TY - JOUR
T1 - Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections
AU - Beck, Roy W.
AU - Riddlesworth, Tonya D.
AU - Ruedy, Katrina
AU - Ahmann, Andrew
AU - Haller, Stacie
AU - Kruger, Davida
AU - McGill, Janet B.
AU - Polonsky, William
AU - Price, David
AU - Aronoff, Stephen
AU - Aronson, Ronnie
AU - Toschi, Elena
AU - Kollman, Craig
AU - Bergenstal, Richard
N1 - Funding Information:
Disclosures: Dr. Beck reports grants from Dexcom during the conduct of the study and other support from Dexcom and Abbott Diabetes Care outside the submitted work. Ms. Ruedy reports grants from Dexcom during the conduct of the study and other fees from Dexcom and Abbott Diabetes Care outside the submitted work. Dr. Ahmann reports grants and personal fees from Dexcom during the conduct of the study; grants from Novo Nordisk, Sanofi, Lexicon, and Medtronic outside the submitted work; and personal fees from Novo Nordisk, Sanofi, Eli Lilly, and Janssen outside the submitted work. Ms. Kruger reports grants from Henry Ford Health System during the conduct of the study; grants from Novo Nordisk, Eli Lilly, Dexcom, and Abbott Diabetes Care outside the submitted work; personal fees from Novo Nordisk, Janssen, Eli Lilly, Boehringer Ingelheim, Sanofi, Dexcom, Abbott Diabetes Care, Intarsia, and AstraZeneca outside the submitted work; and holding Dexcom stock. Dr. McGill reports personal fees from Boehringer Ingelheim, Dexcom, Dynavax, Janssen, Intarcia, Merck, Novo Nordisk, and Valeritas and grants from Dexcom, AstraZeneca/Bristol-Myers Squibb, Novartis, and Lexicon outside the submitted work. Dr. Polonsky reports personal fees from Dexcom during the conduct of the study and from Dexcom and Abbott Diabetes Care outside the submitted work. Dr. Price reports being a Dexcom employee and a shareholder of Dexcom stock. Dr. Aronson reports research support from Merck, Boehringer Ingelheim, Regeneron, Abbott Diabetes Care, Quintiles, ICON, GlaxoSmithKline, Med-pace, Novo Nordisk, Janssen, Sanofi, Bristol-Myers Squibb, AstraZeneca, Becton Dickinson, Eli Lilly, Amgen, and Takeda and personal fees from Novo Nordisk, Janssen, Sanofi, Astra-Zeneca, Becton Dickinson, Eli Lilly, and Amgen outside the submitted work. Dr. Kollman reports grants from Dexcom during the conduct of the study. Dr. Bergenstal reports grants and other fees from Abbott Diabetes Care, Becton Dickinson, Boehringer Ingelheim, Bristol-Myers Squibb/AstraZeneca, Calibra Medical, Eli Lilly, Hygieia, Johnson & Johnson, Medtronic, Novo Nordisk, Roche, Sanofi, Takeda, and Dex-com during the conduct of the study. Dr. Bergenstal is employed by HealthPartners Institute/Park Nicollet Health Services and has contracts with the listed companies for his services as a research investigator or consultant; no personal income from any of these services goes to Dr. Bergenstal. Dr. Bergenstal also reports holding stock in Merck. Authors not named here have disclosed no conflicts of interest. Disclo- sures can also be viewed at www.acponline.org/authors/icmje /ConflictOfInterestForms.do?msNum=M16-2855.
Publisher Copyright:
© 2017 American College of Physicians.
PY - 2017/9/19
Y1 - 2017/9/19
N2 - 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. (The protocol also included a type 1 diabetes cohort in a parallel trial and subsequent second trial.) (ClinicalTrials.gov: NCT02282397) Setting: 25 endocrinology practices in North America. 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 to 79 years (mean, 60 years [SD, 10]), were receiving multiple daily injections of insulin, and had hemoglobin A1c (HbA1c) levels of 7.5% to 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% [95% CI, -0.5% to 0.0%]; 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. Limitation: 6-month follow-up. 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.
AB - 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. (The protocol also included a type 1 diabetes cohort in a parallel trial and subsequent second trial.) (ClinicalTrials.gov: NCT02282397) Setting: 25 endocrinology practices in North America. 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 to 79 years (mean, 60 years [SD, 10]), were receiving multiple daily injections of insulin, and had hemoglobin A1c (HbA1c) levels of 7.5% to 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% [95% CI, -0.5% to 0.0%]; 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. Limitation: 6-month follow-up. 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.
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U2 - 10.7326/M16-2855
DO - 10.7326/M16-2855
M3 - Article
C2 - 28828487
AN - SCOPUS:85029688306
SN - 0003-4819
VL - 167
SP - 365
EP - 374
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 6
ER -