Magnitude of Glycemic Improvement in Patients with Type 2 Diabetes Treated with Basal Insulin: Subgroup Analyses from the MOBILE Study

Georgia Davis, Ryan Bailey, Peter Calhoun, David Price, Roy W Beck, Georgia Davis, Ryan Bailey, Peter Calhoun, David Price, Roy W Beck

Abstract

Objective: To determine if type 2 diabetes patients using basal insulin without prandial insulin with worse glycemic control at baseline would have the greatest benefit from using real-time continuous glucose monitoring (CGM). Methods: We conducted a post hoc analysis of the MOBILE Study, a multicenter trial examining the impact of CGM versus self-monitoring with a blood glucose meter (BGM) in patients with type 2 diabetes treated with basal insulin without prandial insulin. Participants were divided into subgroups based on baseline hemoglobin A1c (HbA1c) and baseline time-in-range 70-180 mg/dL (TIR). Change in TIR from baseline was calculated within each subgroup. Results: In subgroups based on baseline HbA1c, compared with the BGM group, the CGM group had 14% greater increase in TIR for participants with baseline HbA1c ≥8.5%, 14% greater increase for baseline HbA1c ≥9.0%, 22% greater increase for baseline HbA1c ≥9.5%, and 32% greater increase for baseline HbA1c ≥10.0% (P-value for interaction = 0.27). The time spent with glucose >250 mg/dL was significantly lower with CGM compared with BGM among participants with higher HbA1c values (P for interaction = 0.004). Results in subgroups based on baseline TIR paralleled the results in subgroups based on baseline HbA1c. Conclusion: While the benefit of CGM on TIR among patients with type 2 diabetes treated with basal insulin is apparent across the range of baseline glycemic control, the greatest impact of CGM is in those with the worst baseline glycemic control, particularly among those with HbA1c ≥10%. Clinical Trial Registration number: NCT03566693.

Keywords: Basal insulin; Continuous glucose monitoring; Glycemic management; Time-in-range.

Conflict of interest statement

G.D. reports receiving funding paid to her Institution from Insulet. R.B. has no disclosures. P.C. has no disclosures. D.P. is an employee of Dexcom and reports holding stock in the company. Dr. Beck reports no personal financial disclosures but reports that his institution has received funding on his behalf as follows: grant funding and study supplies from Tandem Diabetes Care, Beta Bionics, and Dexcom; study supplies from Medtronic, Ascensia, and Roche; consulting fees and study supplies from Eli Lilly and Novo Nordisk; and consulting fees from Insulet, Bigfoot Biomedical, vTv Therapeutics, and Diasome.

Figures

FIG. 1.
FIG. 1.
Change in HbA1c, TIR, mean glucose, and time above 250 mg/dL by baseline HbA1c. HbA1c, hemoglobin A1c.
FIG. 2.
FIG. 2.
Mean glucose over 24 h by baseline HbA1c. For those with baseline HbA1c

