Glycemic outcomes in adults with T1D are impacted more by continuous glucose monitoring than by insulin delivery method: 3 years of follow-up from the comisair study

Abstract

OBJECTIVE This study assessed the clinical impact of four treatment strategies in adults with type 1 diabetes (T1D): real-Time continuous glucose monitoring (rtCGM) with multiple daily insulin injections (rtCGM1MDI), rtCGM with continuous subcutaneous insulin infusion (rtCGM1CSII), self-monitoring of blood glucose with MDI (SMBG1MDI), and SMBG with CSII (SMBG1CSII). RESEARCH DESIGN AND METHODS This 3-year, nonrandomized, prospective, real-world, clinical trial followed 94 participants with T1D (rtCGM1MDI, n522; rtCGM1CSII, n526; SMBG1MDI, n521; SMBG1CSII, n525). The main end points were changes in A1C, time in range (70- 180 mg/dL [3.9-10 mmol/L]), time below range (<70 mg/dL [<3.9 mmol/L]), glycemic variability, and incidence of hypoglycemia. RESULTS At 3 years, the rtCGM groups (rtCGM1MDIand rtCGM1CSII) had significantly lower A1C (7.0% [53 mmol/mol], P 5 0.0002, and 6.9% [52 mmol/mol], P < 0.0001, respectively), compared with the SMBG1CSII and SMBG1MDI groups (7.7% [61 mmol/mol], P 5 0.3574, and 8.0% [64 mmol/mol], P 5 1.000, respectively), with no significant difference between the rtCGM groups. Significant improvements in percentage of time in rangewereobserved in thertCGMsubgroups (rtCGM1MDI, 48.7-69.0%, P < 0.0001; and rtCGM1CSII, 50.9-72.3%, P < 0.0001) and in the SMBG1CSII group (50.6-57.8%, P 5 0.0114). Significant reductions in time below range were found only in the rtCGM subgroups (rtCGM1MDI, 9.4-5.5%, P50.0387; and rtCGM1CSII, 9.0-5.3%, P 5 0.0235). Seven severe hypoglycemia episodes occurred: SMBG groups, n 5 5; sensor-Augmented insulin regimen groups, n 5 2. CONCLUSIONS rtCGM was superior to SMBG in reducing A1C, hypoglycemia, and other end points in individuals with T1Dregardless of their insulin delivery method.rtCGM1MDIcan be considered an equivalent but lower-cost alternative to sensor-Augmented insulin pump therapy and superior to treatment with SMBG1MDI or SMBG1CSII therapy.