Continuous Glucose Monitoring in People With Type 1 Diabetes on Multiple-Dose Injection Therapy: The Relationship Between Glycemic Control and Hypoglycemia
Open Access
- 17 September 2019
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 43 (1), 53-58
- https://doi.org/10.2337/dc19-0977
Abstract
OBJECTIVE The inverse relationship between overall glucose control and hypoglycemia risk is weakened by the use of real-time continuous glucose monitoring (rtCGM). We assess the relationship between glucose control and hypoglycemia in people with type 1 diabetes using multiple-dose injection (MDI) regimens, including those at highest risk of hypoglycemia. RESEARCH DESIGN AND METHODS CGM data from the intervention (rtCGM) and control (self-monitored blood glucose [SMBG]) phases of the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) and HypoDE studies were analyzed. The relationship between glucose control (HbA1c and mean rtCGM glucose levels) and percentage time spent in hypoglycemia was explored for thresholds of 3.9 mmol/L (70 mg/dL) and 3.0 mmol/L (54 mg/dL), and ANOVA across the range of HbA1c and mean glucose was performed. RESULTS A nonlinear relationship between mean glucose and hypoglycemia was identified at baseline, with the steepest relationship seen at lower values of mean glucose. The use of rtCGM reduces the exposure to hypoglycemia at all thresholds and flattens the relationship between overall glucose and hypoglycemia, with the most marked impact at lower values of mean glucose and HbA1c. Exposure to hypoglycemia varied at all thresholds across the range of overall glucose at baseline, in the SMBG group, and with rtCGM, but the relationships were weaker in the rtCGM group. CONCLUSIONS Use of rtCGM can flatten and attenuate the relationship between overall glucose control and hypoglycemia, exerting its greatest impact at lower values of HbA1c and mean glucose in people with type 1 diabetes using MDI regimens and at highest risk of hypoglycemia.This publication has 18 references indexed in Scilit:
- Glucose Concentrations of Less Than 3.0 mmol/L (54 mg/dL) Should Be Reported in Clinical Trials: A Joint Position Statement of the American Diabetes Association and the European Association for the Study of DiabetesDiabetes Care, 2016
- The Effect of Continuous Glucose Monitoring in Well-Controlled Type 1 DiabetesDiabetes Care, 2009
- Continuous Glucose Monitoring and Intensive Treatment of Type 1 DiabetesThe New England Journal of Medicine, 2008
- Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycaemia in type 1 diabetesDiabetologia, 2007
- Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 DiabetesThe New England Journal of Medicine, 2005
- Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trialBMJ, 2002
- Hypoglycemia in the Diabetes Control and Complications TrialDiabetes, 1997
- The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes MellitusThe New England Journal of Medicine, 1993
- Epidemiology of severe hypoglycemia in the diabetes control and complications trialThe American Journal of Medicine, 1991
- Epidemiology of severe hypoglycemia in the diabetes control and complications trialThe American Journal of Medicine, 1991