Short- and long-term effects of real-time continuous glucose monitoring in patients with type 2 diabetes
Robert A Vigersky, Stephanie J Fonda, Mary Chellappa, M Susan Walker, Nicole M Ehrhardt, Robert A Vigersky, Stephanie J Fonda, Mary Chellappa, M Susan Walker, Nicole M Ehrhardt
Abstract
Objective: To determine whether short-time, real-time continuous glucose monitoring (RT-CGM) has long-term salutary glycemic effects in patients with type 2 diabetes who are not on prandial insulin.
Research design and methods: This was a randomized controlled trial of 100 adults with type 2 diabetes who were not on prandial insulin. This study compared the effects of 12 weeks of intermittent RT-CGM with self-monitoring of blood glucose (SMBG) on glycemic control over a 40-week follow-up period. Subjects received diabetes care from their regular provider without therapeutic intervention from the study team.
Results: There was a significant difference in A1C at the end of the 3-month active intervention that was sustained during the follow-up period. The mean, unadjusted A1C decreased by 1.0, 1.2, 0.8, and 0.8% in the RT-CGM group vs. 0.5, 0.5, 0.5, and 0.2% in the SMBG group at 12, 24, 38, and 52 weeks, respectively (P = 0.04). There was a significantly greater decline in A1C over the course of the study for the RT-CGM group than for the SMBG group, after adjusting for covariates (P < 0.0001). The subjects who used RT-CGM per protocol (≥48 days) improved the most (P < 0.0001). The improvement in the RT-CGM group occurred without a greater intensification of medication compared with those in the SMBG group.
Conclusions: Subjects with type 2 diabetes not on prandial insulin who used RT-CGM intermittently for 12 weeks significantly improved glycemic control at 12 weeks and sustained the improvement without RT-CGM during the 40-week follow-up period, compared with those who used only SMBG.
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References
- National Diabetes Information Clearinghouse. National diabetes statistics [article online], 2011. Available from Accessed 29 May 2011
- Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr 2010;8:29.
- Hoerger TJ, Segel JE, Gregg EW, Saaddine JB. Is glycemic control improving in U.S. adults? Diabetes Care 2008;31:81–86
- Nathan DM, Buse JB, Davidson MB, et al. ; American Diabetes Association European Association for Study of Diabetes Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009;32:193–203
- Rodbard HW, Jellinger PS, Davidson JA, et al. Statement by an American Association of Clinical Endocrinologist/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract 2009;15:540–559
- U.S. Department of Veterans Affairs. VA/DoD clinical practice guidelines: management of diabetes mellitus in primary care (2010) [article online], 2010. Available from Accessed 29 May 2011
- 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
- Beck RW, Hirsch IB, Laffel L, et al. ; Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group The effect of continuous glucose monitoring in well-controlled type 1 diabetes. Diabetes Care 2009;32:1378–1383
- Deiss D, Bolinder J, Riveline JP, et al. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care 2006;29:2730–2732
- 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
- O’Connell MA, Donath S, O’Neal DN, et al. Glycaemic impact of patient-led use of sensor-guided pump therapy in type 1 diabetes: a randomised controlled trial. Diabetologia 2009;52:1250–1257
- Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care 2011;34:795–800
- Zick R, Petersen B, Richter M, Haug C; SAFIR Study Group Comparison of continuous blood glucose measurement with conventional documentation of hypoglycemia in patients with type 2 diabetes on multiple daily insulin injection therapy. Diabetes Technol Ther 2007;9:483–492
- Chico A, Vidal-Ríos P, Subirà M, Novials A. The continuous glucose monitoring system is useful for detecting unrecognized hypoglycemias in patients with type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control. Diabetes Care 2003;26:1153–1157
- 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 7 July 2011. [Epub ahead of print]
- Ehrhardt NM, Chellappa M, Walker MS, Fonda SJ, Vigersky RA. 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
- Welch GW, Jacobson AM, Polonsky WH. The Problem Areas in Diabetes Scale: an evaluation of its clinical utility. Diabetes Care 1997;20:760–766
- National Diabetes Information Clearinghouse. National diabetes statistics [article online], 2011. Available from Accessed 29 May 2011
- Phung OJ, Scholle JM, Talwar M, Coleman CI. Effect of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA 2010;303:1410–1418
- Bennett WL, Wilson LM, Bolen S, et al. Oral diabetes medications for adults with type 2 diabetes: an update. In Comparative Effectiveness Review no. 27 Rockville, MD, Agency for Healthcare Research and Quality (AHRQ), March 2011. Available from Accessed 10 November 2011 (Prepared by Johns Hopkins University Evidence-based Practice Center under contract no. 290-02-0018. AHRQ publ. no. 11-EHC038-EF)
- Gross JL, Kramer CK, Leitão CB, et al. ; Diabetes and Endocrinology Meta-analysis Group (DEMA) Effect of antihyperglycemic agents added to metformin and a sulfonylurea on glycemic control and weight gain in type 2 diabetes: a network meta-analysis. Ann Intern Med 2011;154:672–679
- Welschen LMC, Bloemendal E, Nijpels G, et al. Self-monitoring of blood glucose in patients with type 2 diabetes who are not using insulin: a systematic review. Diabetes Care 2005;28:1510–1517
- Sarol JN, Jr, Nicodemus NA, Jr, Tan KM, Grava MB. Self-monitoring of blood glucose as part of a multi-component therapy among non-insulin requiring type 2 diabetes patients: a meta-analysis (1966-2004). Curr Med Res Opin 2005;21:173–184
- Poolsup N, Suksomboon N, Rattanasookchit S. Meta-analysis of the benefits of self-monitoring of blood glucose on glycemic control in type 2 diabetes patients: an update. Diabetes Technol Ther 2009;11:775–784
- Jansen JP. Self-monitoring of glucose in type 2 diabetes mellitus: a Bayesian meta-analysis of direct and indirect comparisons. Curr Med Res Opin 2006;22:671–681
- Clar C, Barnard K, Cummins E, Royle P, Waugh N; Aberdeen Health Technology Assessment Group Self-monitoring of blood glucose in type 2 diabetes: systematic review. Health Technol Assess 2010;14:1–140
- Polonsky WH, Fisher L, Schikman CH, et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program Study. Diabetes Care 2011;34:262–267
- Franciosi M, Lucisano G, Pellegrini F, et al. ; ROSES Study Group ROSES: role of self-monitoring of blood glucose and intensive education in patients with type 2 diabetes not receiving insulin: a pilot randomized clinical trial. Diabet Med 2011;28:789–796
- Durán A, Martín P, Runkle I, et al. Benefits of self-monitoring blood glucose in the management of new-onset type 2 diabetes mellitus: the St Carlos Study, a prospective randomized clinic-based interventional study with parallel groups. J Diabetes 2010;2:203–211
- American Diabetes Association Standards of medical care in diabetes: 2011 2011;34Suppl. 1:S11–S61
- Handelsman Y, Mechanick JI, Blonde L, et al. ; AACE Task Force for Developing Diabetes Comprehensive Care Plan American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract 2011;17(Suppl. 2):1–53
- National Institute for Health and Clinical Excellence. Type 2 diabetes: national clinical guideline for management in primary and secondary care (update) [article online], 2008. Available from Accessed 2 September 2011
Source: PubMed