References

    1. Beck RW, Riddlesworth TD, Ruedy KJ, et al. : Effect of initiating use of an insulin pump in adults with type 1 diabetes using multiple daily insulin injections and continuous glucose monitoring (DIAMOND): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2017;5:700–708.
    1. Lind M, Polonsky W, Hirsch IB, et al. : Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. JAMA 2017;317:379–387.
    1. Garg S, Jovanovic L: Relationship of fasting and hourly blood glucose levels to HbA1c values: safety, accuracy, and improvements in glucose profiles obtained using a 7-day continuous glucose sensor. Diabetes Care 2006;29:2644–2649.
    1. Beck RW, Riddlesworth T, Ruedy K, et al. : Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. JAMA 2017;317:371–378.
    1. Beck RW, Riddlesworth TD, Ruedy K, et al. : Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Ann Intern Med 2017;167:365–374.
    1. The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group: Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med 2008;359:1464–1476.
    1. Price DA, Deng Q, Kipnes M, Beck SE: Episodic real-time CGM use in adults with type 2 diabetes: results of a pilot randomized controlled trial. Diabetes Ther 2021;12:2089–2099.
    1. Ehrhardt NM, Chellappa M, Walker MS, et al. : The effect of real-time continuous glucose monitoring on glycemic control in patients with type 2 diabetes mellitus. J Diabetes Sci Technol 2011;5:668–675.
    1. Yoo HJ, An HG, Park SY, et al. : Use of a real time continuous glucose monitoring system as a motivational device for poorly controlled type 2 diabetes. Diabetes Res Clin Pract 2008;82:73–79.
    1. den Braber N, Vollenbroek-Hutten MMR, Westerik KM, et al. : Glucose regulation beyond HbA1c in type 2 diabetes treated with insulin: real-world evidence from the DIALECT-2 cohort. Diabetes Care 2021;44:2238–2244.
    1. Bergenstal RM, Layne JE, Zisser H, et al. : Remote application and use of real-time continuous glucose monitoring by adults with type 2 diabetes in a virtual diabetes clinic. Diabetes Technol Ther 2021;23:128–132.
    1. Giugliano D, Maiorino M, Bellastella G, et al. : Relationship of baseline HbA1c, HbA1c change and HbA1c target of <7% with insulin analogues in type 2 diabetes: a meta-analysis of randomised controlled trials. Int J Clin Pract 2011;65:602–612.
    1. Min SH, Yoon J-H, Hahn S, Cho YM: Comparison between SGLT2 inhibitors and DPP4 inhibitors added to insulin therapy in type 2 diabetes: a systematic review with indirect comparison meta-analysis. Diabetes Metabol Res Rev 2017;33:e2818.
    1. Vilsbøll T, Rosenstock J, Yki-Järvinen H, et al. : Efficacy and safety of sitagliptin when added to insulin therapy in patients with type 2 diabetes. Diabetes Obes Metabol 2010;12:167–177.
    1. Reznik Y, Cohen O, Aronson R, et al. : Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial. Lancet 2014;384:1265–1272.
    1. Billings LK, Parkin CG, Price D: Baseline glycated hemoglobin values predict the magnitude of glycemic improvement in patients with type 1 and type 2 diabetes: subgroup analyses from the DIAMOND study program. Diabetes Technol Ther 2018;20:561–565.
    1. Calhoun P, Price D, Beck RW: Glycemic improvement using continuous glucose monitoring by baseline time in range: subgroup analyses from the DIAMOND type 1 diabetes study. Diabetes Technol Ther 2021;23:230–233.
    1. Bailey TS, Zisser HC, Garg SK: Reduction in hemoglobin A1C with real-time continuous glucose monitoring: results from a 12-week observational study. Diabetes Technol Ther 2007;9:203–210.
    1. Pickup JC, Freeman SC, Sutton AJ: Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ 2011;343:d3805.
    1. Pettus J, Price DA, Edelman SV: How patients with type 1 diabetes translate continuous glucose monitoring data into diabetes management decisions. Endocr Pract 2015;21:613–620.
    1. Martens T, Beck RW, Bailey R, et al. : Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin: a randomized clinical trial. JAMA 2021;325:2262–2272.
    1. Peters A, Cohen N, Calhoun P, et al. : Glycaemic profiles of diverse patients with type 2 diabetes using basal insulin: MOBILE study baseline data. Diabetes Obes Metab 2021;23:631–636.
    1. Kleinman LC, Norton EC: What's the risk? A simple approach for estimating adjusted risk measures from nonlinear models including logistic regression. Health Serv Res 2009;44:288–302.
    1. Pettus J, Edelman SV: Differences in use of glucose rate of change (ROC) arrows to adjust insulin therapy among individuals with type 1 and type 2 diabetes who use continuous glucose monitoring (CGM). J Diabetes Sci Technol 2016;10:1087–1093.

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