Patients with type 2 diabetes can benefit from two JAMAs calling for more widespread use of continuous blood glucose monitoring

Patients with type 2 diabetes who have poor blood sugar control may face a higher risk of complications and comorbidities

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 It is not limited to the population recommended by the existing guidelines

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

Different from the traditional "finger piercing" to measure blood sugar, continuous blood glucose monitoring uses sensors to measure the blood glucose level in the subcutaneous tissue fluid at a frequency of once every 5 minutes

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 sugar but still have poor blood glucose control Patients; GDM of gestational diabetes or diabetes with pregnancy

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

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

The 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 prandial insulin

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

After 8 months, the average glycated hemoglobin (HbA1c) of the continuous blood glucose monitoring group improved significantly, from 9.

In the continuous blood glucose monitoring group, it takes 3.

▲HbA1c levels of patients in the two groups at 8 months, orange-continuous blood glucose monitoring group, green-traditional blood glucose meter monitoring group

Figure A: Comparison between 8 months and the study baseline.

Figure B: Cumulative proportion of patients reaching different HbA1c levels

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

The second study was a retrospective cohort study conducted in a real-world environment.

The study included 41,753 patients from the Northern California Comprehensive Health Care System, including 5,673 type 1 diabetes patients and 36080 type 2 diabetes patients
.
These patients are receiving insulin therapy and self-monitoring blood glucose, but have not received continuous blood glucose monitoring before
.

The research team evaluated the impact of continuous blood glucose monitoring (3806 patients) initiated by doctors during the study
.
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%
.
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
.

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)
.

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%
.
Hypoglycemia increases the risk of falls, cardiovascular disease, dementia, and death
.
Patients who started continuous blood glucose monitoring also reduced outpatient visits and telephone visits
.

In addition, sensitivity analysis showed that the higher the compliance with continuous blood glucose monitoring, the more obvious the improvement in HbA1c levels and the less hypoglycemia
.

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
.

JAMA review articles at the same time pointed out in detail the important reasons for these two studies to be concerned
.
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
.
Second, clinical trials have proved the feasibility of continuous blood glucose monitoring in primary medical institutions
.
Furthermore, research also suggests that patient participation is the most likely source of improved blood sugar control, including improving insulin compliance, changing diet, or increasing physical activity based on the results of continuous blood glucose monitoring
.

Note: The original text has been deleted

Reference

[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://medicalxpress.
com/news/2021-06-glucose-diabetes.
html

[5] Wider Use of CGM May Benefit People With Type 2 Diabetes.
Retrieved June 4, 2021, from https://