Glycemic Improvement Using Continuous Glucose Monitoring by Baseline Time in Range: Subgroup Analyses from the DIAMOND Type 1 Diabetes Study

Abstract

The DIAMOND study demonstrated that real-time continuous glucose monitors (rtCGMs) improve glycemia for adults with type 1 diabetes using multiple daily injections. This analysis explores the relationship between baseline time in range (TIR) and improvement in TIR using rtCGMs or self-monitoring of blood glucose (SMBG). Baseline TIR was divided into three categories: <40% (9.6 h per day), <50% (12 h per day), and <60% (14.4 h per day). Compared with SMBG, use of rtCGMs increased mean TIR by an additional 16 min per day for participants with a baseline TIR <40%, 77 min per day for baseline TIR <50%, and 88 min per day for baseline TIR <60%. A greater percentage of participants increased TIR by >4 h per day using rtCGMs within the three baseline TIR groups. For participants with a baseline TIR <50%, 29% of rtCGM users improved their TIR by >4 h per day compared with no SMBG users (P < 0.001). Similar trends were found for improvement in mean glucose and time spent in hyper-and hypoglycemic ranges.

Magnitude of Glycemic Improvement in Patients with Type 2 Diabetes Treated with Basal Insulin: Subgroup Analyses from the MOBILE Study

“… 16 Similar findings were observed among participants with lower baseline TIR. 17 Our results are consistent with and expand these findings to patients with type 2 diabetes on less intensive insulin therapy. The marked reduction in time spent with glucose >250 mg/dL in the subgroup with baseline HbA1c values ≥10% was achieved without significant differences in diabetes medication changes between groups, including the initiation of prandial insulin.…”

Continuous glucose monitoring to assess glucose variability in type 3c diabetes

“…A one-sample t-test was used to describe GV in type 3c diabetes mellitus as compared to standard ranges described in the ATTD consensus. 12 Group differences in GV were also evaluated using one-way ANOVA model, with further post hoc testing performed to determine the association. An independent t-test was used to compare differences in GV in type 3c diabetes mellitus participants who either had or did not have pancreatic enzyme supplementation.…”

“…Randomised control trials have shown improved glycaemic control in both people with type 1 diabetes mellitus and type 2 diabetes mellitus with higher initial HbA 1c using CGM compared to self‐monitoring blood glucose methods 12–15 . There is also strong evidence for the use of CGM in type 1 diabetes mellitus with hypoglycaemia unawareness or frequent hypoglycaemic events, including nocturnal hypoglycaemia 13 .…”

“…Randomised control trials have shown improved glycaemic control in both people with type 1 diabetes mellitus and type 2 diabetes mellitus with higher initial HbA 1c using CGM compared to self-monitoring blood glucose methods. [12][13][14][15] There is also strong evidence for the use of CGM in type 1 diabetes mellitus with hypoglycaemia unawareness or frequent hypoglycaemic events, including nocturnal hypoglycaemia. 13 Many studies in type 1 diabetes mellitus and type 2 diabetes mellitus populations have found that CGM usage resulted in a reduction in mean HbA 1c level, increased TIR and reduced time spent in hypoglycaemia.…”

Clinical Use of a 180-Day Implantable Glucose Monitoring System in Dogs with Diabetes Mellitus: A Case Series

“…Glycemic control is a crucial aspect of the management of diabetes mellitus (DM) and is essential for the prevention of complications in both human and veterinary medicine. Continuous glucose monitoring systems (CGMSs) are frequently used in humans with diabetes, and clinical studies have shown they are effective in reducing hypoglycemia and improving glycemic control [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Thanks to their high performance, CGMSs have gained popularity among veterinarians and are increasingly being used in diabetic dogs (DD) and cats [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”