Majority of MDI users improve glycemic outcomes with CGM
medwireNews: Analysis of the GOLD study suggests that at least three-quarters of people with type 1 diabetes using multiple daily injections (MDI) benefit from continuous glucose monitoring (CGM).
However, few people – just 14% – achieved both response criteria of a reduction in glycated hemoglobin (HbA1c) levels and a decrease in the amount of time spent in hypoglycemia. For most people, it was one or the other.
The findings, presented at the 55th EASD Annual Meeting in Barcelona, Spain, by Arndis Olafsdottir (University of Gothenburg, Sweden), come from a secondary analysis of the randomized crossover GOLD trial.
The 161 study participants, who all had type 1 diabetes and were using MDI for insulin delivery, achieved an average 0.43% reduction in HbA1c and a 29-minute reduction in the daily time spent in hypoglycemia during their 26 weeks of using CGM compared with the same duration of self-monitored blood glucose (SMBG).
Olafsdottir and team defined responders as those with at least a 0.4% reduction in HbA1c or a 20-minute reduction in time in hypoglycemia. Although 78% of participants met one of these criteria, few met both – overall, in fact, reduction in HbA1c significantly correlated with an increase in hypoglycemic time.
An equal proportion of people achieved one or the other criterion; 22% achieved neither.
People with the poorest glycemic control at baseline benefitted most from CGM, so those with the highest HbA1c were the most likely to respond according to the HbA1c measure and those with the longest time in hypoglycemia were the most likely to meet the hypoglycemia target.
Being female and having a higher score for hypoglycemia confidence were also associated with achieving the hypoglycemia response criterion.
Olafsdottir noted that the baseline frequency of SMBG was not associated with either measure of response.
“These results show that it is not possible to find just one criterion to choose which patients should receive CGM,” she said.
She stressed in particular that fact that some guidelines stipulate a certain frequency of SMBG to qualify patients for CGM, yet the GOLD trial showed no association between SMBG and CGM response.
“Therefore it is important that as many patients as possible are offered CGM therapy,” concluded Olafsdottir.
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