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04-08-2020 | Diabetes | News | Article

Factory-calibrated CGM may assist glucose control for young adults with type 1 diabetes

Eleanor McDermid

medwireNews: The Dexcom G6 continuous glucose monitoring (CGM) system may be a good option to help young adults with type 1 diabetes control their blood glucose, show the results of the MILLENNIAL trial.

The G6 is the first Dexcom CGM version that does not require user calibration, so fingerstick measurements are needed only if there is reason to doubt the accuracy of the CGM reading.

“The reduced daily burden of using factory-calibrated CGM […] may have been a contributory factor associated with the greater satisfaction and openness reported in this study, as well as reduced daily hassle associated with the device,” write Hood Thabit (Manchester Royal Infirmary, UK) and study co-authors in Diabetes Care.

The 30 participants, who were aged an average of 21.2 years, used the G6 system for a median 84.0% (interquartile range 62.6–94.0%) of the 8-week active study period. The researchers say this amount of use is markedly higher than that seen in some other studies, and may also reflect the convenience of the participants being able to use a smartphone app, so they had no need to carry an additional device.

“Device burden is known to be associated with discontinuation of CGM use in this cohort,” they say.

However, the team notes that their study was limited by its relatively short duration. A recent study in the same age group reported that initially high CGM use (over the first 28 days) reduced markedly by 26 weeks, reducing the impact of CGM on glycemic outcomes. On the other hand, participants in that study used the older Dexcom G5 system, which requires two daily fingerstick tests for calibration.

The current study’s primary outcome was time in blood glucose range 70–180 mg/dL (3.9–10.0 mmol/L). The participants remained within this range for 35.7% of the time while using CGM and for 24.6% (measured by blinded CGM) during 8 weeks of using self-monitored blood glucose. The two phases occurred in a randomly assigned order with a 3- to 4-week washout between, and the 11.1% absolute difference between the two phases was statistically significant.

The difference was accounted for by a large (11.9%) difference in the time spent above 180 mg/dL. The study participants spent only a very small amount of time below 70 mg/dL, and this did not significantly differ between the phases, at 1.45% and 0.58% for the CGM and self-monitored phases, respectively.

Baseline glycated hemoglobin (HbA1c) was 9.3% (78.4 mmol/mol) on average. During the CGM phase it fell by 0.53% (5.9 mmol/mol), whereas it increased by 0.24% (2.6 mmol/mol) during the self-monitored blood glucose phase, giving a significant 0.76% (8.5 mmol/mol) difference between the phases.

“Although the time in target achieved by CGM in our study was relatively low compared with that reported by others, the reduction in HbA1c achieved is nevertheless clinically meaningful in this young population in the reduction of the risk of future complications,” say Thabit and team.

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

Diabetes Care 2020; doi:10.2337/dc20-0736

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