Continuous glucose monitoring in people with type 1 diabetes on multiple-dose injection therapy: the relationship between glycemic control and hypoglycemia
File(s)DC19-0977.R1_Proof_hi.pdf (1.21 MB)
Accepted version
Author(s)
Type
Journal Article
Abstract
OBJECTIVE: The inverse relationship between overall glucose control and hypoglycemia risk is weakened by the use of real-time continuous glucose monitoring (rtCGM). We assess the relationship between glucose control and hypoglycemia in people with type 1 diabetes using multiple-dose injection (MDI) regimens, including those at highest risk of hypoglycemia. RESEARCH DESIGN AND METHODS: CGM data from the intervention (rtCGM) and control (self-monitored blood glucose [SMBG]) phases of the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) and HypoDE studies were analyzed. The relationship between glucose control (HbA1c and mean rtCGM glucose levels) and percentage time spent in hypoglycemia was explored for thresholds of 3.9 mmol/L (70 mg/dL) and 3.0 mmol/L (54 mg/dL), and ANOVA across the range of HbA1c and mean glucose was performed. RESULTS: A nonlinear relationship between mean glucose and hypoglycemia was identified at baseline, with the steepest relationship seen at lower values of mean glucose. The use of rtCGM reduces the exposure to hypoglycemia at all thresholds and flattens the relationship between overall glucose and hypoglycemia, with the most marked impact at lower values of mean glucose and HbA1c. Exposure to hypoglycemia varied at all thresholds across the range of overall glucose at baseline, in the SMBG group, and with rtCGM, but the relationships were weaker in the rtCGM group. CONCLUSIONS: Usage of rtCGM can flatten and attenuate the relationship between overall glucose control and hypoglycemia, exerting its greatest impact at lower values of HbA1c and mean glucose in people with type 1 diabetes using MDI regimens and at highest risk of hypoglycemia.
Date Issued
2019-09-17
Date Acceptance
2019-08-27
Citation
Diabetes Care, 2019, 43 (1), pp.53-58
ISSN
0149-5992
Publisher
American Diabetes Association
Start Page
53
End Page
58
Journal / Book Title
Diabetes Care
Volume
43
Issue
1
Copyright Statement
© 2019 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.
Sponsor
National Institute for Health Research
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31530662
PII: dc19-0977
Grant Number
RDA11 79560
RDA29
Subjects
Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
DAILY INSULIN INJECTIONS
INTENSIVE TREATMENT
ADULTS
MULTICENTER
DIAMOND
Adult
Blood Glucose
Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 1
Dose-Response Relationship, Drug
Female
Glycated Hemoglobin A
Humans
Hypoglycemia
Hypoglycemic Agents
Injections, Subcutaneous
Insulin
Male
Middle Aged
Humans
Diabetes Mellitus, Type 1
Hypoglycemia
Insulin
Blood Glucose
Hypoglycemic Agents
Blood Glucose Self-Monitoring
Injections, Subcutaneous
Dose-Response Relationship, Drug
Adult
Middle Aged
Female
Male
Glycated Hemoglobin A
11 Medical and Health Sciences
Endocrinology & Metabolism
Publication Status
Published online
Coverage Spatial
United States
Date Publish Online
2019-09-17