More people with type 2 diabetes can benefit!

▎Editor of WuXi AppTec's content team.
Patients with type 2 diabetes who have poor blood sugar control may face higher risks of complications and comorbidities
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Achieving blood sugar goals is critical to improving the health of people with diabetes
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About 30% of patients with type 2 diabetes need insulin therapy.
Although blood glucose self-monitoring is a standard part of diabetes self-management, a considerable number of patients do not self-adjust insulin well
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Recently, the Journal of the American Medical Association (JAMA) published two important studies in a row, showing that continuous blood glucose monitoring (CGM) can benefit a wider range of patients with type 2 diabetes, help better control blood sugar and reduce the risk of hypoglycemia, and Not only limited to the population recommended by the existing guidelines
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In an editorial published in the same JAMA journal, two endocrinologists from the University of Chicago pointed out that the results of these two studies have important clinical significance
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"Research provides strong evidence that continuous blood glucose monitoring can help control diabetes in multiple patient groups
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" Image source: 123RF is different from the traditional "finger" measurement of blood glucose, continuous blood glucose monitoring is performed every 5 minutes through a sensor The frequency of measuring the blood glucose level in the subcutaneous tissue fluid
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Clinical trials in patients with type 2 diabetes have proven that continuous blood glucose monitoring can improve diabetes control and reduce hypoglycemia
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Taking the recommendations of the Chinese guidelines as an example, the current applicable populations of continuous blood glucose monitoring system mainly include: type 1 diabetes; type 2 diabetes patients who need intensive insulin therapy; type 2 diabetes who use hypoglycemic therapy under self-monitoring of blood glucose but still have poor blood glucose control Patients; gestational diabetes with GDM or diabetes with pregnancy
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Among them, for patients with type 2 diabetes who need intensive insulin therapy, the intensive insulin therapy program includes a basic-meal insulin therapy program (multiple subcutaneous injections of insulin or continuous subcutaneous insulin infusion using an insulin pump) or premixed insulin injections per day 2 Or 3 times plan
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However, there are still some questions to be answered in practical applications: Can the results of clinical trials for patients with type 2 diabetes be translated into benefits in the conventional real-world environment? Can patients with type 2 diabetes who use low-intensity insulin regimens also benefit? In response to these problems, the randomized clinical trials and observational studies published this time provide important new evidence
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Screenshot source: JAMA's first randomized clinical trial proved that continuous blood glucose monitoring can achieve better blood glucose control in adult patients with type 2 diabetes who only inject basal insulin without using mealtime insulin
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Compared with the current recommended population, the insulin treatment plan for these type 2 diabetic patients is simpler
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The study recruited 175 adult patients with type 2 diabetes who were using basal insulin (medium-acting and long-acting) but not yet using mealtime insulin in 15 primary medical institutions in the United States
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These patients were divided into 2:1 groups to receive continuous blood glucose monitoring (n = 116) or traditional blood glucose meter monitoring (n = 59)
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After 8 months, the average glycated hemoglobin (HbA1c) of the continuous blood glucose monitoring group improved significantly, from 9.
1% to 8.
0%, and the HbA1c of the control group decreased from 9.
0% to 8.
4% (adjusted difference -0.
4%; P =0.
02)
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In the continuous blood glucose monitoring group, it takes 3.
6 hours longer for patients in the continuous blood glucose monitoring group to stabilize their blood glucose within the target range (70-180 mg/dL) (59% vs 43% in the whole day, 15% after adjustment; p<0.
001); The time for blood glucose to exceed 250 mg/dL was 3.
8 hours shorter (11% vs 27%, adjusted difference −16%; p<0.
001); average blood glucose was low by 26 mg/dL per day
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One patient (1% vs 2%) in each group had a severe hypoglycemia event
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▲HbA1c levels of patients in the two groups at 8 months, orange-continuous blood glucose monitoring group, green-traditional blood glucose meter monitoring group
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(Image source: Reference [1]) Figure A: Comparison between 8 months and the research baseline.
The dot below the diagonal represents the decrease in HbA1c levels at 8 months
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Figure B: Cumulative proportion of patients reaching different HbA1c levels
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Exploratory analysis showed that there was no difference in the improvement of HbA1c among patients of different age groups, education levels, and baseline disease control
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Screenshot source: JAMA's second study is a retrospective cohort study conducted in a real-world environment.
