The Continuous Glucose Monitoring System Is Useful for Detecting Unrecognized Hypoglycemias in Patients With Type 1 and Type 2 Diabetes but Is Not Better Than Frequent Capillary Glucose Measurements for Improving Metabolic Control

Abstract

OBJECTIVE -To evaluate whether the continuous glucose monitoring system (CGMS; MiniMed, Sylmar, CA) is useful for investigating the incidence of unrecognized hypoglycemias in type 1 and type 2 diabetic patients and for improving metabolic control in type 1 diabetic patients. RESEARCH DESIGN AND METHODS-A total of 70 diabetic subjects (40 type 1 and 30 type 2 subjects) were monitored using the CGMS. The number of unrecognized hypoglycemias was registered. Furthermore, the 40 type 1 diabetic patients whose treatment was modified in accordance with the information obtained from the CGMS were compared with a control group of 35 different type 1 diabetic patients using intensive capillary glucose measurements. HbA 1c levels were measured before the monitoring period and 3 months later.RESULTS -The CGMS detected unrecognized hypoglycemias in 62.5% of the type 1 diabetic patients and in 46.6% of the type 2 diabetic patients. We found that 73.7% of all events occurred at night. HbA 1c concentrations decreased significantly in both the group of type 1 diabetic subjects monitored with the CGMS (from 8.3 Ϯ 1.6 to 7.5 Ϯ 1.2%, P Ͻ 0.01) and the control group (from 8.0 Ϯ 1.4 to 7.5 Ϯ 0.8%, P Ͻ 0.01). The greatest reduction was observed in the subgroup of patients who started continuous subcutaneous insulin infusion therapy, both in the CGMS-monitored and control groups (from 9.4 Ϯ 2 to 7.2 Ϯ 1.4% and from 8.1 Ϯ 1.8 to 7.1 Ϯ 0.6%, respectively).CONCLUSIONS -The CGMS is useful for detecting unrecognized hypoglycemias in type 1 and type 2 diabetic subjects; however, it is not better than standard capillary glucose measurements for improving metabolic control of type 1 diabetic subjects, regardless of the therapeutic regimen. Diabetes Care 26:1153-1157, 2003S ome relevant prospective studies have demonstrated that good metabolic control of diabetes decreases the risk of chronic complications (1,2).Intensive therapeutic regimens with multiple insulin injections (MIIs) combined with frequent measurements of capillary blood glucose levels are known to be the most useful ways of achieving good metabolic control. It is also known that intensive regimens can increase the number of hypoglycemias and that the perception of autonomic symptomatology may decrease over time.It is often difficult to achieve optimal control (3,4), despite intensive insulin therapy and frequent self-monitoring of blood glucose, partly because of the limitations of the glycemic profile obtained from intermittent fingersticks (5). A new Holter-style sensor system recently came on the market (continuous glucose monitoring system [CGMS]; MiniMed) for continuously measuring glucose concentrations in subcutaneous tissue (6). This system has been validated by several reports (7,8) and has been shown to provide a good correlation between blood and interstitial glucose levels (9 -11). The continuous glucose profile obtained using this system is easy for physicians to interpret, thus patient treatment can be modified and glucose control improved. Recent studies have show...

Incidence and care‐related costs of severe hypoglycaemia requiring emergency treatment in Andalusia (Spain): the PAUEPAD project

“…These results are consistent with those of Chico et al . 22, who observed unrecognized hypoglycaemia in 47–62% of people with diabetes, with 73.7% of all events occurring at night. These data underline the need to improve the prevention and detection of nocturnal hypoglycaemia.…”

Continuous Glucose Monitoring System in children with type 1 diabetes mellitus: a systematic review and meta-analysis

“…Table 1 summarises characteristics of the included trials. Five RCTs involving 131 participants met our predefined inclusion criteria [15][16][17][18][19]; the remaining 20 studies were excluded [7,[11][12][13][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Table 2 summarises the characteristics of excluded trials, including reasons for exclusion.…”

“…Guardian Continuous Monitoring System used Boland et al [21] Non-randomised, uncontrolled trial Burdick et al [22] Non-randomised, uncontrolled trial. Real-Time glucose sensing system used Chase et al [23] RCT; GlucoWatch G2 Biographer used Chico et al [24] Non-randomised, uncontrolled trial Deiss et al [25] Non-randomised, uncontrolled trial Deiss et al [26] RCT; Guardian RT system used DirectNet [27] RCT; GlucoWatch G2 Biographer used DirectNet [28] RCT; GlucoWatch G2 Biographer used Fiallo-Scharer et al [29] RCT; GlucoWatch G2 Biographer used Garg et al [30] RCT; DexCom STS system used Halvorson et al [31] Non-randomised, uncontrolled trial. Paradigm Real-Time system used Kaufman et al [11] Non-randomised, uncontrolled trial Salardi et al [12] Non-randomised, uncontrolled trial Schaepelynck-Belicar et al [13] Non-randomised, uncontrolled trial Tanenberg et al [32] Randomised controlled trial performed in adults Tansey et al [33] Non-randomised study; did not report any of our defined outcomes Weinstein et al [34] Non-randomised, uncontrolled trial.…”

Real-time continuous glucose monitoring (CGM) integrated into the treatment of type 1 diabetes: Consensus of experts from SFD, EVADIAC and SFE

“…Nocturnal and postprandial glucose excursions not detected by SMBG have been identified as causes of failure of glucose control [14]. However, the contribution of professional CGM to improved glucose control in adult [15] and paediatric [16,51] populations is inconsistent [17,18]. The duration of a patient's use of CGM is apparently crucial to its effectiveness.…”