes report. The slides presented are available to help you learn about the Time-in-Range movement and gain an understanding about what’s to come in the realm of diabetes care management.
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