Continuous glucose monitoring in type 2 diabetes

Continuous glucose monitoring has shown to improve A1c in type 1 diabetes by 0.5% . The current randomized clinical trial reveals that similar A1c benefits (-0.3%) are seen in adults with type 2 diabetes receiving multiple daily insulin injections. A group of 160 participants were followed for 24 weeks.

It would be important to discuss the role of CGM with insulin-dependent DM2 patients, and when appropriate to intervene.

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Also see:

The future: implantable glucose meter

New glucose meter without fingersticks

 

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Background: Continuous glucose monitoring (CGM), which studies have shown is beneficial for adults with type 1 diabetes, has not been well-evaluated in those with type 2 diabetes receiving insulin.

Objective: To determine the effectiveness of CGM in adults with type 2 diabetes receiving multiple daily injections of insulin.

Design: Randomized clinical trial

Setting: 25 endocrinology practices in North America.

Primary Funding Source: Dexcom.

Patients: 158 adults who had had type 2 diabetes for a median of 17 years (interquartile range, 11 to 23 years). Participants were aged 35-79 years (mean 60), were receiving multiple daily injections of insulin, and had hemoglobin A1c (HbA1c) levels of 7.5-9.9% (mean, 8.5%).

Intervention: Random assignment to CGM (n = 79) or usual care (control group, n = 79).

Measurements: The primary outcome was HbA1c reduction at 24 weeks.

Results:

Mean HbA1c levels decreased to 7.7% in the CGM group and 8.0% in the control group at 24 weeks (adjusted difference in mean change, −0.3%, p = 0.022).

The groups did not differ meaningfully in CGM-measured hypoglycemia or quality-of-life outcomes. The CGM group averaged 6.7 days (SD, 0.9) of CGM use per week.

Conclusion:

A high percentage of adults who received multiple daily insulin injections for type 2 diabetes used CGM on a daily or near-daily basis for 24 weeks and had improved glycemic control. Because few insulin-treated patients with type 2 diabetes currently use CGM, these results support an additional management method that may benefit these patients.