Sustained use of real-time continuous glucose monitoring (rtCGM) over 24 months led to significant improvements in hypoglycemia-related glucose control, particularly in patients with impaired awareness of hypoglycemia (IAH), according to study results published in Diabetes Care.
Although the use of rtCGM among patients with type 1 diabetes has increased in recent years, limited data are available on the long-term benefits of sustained use of rtCGM. The objective of the current study was to determine the benefits of real-world rtCGM use up to 24 months.
The primary endpoint was evolution of glycated hemoglobin (HbA1c) over time between baseline and 24 months after initiation of rtCGM. Secondary endpoints included the effects of rtCGM on acute diabetes complications (hypoglycemia and/or ketoacidosis), work absenteeism, quality of life, proportion of participants with HbA1c less than 7%, and reasons for discontinuing rtCGM.
The prospective, observational cohort study included 441 adults with insulin pumps and fully reimbursed CGM, of which 44% had IAH. During the study period, 81 (18.4%) patients stopped using rtCGM, mostly because of the system itself.
At 24 months, the evolution of HbA1c was significantly lower compared with levels at baseline (7.37% vs 7.64%, respectively; P <.0001). No difference in evolution of HbA1c was reported for individuals with and without IAH.
In participants with and without IAH, hypoglycemia-related events declined, but the proportion of reduction was larger for patients with IAH compared with patients with normal hypoglycemia awareness, especially for severe hypoglycemia (862 events/100 patient-years in the year before the study vs 119 events/100 patient-years after 24 months; P <.0001).
The percentage of patients who reached the clinical consensus targets for hypoglycemia as measured by rtCGM from the first 2 weeks until 24 months was higher, and this was not achieved at the expanse of a deterioration of overall glycemic control.
Furthermore, the proportion of individuals who reached the target HbA1c of less than 7% was higher with the use of rtCGM compared with the year prior to rtCGM reimbursement. At 24 months, 25.4% of patients achieved HbA1c of less than 7% without severe hypoglycemia compared with 11% of patients at baseline (P <.0001).
The study had several limitations, including a high dropout rate, nonrandomized and observational design, and the use of various sensor-insulin pump combinations with different suspend features and levels of accuracy.
“Use of rtCGM led to sustained improvements in hypoglycemia-related glucose control over 24 months,” concluded the researchers. “Lower fear of hypoglycemia, less acute hypoglycemia-related events, and [fewer] diabetes-related days off from work were observed, particularly in those with IAH.”
Charleer S, De Block C, Nobels F, et al; RESCUE Trial Investigators. Sustained impact of real-time continuous glucose monitoring in adults with type 1 diabetes on insulin pump therapy: results after the 24-month RESCUE study. Published online Oct 16, 2020. Diabetes Care. doi: 10.2337/dc20-1531