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Jan 31, 2023
The following is the summary of “Improved Effectiveness of Immediate Continuous Glucose Monitoring in Hypoglycemia-Prone People with Type 1 Diabetes Compared with Hypoglycemia-Focused Psychoeducation Following a Previous Structured Education: A Randomized Controlled Trial” published in the December 2023 issue of Diabetes technology and therapeutics by Serné, et al.
Patients with problematic hypoglycemia and impaired awareness of hypoglycemia (IAH) may benefit from a step-wise approach to care, beginning with psychoeducational programs centered around blood glucose awareness training and progressing to diabetes technology in cases where these measures prove insufficient. Clinical efficacy of HypoAware first, with CGM added as needed, versus immediate CGM was compared in individuals with type 1 diabetes who had problems with hypoglycemia despite having received formal education in insulin adjustment. A randomized controlled experiment was conducted (N=52, mean age 53, 56% females). HypoAware was attended by the stepped-care population. After 6 months, CGM was started if a severe hypoglycemia event (SHE) had occurred or if IAH was still present.
Those in the control group immediately began using CGM. In this study, the number of people who reported having SHE was the primary outcome. Glycated hemoglobin (HbA1c), the proportion of individuals achieving an IAH TBR (54 mg/dL), and patient-reported outcomes were assessed at 6- and 12-month intervals, respectively, as secondary outcomes (PROs). At 6 months, patients in the CGM group reported a significantly lower incidence of SHE than those in the non-CGM group by -39% (P<0.05). With CGM, patients saw a greater reduction in HbA1c (-0.47 percentage points, P<0.05). As many as 31% of patients in both groups experienced a return of IAH. Those who used CGM had a significantly lower TBR (<54 mg/dL) (2.4 percentage points, P<0.05). CGM/intermittent scanning CGM was initiated by 93% of patients in the stepped-care group.
The stepped-care group continued to have a greater rate of SHE at 12 months. In terms of quality of life indicators, researchers observed no differences. Individuals with problematic hypoglycemia and IAH, despite prior instruction in insulin dosage modification, benefit more from the immediate use of CGM than from a hypoglycemia-focused reeducation program in terms of reducing SHE risk and achieving glycemic objectives.
Source: liebertpub.com/doi/10.1089/dia.2022.0232
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