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Continuous Glucose Monitor Use Prevents Glycemic Deterioration in Insulin-Treated Patients with Type 2 Diabetes

Andrew J Karter1, Melissa M Parker1, Howard H Moffet1

  • 1Kaiser Permanente-Division of Research, Oakland, California, USA.

Diabetes Technology & Therapeutics
|February 1, 2022
PubMed

Insights

Continuous glucose monitoring (CGM) may help prevent worsening glycemic control in well-managed patients with type 2 diabetes (T2D) on insulin. While CGM initiation showed a slight HbA1c decrease, it did not significantly impact severe hypoglycemia rates.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Diabetes Management

Background:

  • Continuous glucose monitoring (CGM) is recommended for poorly controlled insulin-treated type 2 diabetes (T2D) to improve glycemic control and reduce hypoglycemia.
  • The utility of CGM in lower-risk T2D patients, specifically those with hemoglobin A1c (HbA1c) <8% and no recent severe hypoglycemia, remains understudied.

Purpose of the Study:

  • To evaluate the impact of CGM initiation on glycemic control and severe hypoglycemia rates in insulin-treated T2D patients with well-controlled HbA1c levels.

Main Methods:

  • A retrospective study analyzed 17,422 insulin-treated T2D patients with HbA1c <8% and no recent severe hypoglycemia.
  • 149 patients initiated CGM, serving as the intervention group, while 17,273 patients did not initiate CGM (reference group).
  • Changes in HbA1c and severe hypoglycemia rates were compared for 12 months before and after CGM initiation using a weighted adjusted difference-in-difference model.

Main Results:

  • CGM initiation was associated with a decrease in HbA1c (-0.06%), whereas non-initiation showed an increase in HbA1c (+0.32%).
  • The weighted adjusted difference-in-difference analysis indicated a net benefit of -0.30% in HbA1c change for CGM initiators (95% CI -0.50% to -0.10%, P=0.004).
  • No significant difference in the rates of severe hypoglycemia was observed between the CGM initiators and non-initiators.

Conclusions:

  • CGM initiation may be beneficial in preventing glycemic deterioration among well-controlled, insulin-treated T2D patients.
  • The study suggests CGM's utility extends beyond poorly controlled diabetes, potentially aiding in maintaining glycemic stability in lower-risk populations.
  • Further research may explore long-term outcomes and cost-effectiveness of CGM in this patient group.
Keywords:
Continuous glucose monitorsGlycemic controlHypoglycemiaReal-world evidenceSelf-monitoring of blood glucoseType 2 diabetes

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