OBJECTIVE The aim of this trial was to compare the efficacy of real-time and intermittently scanned continuous glucose monitoring (rtCGM and isCGM, respectively) in maintaining optimal glycemic control. RESEARCH DESIGN AND METHODS In this randomized study, adults with type 1 diabetes (T1D) and normal hypoglycemia awareness (Gold score <4) used rtCGM (Guardian Connect Mobile) or isCGM (FreeStyle Libre) during 4 days of physical activity (exercise phase) and in the subsequent 4 weeks at home (home phase). Primary end points were time in hypoglycemia (<3.9 mmol/L [<70 mg/dL]) and time in range (3.9–10.0 mmol/L [70–180 mg/dL]). The isCGM group wore an additional masked Enlite sensor (iPro2) for 6 days to check for bias between the different sensors used by the rtCGM and isCGM systems. RESULTS Sixty adults with T1D (mean age 38 ± 13 years; A1C 62 ± 12 mmol/mol [7.8 ± 1.1%]) were randomized to rtCGM ( n = 30) or isCGM ( n = 30). All participants completed the study. Percentage of time in hypoglycemia (<3.9 mmol/L [<70 mg/dL]) was lower among rtCGM versus isCGM participants in the exercise phase (6.8 ± 5.5% vs. 11.4 ± 8.6%, respectively; P = 0.018) and during the home phase (5.3 ± 2.5% vs. 7.3 ± 4.4%, respectively; P = 0.035). Hypoglycemia differences were significant and most notable during the night. rtCGM participants spent more time in range (3.9–10 mmol/L [70–180 mg/dL]) than isCGM participants throughout both the exercise (78.5 ± 10.2% vs. 69.7 ± 16%, respectively; P = 0.0149) and home (75.6 ± 9.7% vs. 67.4 ± 17.8%, respectively; P = 0.0339) phases. The results were robust to the insignificant bias between rtCGM and isCGM sensors that masked CGM found in the isCGM arm. CONCLUSIONS rtCGM was superior to isCGM in reducing hypoglycemia and improving time in range in adults with T1D with normal hypoglycemia awareness, demonstrating the value of rtCGM alarms during exercise and in daily diabetes self-management.

Background: The aim of this trial was to compare the efficacy of real-time and <a>intermittently-scanned </a>continuous glucose monitoring (rtCGM and isCGM, respectively) in maintaining optimal glycemic control. <p>Methods: <a>In this randomized study, adults with T1D and normal hypoglycemia</a><b> </b>awareness (GOLD score <4) used rtCGM (Guardian Connect Mobile) or isCGM (Freestyle Libre) during 4 days of physical activity (exercise phase) and in subsequent 4 weeks at home (home phase). Primary endpoints were time in hypoglycemia (<3.9 mmol/l [<70 mg/dl]) and time in range (3.9-10.0 mmol/l [70-180 mg/dl]). The isCGM group wore an additional masked Enlite sensor (iPro2) for 6 days to check for bias between the different sensors used by the rtCGM and isCGM systems.<b></b></p> <p>Results: Sixty adults with T1D (mean age 38±13 years, A1C 62±12 mmol/mol [7.8±1.1%]) were randomized to rtCGM (n=30) or isCGM (n=30). All participants completed the study. Percentage of time in hypoglycemia (<3.9 mmol/l [<70 mg/dl)) was lower among rtCGM vs. isCGM participants in the exercise phase (6.8±5.5% vs. 11.4±8.6%, respectively; p=0.018) and during the home phase (5.3±2.5% vs. 7.3±4.4%, respectively; p=0.035). Hypoglycemia differences were significant and most notable during the night. rtCGM participants spent more time in range (3.9-10 mmol/l [70-180 mg/dl]) than isCGM participants throughout both the exercise (78.5±10.2% vs. 69.7±16%, respectively; p=0.0149) and home (75.6±9.7% vs. 67.4±17.8%, respectively; p=0.0339) phases. The results were robust to the insignificant bias between rtCGM and isCGM sensors that masked CGM found in the isCGM arm.<a></a></p> <p>Conclusion: rtCGM was superior to isCGM in reducing hypoglycemia and improving time in range in T1D adults with normal hypoglycemia awareness, demonstrating the value of rtCGM alarms during exercise and in daily diabetes self-management.</p> <br>

