The Effect of Discontinuing Continuous Glucose Monitoring in Adults With Type 2 Diabetes Treated With Basal Insulin

Grazia Aleppo, Roy W Beck, Ryan Bailey, Katrina J Ruedy, Peter Calhoun, Anne L Peters, Rodica Pop-Busui, Athena Philis-Tsimikas, Shichun Bao, Guillermo Umpierrez, Georgia Davis, Davida Kruger, Anuj Bhargava, Laura Young, John B Buse, Janet B McGill, Thomas Martens, Quang T Nguyen, Ian Orozco, William Biggs, K Jean Lucas, William H Polonsky, David Price, Richard M Bergenstal, MOBILE Study Group, Type 2 Diabetes Basal Insulin Users: The Mobile Study (MOBILE) Study Group:, Thomas Martens, Anders Carlson, Richard M Bergenstal, Sharon Chambers, Shoua Yang, Laura Young, John Buse, M Sue Kirkman, Alexander Kass, Rachael Fraser, Davida Kruger, Terra Cushman, Georgia Davis, Clementina Ramos, Guillermo Umpierrez, Anne L Peters, Maria Magar, Martha Walker, Sara Serafin-Dokhan, Janet B McGill, Maamoun Salam, Stacy Hurst, Mary Jane Clifton, Grazia Aleppo, Jelena Kravarusic, Anupam Bansal, Candice Fulkerson, Rodica Pop-Busui, Lynn Ang, Caroline Richardson, Kara Mizokami-Stout, Jake Reiss, Virginia Leone, Anuj Bhargava, Kirstie Stifel, Athena Philis-Tsimikas, George Dailey, Amy Change, James McCallum, Maria Isabel Garcia, Shichun Bao, Dianne Davis, Cynthia Lovell, Connie Root, William Biggs, Freida Toler, Lori Wilhelm, Robin Eifert, Lorena Murguia, Becky Cota, Quang T Nguyen, Loida Nguyen, Randie Lipski, Ian Orozco, Mary Katherine Lawrence, Adelle Fournier, Matthew Carter, K Jean Lucas, Stephanie Hoover, Roy W Beck, Katrina J Ruedy, Peter Calhoun, Ryan Bailey, Nathan Cohen, Thomas Mouse, Jessica Rusnak, Tiffany Campos, David Price, Nelly Njeru, Tom Arant, Stayce E Beck, Andrew Balo, Grazia Aleppo, Roy W Beck, Ryan Bailey, Katrina J Ruedy, Peter Calhoun, Anne L Peters, Rodica Pop-Busui, Athena Philis-Tsimikas, Shichun Bao, Guillermo Umpierrez, Georgia Davis, Davida Kruger, Anuj Bhargava, Laura Young, John B Buse, Janet B McGill, Thomas Martens, Quang T Nguyen, Ian Orozco, William Biggs, K Jean Lucas, William H Polonsky, David Price, Richard M Bergenstal, MOBILE Study Group, Type 2 Diabetes Basal Insulin Users: The Mobile Study (MOBILE) Study Group:, Thomas Martens, Anders Carlson, Richard M Bergenstal, Sharon Chambers, Shoua Yang, Laura Young, John Buse, M Sue Kirkman, Alexander Kass, Rachael Fraser, Davida Kruger, Terra Cushman, Georgia Davis, Clementina Ramos, Guillermo Umpierrez, Anne L Peters, Maria Magar, Martha Walker, Sara Serafin-Dokhan, Janet B McGill, Maamoun Salam, Stacy Hurst, Mary Jane Clifton, Grazia Aleppo, Jelena Kravarusic, Anupam Bansal, Candice Fulkerson, Rodica Pop-Busui, Lynn Ang, Caroline Richardson, Kara Mizokami-Stout, Jake Reiss, Virginia Leone, Anuj Bhargava, Kirstie Stifel, Athena Philis-Tsimikas, George Dailey, Amy Change, James McCallum, Maria Isabel Garcia, Shichun Bao, Dianne Davis, Cynthia Lovell, Connie Root, William Biggs, Freida Toler, Lori Wilhelm, Robin Eifert, Lorena Murguia, Becky Cota, Quang T Nguyen, Loida Nguyen, Randie Lipski, Ian Orozco, Mary Katherine Lawrence, Adelle Fournier, Matthew Carter, K Jean Lucas, Stephanie Hoover, Roy W Beck, Katrina J Ruedy, Peter Calhoun, Ryan Bailey, Nathan Cohen, Thomas Mouse, Jessica Rusnak, Tiffany Campos, David Price, Nelly Njeru, Tom Arant, Stayce E Beck, Andrew Balo

Abstract

Objective: To explore the effect of discontinuing continuous glucose monitoring (CGM) after 8 months of CGM use in adults with type 2 diabetes treated with basal without bolus insulin.

Research design and methods: This multicenter trial had an initial randomization to either real-time CGM or blood glucose monitoring (BGM) for 8 months followed by 6 months in which the BGM group continued to use BGM (n = 57) and the CGM group was randomly reassigned either to continue CGM (n = 53) or discontinue CGM with resumption of BGM for glucose monitoring (n = 53).

