Real-time continuous blood glucose monitoring with alarm improves blood glucose control in patients with type 1 diabetes

This article comes from the NEJM Journal Watch Real-Time Continuous Glucose Monitoring with Alerts Improves Glycemic Control in Type 1 Diabetes Real-Time Continuous Glucose Monitoring with Alerts Improves Glycemic Control in Type 1 Diabetes Comment by Bruce Soloway, MD but not A fair reimbursement policy may prevent patients from using this rapidly evolving technology
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The intermittent scanning continuous blood glucose monitor (isCGM) requires the patient to manually scan using the receiver or smartphone, while the more expensive real-time continuous blood glucose monitor (rtCGM) can automatically send readings to the receiver or smartphone every few minutes
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Real-time monitors can alert diabetic patients when blood sugar levels are high or low, so it may help avoid hypoglycemia
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However, the benefits of switching from isCGM to rtCGM are not yet clear
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In the largest and longest-duration comparative trial to date, manufacturer-funded researchers recruited 254 patients with type 1 diabetes (average glycosylated hemoglobin [HbA1c) who had been using isCGM for at least 6 months (20% of patients used insulin pumps) ], 7.
4%) adult patients
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Participants were randomly divided into two groups, one group continued to use isCGM, and the other group was replaced with rtCGM with individualized alarms
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All patients received relevant education on the use of CGM and insulin to control type 1 diabetes
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Before randomization, this trial used masked rtCGM to collect data for 4 weeks.
In addition, in the isCGM group, masked rtCGM was also used to collect data in the last month of the study
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After 6 months, the blood glucose of the rtCGM group was within the target range (70-180 mg/dL) for a significantly longer time (60% vs.
52%)
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HbA1c in the rtCGM group was significantly lower (7.
1% vs.
7.
4%), the time for blood glucose <54 mg/dL was significantly shorter (0.
47% vs.
0.
84%), patients were less concerned about hypoglycemia and reached the goal of blood glucose control (Most currently recognized targets) are more likely
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Comment on the improvement of patients' blood glucose control in this study may translate into fewer long-term complications, but whether patients can use these fast-developing devices depends on the payer's judgment of long-term cost-effectiveness, and data in this area are still scarce
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The reviewed article Visser MM et al.
Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): A 6-month, prospective, multicentre, randomised controlled trial.
Lancet 2021 Jun 12; 397:2275.
(https://doi.
org/10.
1016/S0140-6736(21)00789-3) Related reading NEJM Journal Watch The NEJM Journal Watch is published by NEJM Group.
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