Rapid improvements in glycemic management with use of continuous glucose monitoring in adults with type 2 diabetes treated with basal insulin: 3-month analysis of the MOBILE study

Abstract

Introduction This analysis investigated whether use of real-time continuous glucose monitoring (CGM) compared with blood glucose monitoring (BGM) results in rapidly improved glycemic management in adults with type 2 diabetes (T2D) treated with basal insulin. Research design and methods Using data from the MOBILE study where adults (n=175) with T2D treated with basal insulin without prandial insulin were randomized (2:1) to either CGM (n=116) or BGM (n=59), the treatment effect on glycemic management was determined over 3 months. The main outcome was a between-group difference in hemoglobin A1c (HbA1c) at 3 months adjusted for baseline value. Other outcomes included changes in CGM-derived glucose metrics and hypoglycemic events. Results After 3 months, there was a greater reduction from baseline in mean HbA1c in the CGM group compared with the BGM group, from 9.1±1.0% (76±11mmol/mol) to 8.0±1.2% (64±13mmol/mol) in the CGM group and from 9.0±0.9% (75±10mmol/mol) to 8.5±1.5% (69±16mmol/mol) in the BGM group (adjusted difference, −0.6% (95% CI –0.9% to −0.3%); −6.6mmol/mol (95% CI –10.2 to –2.9), p<0.001). Mean time spent in range 70–180mg/dL (3.9–10.0mmol/L) increased significantly more in the CGM group than the BGM group (adjusted difference, +9.3% (95% CI 2.1% to 16.4%), p<0.001). There also was a greater reduction in mean time >250mg/dL (>13.9mmol/L) with CGM (adjusted difference, −5.8% (95% CI −10.4% to −1.2%), p<0.001) without an increase in time <70mg/dL (<3.9mmol/L). Mean weekly hypoglycemic event rate was lower with CGM than BGM (adjusted difference, −0.2 events per week (95% CI −0.4 to –0.1), p<0.001). Further, in the CGM group, significant improvements in CGM metrics were observed during the first 7days of CGM use. Conclusions In adults with basal insulin-treated T2D, use of CGM compared with BGM resulted in rapidly improved glycemic management, with a substantial reduction in HbA1c over 3 months.