Results: In the group that discontinued CGM, mean time in range (TIR) 70-180 mg/dL, which improved from 38% before initiating CGM to 62% after 8 months of CGM, decreased after discontinuing CGM to 50% at 14 months (mean change from 8 to 14 months -12% [95% CI -21% to -3%], P = 0.01). In the group that continued CGM use, little change was found in TIR from 8 to 14 months (baseline 44%, 8 months 56%, 14 months 57%, mean change from 8 to 14 months 1% [95% CI -11% to 12%], P = 0.89). Comparing the two groups at 14 months, the adjusted treatment group difference in mean TIR was -6% (95% CI -16% to 4%, P = 0.20).

Conclusions: In adults with type 2 diabetes treated with basal insulin who had been using real-time CGM for 8 months, discontinuing CGM resulted in a loss of about one-half of the initial gain in TIR that had been achieved during CGM use.

Trial registration: ClinicalTrials.gov NCT03566693.

© 2021 by the American Diabetes Association.

Figures

Figure 1
Figure 1
Glycemic outcomes by treatment and visit. Mean TIR 70–180 mg/dL (A) and mean HbA1c (B) at baseline, month 8, and month 14. The continue CGM group showed CGM for the full 14 months, and the BGM group used BGM for the full 14 months. The discontinue CGM group used CGM through month 8 and then discontinued CGM and used BGM through month 14. Error bars represent 95% CIs.
Figure 2
Figure 2
Twenty-four-hour plots of phase 2 TIR at baseline, month 8, and month 14 for each treatment group. A plot of TIR 70–180 mg/dL is shown for the discontinue CGM group (A), continue CGM group (B), and BGM group (C) at baseline, month 8, and month 14 according to time of day. Symbols denote the hourly median values for TIR.

References

    1. Beck RW, Riddlesworth T, Ruedy K, et al. .; DIAMOND Study Group . 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. .; DIAMOND Study Group . 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. Pratley RE, Kanapka LG, Rickels MR, et al. .; Wireless Innovation for Seniors With Diabetes Mellitus (WISDM) Study Group . Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial. JAMA 2020;323:2397–2406
    1. Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C; DIAMOND Study Group . Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial. J Diabetes Sci Technol 2017;11:1138–1146
    1. Tamborlane WV, Beck RW, Bode BW, et al. .; 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. Martens T, Beck RW, Bailey R, et al. .; MOBILE Study Group . 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. Nathan DM, Genuth S, Lachin J, et al. .; Diabetes Control and Complications Trial Research Group . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–986
    1. Beck RW, Bocchino LE, Lum JW, et al. . An evaluation of two capillary sample collection kits for laboratory measurement of HbA1c. Diabetes Technol Ther 2021;23:537–545
    1. Beck RW, Bergenstal RM, Riddlesworth TD, et al. . Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care 2019;42:400–405
    1. Lu J, Wang C, Shen Y, et al. . Time in range in relation to all-cause and cardiovascular mortality in patients with type 2 diabetes: a prospective cohort study. Diabetes Care 2021;44:549–555
    1. Guo Q, Zang P, Xu S, et al. . Time in range, as a novel metric of glycemic control, is reversely associated with presence of diabetic cardiovascular autonomic neuropathy independent of HbA1c in Chinese type 2 diabetes. J Diabetes Res 2020;2020: 5817074.
    1. Kim MY, Kim G, Park JY, et al. . The association between continuous glucose monitoring-derived metrics and cardiovascular autonomic neuropathy in outpatients with type 2 diabetes. Diabetes Technol Ther 2021;23:434–442
    1. Lu J, Ma X, Shen Y, et al. . Time in range is associated with carotid intima-media thickness in type 2 diabetes. Diabetes Technol Ther 2020;22:72–78
    1. Lu J, Ma X, Zhou J, et al. . Association of time in range, as assessed by continuous glucose monitoring, with diabetic retinopathy in type 2 diabetes. Diabetes Care 2018;41:2370–2376
    1. Mayeda L, Katz R, Ahmad I, et al. . Glucose time in range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease. BMJ Open Diabetes Res Care 2020;8:e000991
    1. Ranjan AG, Rosenlund SV, Hansen TW, Rossing P, Andersen S, Nørgaard K. Improved time in range over 1 year is associated with reduced albuminuria in individuals with sensor-augmented insulin pump-treated type 1 diabetes. Diabetes Care 2020;43:2882–2885
    1. Yoo JH, Choi MS, Ahn J, et al. . Association between continuous glucose monitoring-derived time in range, other core metrics, and albuminuria in type 2 diabetes. Diabetes Technol Ther 2020;22:768–776
    1. Battelino T, Conget I, Olsen B, et al. .; SWITCH Study Group . The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia 2012;55:3155–3162
    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. Ólafsdóttir AF, Polonsky W, Bolinder J, et al. . A randomized clinical trial of the effect of continuous glucose monitoring on nocturnal hypoglycemia, daytime hypoglycemia, glycemic variability, and hypoglycemia confidence in persons with type 1 diabetes treated with multiple daily insulin injections (GOLD-3). Diabetes Technol Ther 2018;20:274–284

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren