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The majority of people with type 1 diabetes and multiple daily insulin injections benefit from using continuous glucose monitoring : An analysis based on the GOLD randomized trial (GOLD-5)

Ólafsdóttir, Arndís F. ; Bolinder, Jan ; Heise, Tim ; Polonsky, William ; Ekelund, Magnus LU ; Wijkman, Magnus ; Pivodic, Aldina ; Ahlén, Elsa ; Schwarcz, Erik and Nyström, Thomas , et al. (2021) In Diabetes, Obesity and Metabolism 23(2). p.619-630
Abstract

Aim: To identify responders to continuous glucose monitoring (CGM) in relation to reductions in HbA1c and percentage of time spent in hypoglycaemia after initiation of CGM for individuals with type 1 diabetes treated with multiple daily insulin injections. Materials and Methods: We analysed data from 142 participants in the GOLD randomized clinical trial. We evaluated how many lowered their HbA1c by more than 0.4% (>4.7 mmol/mol) or decreased the time spent in hypoglycaemia over 24 hours by more than 20 or 30 minutes, and which baseline variables were associated with those improvements. Results: Lower reduction of HbA1c was associated with greater reduction of hypoglycaemia (r = −0.52; P <.0001). During CGM, 47% of participants... (More)

Aim: To identify responders to continuous glucose monitoring (CGM) in relation to reductions in HbA1c and percentage of time spent in hypoglycaemia after initiation of CGM for individuals with type 1 diabetes treated with multiple daily insulin injections. Materials and Methods: We analysed data from 142 participants in the GOLD randomized clinical trial. We evaluated how many lowered their HbA1c by more than 0.4% (>4.7 mmol/mol) or decreased the time spent in hypoglycaemia over 24 hours by more than 20 or 30 minutes, and which baseline variables were associated with those improvements. Results: Lower reduction of HbA1c was associated with greater reduction of hypoglycaemia (r = −0.52; P <.0001). During CGM, 47% of participants lowered their HbA1c values by more than 0.4% (>4.7 mmol/mol) than with self-measurement of blood glucose, and 47% decreased the time spent in hypoglycaemia by more than 20 minutes over 24 hours. Overall, 78% either reduced their HbA1c by more than 0.4% (>4.7 mmol/mol) or the time spent in hypoglycaemia by more than 20 minutes over 24 hours, but only 14% improved both. Higher HbA1c, a lower percentage of time at less than 3.0 or 3.9 mmol/L, a lower coefficient of variation (CV) and a higher percentage of time above 13.9 mmol/L (P =.016) were associated with greater HbA1c reduction during CGM. The variables associated with a greater reduction of time in hypoglycaemia were female sex, greater time with glucose levels at less than 3.0 mmol/L, higher CV, and higher hypoglycaemia confidence as evaluated by a hypoglycaemic confidence questionnaire. Conclusion: The majority of people with type 1 diabetes managed by multiple daily insulin injections benefit from CGM; some experienced reduced HbA1c while others reduced the time spent in hypoglycaemia. These factors need to be considered by healthcare professionals and decision-makers for reimbursement and diabetes guidelines.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
clinical trial, CGM, randomized trial, type 1 diabetes
in
Diabetes, Obesity and Metabolism
volume
23
issue
2
pages
619 - 630
publisher
Wiley-Blackwell
external identifiers
  • scopus:85097510910
  • pmid:33200487
ISSN
1462-8902
DOI
10.1111/dom.14257
language
English
LU publication?
yes
id
7416a7c4-49a2-453b-b643-19e81abc2950
date added to LUP
2020-12-23 10:17:03
date last changed
2024-06-13 02:53:58
@article{7416a7c4-49a2-453b-b643-19e81abc2950,
  abstract     = {{<p>Aim: To identify responders to continuous glucose monitoring (CGM) in relation to reductions in HbA1c and percentage of time spent in hypoglycaemia after initiation of CGM for individuals with type 1 diabetes treated with multiple daily insulin injections. Materials and Methods: We analysed data from 142 participants in the GOLD randomized clinical trial. We evaluated how many lowered their HbA1c by more than 0.4% (&gt;4.7 mmol/mol) or decreased the time spent in hypoglycaemia over 24 hours by more than 20 or 30 minutes, and which baseline variables were associated with those improvements. Results: Lower reduction of HbA1c was associated with greater reduction of hypoglycaemia (r = −0.52; P &lt;.0001). During CGM, 47% of participants lowered their HbA1c values by more than 0.4% (&gt;4.7 mmol/mol) than with self-measurement of blood glucose, and 47% decreased the time spent in hypoglycaemia by more than 20 minutes over 24 hours. Overall, 78% either reduced their HbA1c by more than 0.4% (&gt;4.7 mmol/mol) or the time spent in hypoglycaemia by more than 20 minutes over 24 hours, but only 14% improved both. Higher HbA1c, a lower percentage of time at less than 3.0 or 3.9 mmol/L, a lower coefficient of variation (CV) and a higher percentage of time above 13.9 mmol/L (P =.016) were associated with greater HbA1c reduction during CGM. The variables associated with a greater reduction of time in hypoglycaemia were female sex, greater time with glucose levels at less than 3.0 mmol/L, higher CV, and higher hypoglycaemia confidence as evaluated by a hypoglycaemic confidence questionnaire. Conclusion: The majority of people with type 1 diabetes managed by multiple daily insulin injections benefit from CGM; some experienced reduced HbA1c while others reduced the time spent in hypoglycaemia. These factors need to be considered by healthcare professionals and decision-makers for reimbursement and diabetes guidelines.</p>}},
  author       = {{Ólafsdóttir, Arndís F. and Bolinder, Jan and Heise, Tim and Polonsky, William and Ekelund, Magnus and Wijkman, Magnus and Pivodic, Aldina and Ahlén, Elsa and Schwarcz, Erik and Nyström, Thomas and Hellman, Jarl and Hirsch, Irl B. and Lind, Marcus}},
  issn         = {{1462-8902}},
  keywords     = {{clinical trial, CGM, randomized trial, type 1 diabetes}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{619--630}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Diabetes, Obesity and Metabolism}},
  title        = {{The majority of people with type 1 diabetes and multiple daily insulin injections benefit from using continuous glucose monitoring : An analysis based on the GOLD randomized trial (GOLD-5)}},
  url          = {{http://dx.doi.org/10.1111/dom.14257}},
  doi          = {{10.1111/dom.14257}},
  volume       = {{23}},
  year         = {{2021}},
}