Compared with usual care, use of continuous glucose monitoring improved glycemic control in patients with poorly controlled type 2 diabetes who were receiving multiple daily injections of basal–bolus, according to results of a trial published in the Annals of Internal Medicine.
Patients with type 1 diabetes often use continuous glucose monitoring to measure their blood glucose levels, and these continuous assessments have resulted in better glycemic control in this patient population. Little was known, however, on whether continuous glucose monitoring might also benefit patients with type 2 diabetes.
The 24-week trial evaluated the effectiveness of continuous glucose monitoring compared with usual care in patients with type 2 diabetes who were receiving multiple injections of insulin per day. A total of 158 adults with type 2 diabetes from 25 endocrinology practices across North America were randomized to either continuous glucose monitoring (n = 79) or usual care (n = 79). Patients had a mean age of 60 years, a median duration of diabetes of 17 years, and baseline hemoglobin A1C levels ranging from 7.5% to 9.9% (mean 8.5%).
All patients were given a Contour Next USB meter and test strips, and patients in the continuous glucose monitoring group were given a system that measures glucose concentrations from the intestinal fluid in the range of 40 to 400 mg/dL every 5 minutes. Those in the usual care group were instructed to measure their blood glucose at least four times per day. The protocol did not specify insulin adjustments in either group, and these changes were made at the physician’s discretion.
After 24 weeks, the mean changes in hemoglobin A1C were –1.0% in the continuous glucose monitoring group compared with –0.6% in the usual care group (adjusted difference –0.3%, P = 0.005). No meaningful differences were observed in rates of hypoglycemia or quality-of-life outcomes.
In an accompanying editorial, the authors highlighted some of the challenges of using continuous glucose monitoring in patients with type 2 diabetes. These included comprehensive education for patients and the providers overseeing their care, cost-effectiveness of this approach given the modest improvements, and ease of use.
“Currently, insurance coverage for type 2 diabetes remains somewhat limited, given the small number of studies in specific diabetic subgroups showing modest improvements in short-term outcomes,” the authors wrote. “Clinicians should carefully select real-time-continuous glucose monitoring candidates who may achieve maximum clinical utility, such as those who have type 1 diabetes, high risk for hypoglycemia, and high medical literacy; those who adhere to medical device instructions; and now patients with type 2 diabetes receiving multiple daily injections of insulin.”
Because of an editing error, the article was corrected on October 12, 2017. Pharmacy Today apologizes for the error.
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