CGM predictive low glucose alerts may prevent rebound hyperglycemia
medwireNews: Predictive low glucose alerts are associated with a reduced frequency and severity of rebound hyperglycemia among people using real-time continuous glucose monitoring (CGM), show study findings presented at the virtual ADA 80th Scientific Sessions.
Giada Acciaroli (Dexcom Inc, San Diego, California, USA) said the data suggest that “[r]ebound hyperglycemia events may represent an actionable goal for patients to reduce their glycemic variability.”
The study included data from a convenience sample of 24,518 anonymized users of the Dexcom G5 CGM device who transitioned to the G6 device, which has an “urgent low soon” feature, during 2018.
Acciaroli and team found that the transition from the G5 to G6 device was associated with significant improvements in the mean frequency, severity, and duration of rebound hyperglycemia events, which were defined as any series of sensor glucose values (SGVs) above 180 mg/dL (10 mmol/L) that occurred up to 2 hours after a low SGV (<70 or <55 mg/dL; <3.9 or 3.0 mmol/L).
Specifically, following a hypoglycemia event below 70 mg/dL, there was a significant 7% reduction in mean frequency of rebound hyperglycemia events per week with G6 versus G5 (1.70 vs 1.83), an 8% reduction in mean rebound hyperglycemia duration (197 vs 214 min), and a 13% reduction in severity, defined as the area under the curve (AUC) for consecutive SGVs above 180 mg/dL (13,638 vs 15,601 min per mg/dL).
And the difference between the G6 and G5 devices was even more pronounced following hypoglycemia below 55 mg/dL, with a significant 33% reduction in rebound hyperglycemia events per week (0.52 vs 0.78), a 22% reduction in event duration (171 vs 219 mins), and a 27% reduction in event severity (AUC 12,283 vs 16,741 min per mg/dL).
Acciaroli also reported that there was a positive correlation between rebound hyperglycemia frequency and glycemic variability, whereby the number of rebound hyperglycemia events per week increased with increasing SGV coefficient of variation (CV).
Further analysis showed that, among the G6 population, rebound hyperglycemia frequency and duration were significantly higher among individuals with unstable SGVs (CV >39.1%) than among those with stable SGVs (CV <31.2%), at 3.03 versus 0.41 events per week and 217 versus 133 minutes, respectively.
Acciaroli said this suggests that “reducing rebound hyperglycemia may help [to lower] glycemic variability,” which in turn could decrease morbidity and mortality that has previously been associated with increased glycemic variability.
She concluded: “The [urgent low soon] alert in the G6 CGM system, intended to reduce hypoglycemia, mitigates rebound hyperglycemia events in users who transition from a system without predictive alerts and may contribute to other metrics of improved glycemic control.”
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