The Effect of Real-Time Continuous Glucose Monitoring on Glycemic Control in Patients with Type 2 Diabetes Mellitus.
Ehrhardt, Nicole M. M.D., MAJ MC; Chellappa, Mary M.D.; Walker, M. Susan Ph.D., C.D.E.; Fonda, Stephanie J. Ph.D.; Vigersky, Robert A. M.D., COL MC
[Article]
Journal of Diabetes Science & Technology.
5(3):668-675, May 2011.
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Background: Real-time continuous glucose monitoring (RT-CGM) improves hemoglobin A1c (A1C) and hypoglycemia in people with type 1 diabetes mellitus and those with type 2 diabetes mellitus (T2DM) on prandial insulin; however, it has not been tested in people with T2DM not taking prandial insulin. We evaluated the utility of RT-CGM in people with T2DM on a variety of treatment modalities except prandial insulin.
Methods: We conducted a prospective, 52-week, two-arm, randomized trial comparing RT-CGM (n = 50) versus self-monitoring of blood glucose (SMBG) (n = 50) in people with T2DM not taking prandial insulin. Real-time continuous glucose monitoring was used for four 2-week cycles (2 weeks on/1 week off). All patients were managed by their usual provider. This article reports on changes in A1C 0-12 weeks.
Results: Mean ( /-standard deviation) decline in A1C at 12 weeks was 1.0% ( /-1.1%) in the RT-CGM group and 0.5% ( /-0.8%) in the SMBG group (p = .006). There were no group differences in the net change in number or dosage of hypoglycemic medications. Those who used the RT-CGM for /-48 days (per protocol) reduced their A1C by 1.2% ( /-1.1%) versus 0.6% ( /-1.1%) in those who used it <48 days (p = .003). Multiple regression analyses statistically adjusting for baseline A1C, an indicator for usage, and known confounders confirmed the observed differences between treatment groups were robust (p = .009). There was no improvement in weight or blood pressure.
Conclusions: Real-time continuous glucose monitoring significantly improves A1C compared with SMBG in patients with T2DM not taking prandial insulin. This technology might benefit a wider population of people with diabetes than previously thought.
(C)2011Sage Publications