Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data Full Text
BMJ,  Evidence Based Medicine

Pickup JC et al. - Continuous glucose monitoring was associated with a significant reduction in HbA1c percentage, which was greatest in those with the highest HbA1c at baseline and who most frequently used the sensors. Exposure to hypoglycaemia was also reduced during continuous glucose monitoring. The most cost effective or appropriate use of continuous glucose monitoring is likely to be when targeted at people with type 1 diabetes who have continued poor control during intensified insulin therapy and who frequently use continuous glucose monitoring.

Methods
  • Meta-analysis of randomised controlled trials.
  • Cochrane database for randomised controlled trials, Ovid Medline, Embase, Google Scholar, lists of papers supplied by manufacturers of continuous glucose monitors, and cited literature in retrieved articles.
  • Two step meta-analysis of individual patient data with the primary outcome of final glycated haemoglobin (HbA1c) percentage and area under the curve of hypoglycaemia (glucose concentration <3.9 mmol/L) during either treatment, followed by one step metaregression exploring patient level determinants of HbA1c and hypoglycaemia.

Results
  • Six trials were identified, consisting of 449 patients randomised to continuous glucose monitoring and 443 to self monitoring of blood glucose.
  • The overall mean difference in HbA1c for continuous glucose monitoring versus self monitoring of blood glucose was -0.30% (95% confidence interval -0.43% to -0.17%) (-3.0, -4.3 to -1.7 mmol/mol).
  • A best fit regression model of determinants of final HbA1c showed that for every one day increase of sensor usage per week the effect of continuous glucose monitoring versus self monitoring of blood glucose increased by 0.150% (95% credibility interval -0.194% to -0.106%) (1.5, -1.9 to -1.1 mmol/mol) and every 1% (10 mmol/mol) increase in baseline HbA1c increased the effect by 0.126% (-0.257% to 0.0007%) (1.3, -2.6 to 0.0 mmol/mol).
  • The model estimates that, for example, a patient using the sensor continuously would experience a reduction in HbA1c of about 0.9% (9 mmol/mol) when the baseline HbA1c is 10% (86 mmol/mol).
  • The overall reduction in area under the curve of hypoglycaemia was -0.28 (-0.46 to -0.09), corresponding to a reduction in median exposure to hypoglycaemia of 23% for continuous glucose monitoring compared with self monitoring of blood glucose.
  • In a best fit regression model, baseline area under the curve of hypoglycaemia was only weakly related to the effect of continuous glucose monitoring compared with self monitoring of blood glucose on hypoglycaemia outcome, and sensor usage was unrelated to hypoglycaemia at outcome.

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access Full Text, PubMed, Publisher and related articles...

Your Unread Messages in Endocrinology

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Endocrinology Articles

1 Effect of repaglinide versus glimepiride on daily blood glucose variability and changes in blood inflammatory and oxidative stress markers Full Text Diabetology & Metabolic Syndrome, June 4, 2014    Free full text    Clinical Article

2 Efficacy and safety of dulaglutide monotherapy versus metformin in type 2 diabetes in a randomized controlled trial (AWARD-3) Diabetes Care, May 29, 2014    Clinical Article

3 Effects of low dose metformin in adolescents with type I diabetes mellitus: A randomized, double-blinded placebo-controlled study Full Text Pediatric Diabetes, April 7, 2014    Free full text    Clinical Article

4 Effect of 25 (OH) D replacements in patients with primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency on serum 25(OH) D, calcium and PTH levels: A meta-analysis and review of literature Clinical Endocrinology, January 7, 2014    Evidence Based Medicine    Review Article

5 Thyroid-stimulating hormone, thyroglobulin, and thyroid hormones and risk of differentiated thyroid carcinoma: The EPIC study Journal of the National Cancer Institute, May 14, 2014    Clinical Article

6 Comparing dosing of basal insulin analogues detemir and glargine: Is it really unit-per-unit and dose-per-dose? Annals of Pharmacotherapy, March 12, 2014    Clinical Article

7 The effect of Mediterranean diet on the development of type 2 diabetes mellitus: A meta-analysis of 10 prospective studies and 136846 participants Metabolism, May 8, 2014    Review Article

8 Advancing basal insulin replacement in type 2 diabetes inadequately controlled with insulin glargine plus oral agents: a comparison of adding albiglutide, a weekly GLP-1 receptor agonist, versus thrice-daily prandial insulin lispro Diabetes Care, June 6, 2014    Clinical Article

9 Effect of large doses of parenteral vitamin D on glycaemic control and calcium/phosphate metabolism in patients with stable type 2 diabetes mellitus: A randomised, placebo-controlled, prospective pilot study Full Text Swiss Medical Weekly, April 4, 2014    Free full text    Review Article

10 Higher ferritin levels, but not serum iron or transferrin saturation, are associated with Type 2 diabetes mellitus in adult men and women free of genetic haemochromatosis Clinical Endocrinology, June 24, 2014    Clinical Article

11 Glycated hemoglobin as a marker of subclinical atherosclerosis and cardiac remodeling among non-diabetic adults from the general population Diabetes Research and Clinical Practice, June 27, 2014    Clinical Article

12 Effects of green tea or green tea extract on insulin sensitivity and glycaemic control in populations at risk of type 2 diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials Journal of Human Nutrition and Dietetics, November 11, 2013    Clinical Article

13 Reduced risk of hypoglycemia with once-daily glargine versus twice-daily NPH and number needed to harm with NPH to demonstrate the risk of one additional hypoglycemic event in type 2 diabetes: Evidence from a long-term controlled trial Journal of Diabetes and its Complications, June 5, 2014    Clinical Article

14 High protein weight loss diets in obese subjects with type 2 diabetes mellitus Nutrition, Metabolism & Cardiovascular Diseases, January 3, 2014    Clinical Article

15 Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the st. carlos gestational diabetes study Diabetes Care, June 23, 2014    Clinical Article
Exclusive Author Commentary

16 Plasma advanced glycation endproducts are associated with incident cardiovascular events in individuals with type 2 diabetes: a case-cohort study with a median follow-up of 10 years (EPIC-NL) Diabetes, May 23, 2014    Clinical Article

17 Dapagliflozin added to glimepiride in patients with type 2 diabetes mellitus sustains glycemic control and weight loss over 48 weeks: A randomized, double-blind, parallel-group, placebo-controlled trial Full Text Diabetes Therapy, June 18, 2014    Free full text    Clinical Article

18 Incidence of pancreatitis and pancreatic cancer in a randomized controlled multicenter trial (SAVOR-TIMI 53) of the dipeptidyl peptidase-4 (DPP-4) inhibitor saxagliptin Diabetes Care, June 20, 2014    Clinical Article

19 The efficacy of metformin-based oral anti-diabetic drug is not inferior to insulin glargine in newly diagnosed type 2 diabetic patients with severe hyperglycemia after short-term intensive insulin therapy Journal of Diabetes, June 2, 2014    Clinical Article

20 Association between waist circumference (WC) values and hypertension, heart disease (HD) and diabetes, reported by the elderly – SABE survey: Health, wellness and aging, 2000 and 2006 Archives of Gerontology and Geriatrics, June 3, 2014    Clinical Article

Indexed Journals in Endocrinology: Endocrinology, Journal of Endocrinology, Clinical Endocrinology, Diabetesmore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close