By comparing the data of more than 40,000 patients, it is found that after continuous blood glucose monitoring is initiated, the HbA1c level of type 2 diabetes patients decreases more than type 1 diabetes Patient
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The lead author of the study, Dr.
Andrew J.
Karter, senior research scientist at Kaiser Permanente, an authoritative medical institution in the United States, said: "Continuous blood glucose monitoring may improve blood glucose control as effective as patients taking a new hypoglycemic drug
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" The study was integrated from Northern California.
A total of 41,753 patients were included in the healthcare system, including 5,673 type 1 diabetes patients and 36080 type 2 diabetes patients
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These patients are receiving insulin therapy and self-monitoring blood glucose, but have not received continuous blood glucose monitoring before
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The research team evaluated the impact of continuous blood glucose monitoring (3806 patients) initiated by doctors during the study
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Comparing the results of the 12 months before the study and the 12 months after the study showed that the HbA1c level of patients who initiated continuous blood glucose monitoring decreased by 0.
4% (P<0.
001), from 8.
17% to 7.
76%, and other control patients decreased from 8.
28% To 8.
19%
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For different blood glucose goals, the initiation of continuous blood glucose monitoring also brought more positive changes, including the proportion of patients with HbA1c<7% and <8% increased more, and the proportion of patients with HbA1c>9% decreased more
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It is worth noting that the reduction of HbA1c levels in type 2 diabetes patients is greater than that in type 1 diabetes patients (-0.
56% vs -0.
34%; P=0.
003)
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For patients who started continuous blood glucose monitoring, the risk of emergency visits or hospitalization due to hypoglycemia improved significantly (decreasing difference -2.
73%; P=0 001), the incidence decreased from 5.
1% to 3.
0%, while the control group increased from 1.
9% As high as 2.
3%
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Hypoglycemia increases the risk of falls, cardiovascular disease, dementia, and death
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Patients who initiated continuous blood glucose monitoring also reduced outpatient visits and telephone visits
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In addition, the sensitivity analysis showed that the higher the compliance with continuous blood glucose monitoring, the more obvious the improvement of HbA1c level and the less hypoglycemia
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However, there was no significant difference between the two groups of patients in the proportion of emergency visits or hospitalizations due to hyperglycemia or other reasons
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Image source: 123RFJAMA concurrent review article pointed out in detail the important reasons why these two studies are worthy of attention
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First of all, studies have shown that continuous blood glucose monitoring has a wide range of population benefits in patients with type 2 diabetes, and the effects in clinical trials can be replicated in the real environment
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Second, clinical trials have proved the feasibility of continuous blood glucose monitoring in primary medical institutions
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Furthermore, research also suggests that patient participation is the most likely source of improved blood glucose control, including improving insulin compliance, changing diet, or increasing physical activity based on the results of continuous blood glucose monitoring
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"Promoting the application of continuous blood glucose monitoring can help greatly improve diabetes control and reduce complications, especially in the people who need it most
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Now is the time to expand access to continuous blood glucose monitoring for patients with type 2 diabetes
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" The review article concluded
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Related reading What are the benefits of continuous blood glucose monitoring for patients treated with insulin? Swedish long-term data update answer sheet American Diabetes Association released: Recommend all-day blood glucose monitoring and continuous blood glucose monitoring.
West China Hospital takes the lead and publishes BMJ: SGLT-2 inhibitor/GLP-1 receptor agonist treatment for type 2 diabetes allows diabetics to bid farewell to daily injections ! Once a week, the new long-acting insulin welcomes important progress, and two consecutive results reference materials [1] Martens T, Beck RW, Bailey R, et al.
, (2021).
Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin: A Randomized Clinical Trial.
JAMA, doi:10.
1001/jama.
2021.
7444[2] Karter AJ, Parker MM, Moffet HH, Gilliam LK, Dlott R.
Association of Real-time Continuous Glucose Monitoring With Glycemic Control and Acute Metabolic Events Among Patients With Insulin-Treated Diabetes.
JAMA, doi:10.
1001/jama.
2021.
6530[3] Peek ME, Thomas CC.
Broadening Access to Continuous Glucose Monitoring for Patients With Type 2 Diabetes.
JAMA, doi:10.
1001/ jama.
2021.
6208[4] Continuous glucose monitors help manage type 2 diabetes.
Retrieved June 4, 2021, from https:
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If you need guidance on the treatment plan, please go to a regular hospital for treatment
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