Background: The aim of this trial was to compare the efficacy of real-time and <a>intermittently-scanned </a>continuous glucose monitoring (rtCGM and isCGM, respectively) in maintaining optimal glycemic control. <p>Methods: <a>In this randomized study, adults with T1D and normal hypoglycemia</a><b> </b>awareness (GOLD score <4) used rtCGM (Guardian Connect Mobile) or isCGM (Freestyle Libre) during 4 days of physical activity (exercise phase) and in subsequent 4 weeks at home (home phase). Primary endpoints were time in hypoglycemia (<3.9 mmol/l [<70 mg/dl]) and time in range (3.9-10.0 mmol/l [70-180 mg/dl]). The isCGM group wore an additional masked Enlite sensor (iPro2) for 6 days to check for bias between the different sensors used by the rtCGM and isCGM systems.<b></b></p> <p>Results: Sixty adults with T1D (mean age 38±13 years, A1C 62±12 mmol/mol [7.8±1.1%]) were randomized to rtCGM (n=30) or isCGM (n=30). All participants completed the study. Percentage of time in hypoglycemia (<3.9 mmol/l [<70 mg/dl)) was lower among rtCGM vs. isCGM participants in the exercise phase (6.8±5.5% vs. 11.4±8.6%, respectively; p=0.018) and during the home phase (5.3±2.5% vs. 7.3±4.4%, respectively; p=0.035). Hypoglycemia differences were significant and most notable during the night. rtCGM participants spent more time in range (3.9-10 mmol/l [70-180 mg/dl]) than isCGM participants throughout both the exercise (78.5±10.2% vs. 69.7±16%, respectively; p=0.0149) and home (75.6±9.7% vs. 67.4±17.8%, respectively; p=0.0339) phases. The results were robust to the insignificant bias between rtCGM and isCGM sensors that masked CGM found in the isCGM arm.<a></a></p> <p>Conclusion: rtCGM was superior to isCGM in reducing hypoglycemia and improving time in range in T1D adults with normal hypoglycemia awareness, demonstrating the value of rtCGM alarms during exercise and in daily diabetes self-management.</p> <br>

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Hypoglykemie spojená s léčbou pacientů s diabetem mellitem 2. typu stále představuje zásadní problém. Je spojena se zvýšenou mortalitou a významně snižuje i samotnou kvalitu života, což se nejvíce projevuje u starších nemocných. Proto je nutné neustále revidovat antidiabetickou terapii a pátrat po rizicích s ní spojených. Právě starší pacienti s diabetem jsou však často ponecháni na nevhodné léčbě deriváty sulfonylurey (DSU), které jsou po inzulinu nejrizikovější hypoglykemizující medikací. V naší retrospektivní studii jsme porovnávali výskyt těžké hypoglykemie z jakýchkoliv příčin u diabetiků 2. typu vedoucí k hospitalizaci na Interní oddělení Masarykovy nemocnice v Ústí nad Labem v závislosti na užívání různé antidiabetické terapie. Předpokládali jsme negativní vliv hypoglykemizující terapie ( především DSU) u starších pacientů. Celkem bylo přijato 32 pacientů s diabetem mellitem 2. typu (prům. věk 76,5 ±8,2 let), z nichž užívalo DSU 18 pacientů a jejich průměrný věk byl 77,4 let s poměrně širokým rozpětím 65 až alarmujících 93 let. Průměrná hodnota odhadované glomerulární filtrace (eGFR) činila 0,745 (±0,293) ml/s/1,73m 2 a navíc se jednalo o relativně polymorbidní pacienty, průměrný počet komorbidit byl 3,125, u pacientů užívajících DSU dokonce 3,5. Epizody hypoglykemie jsou zejména pro starší pacienty s diabetem mellitem 2. typu z výše popsaných důvodů velmi nebezpečné a z tohoto pohledu se jeví deriváty SU jako preparáty nevhodné.