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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.
BMJ 2011; 343:d3805BMJ

Abstract

OBJECTIVE

To determine the clinical effectiveness of real time continuous glucose monitoring compared with self monitoring of blood glucose in type 1 diabetes.

DESIGN

Meta-analysis of randomised controlled trials.

DATA SOURCES

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. Studies reviewed Randomised controlled trials of two or more months' duration in men and non-pregnant women with type 1 diabetes that compared real time continuous glucose monitoring with self monitoring of blood glucose and where insulin delivery was the same in both arms. Analysis Two step meta-analysis of individual patient data with the primary outcome of final glycated haemoglobin (HbA(1c)) 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 HbA(1c) 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 HbA(1c) 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 HbA(1c) 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 HbA(1c) 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 HbA(1c) of about 0.9% (9 mmol/mol) when the baseline HbA(1c) 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.

CONCLUSIONS

Continuous glucose monitoring was associated with a significant reduction in HbA(1c) percentage, which was greatest in those with the highest HbA(1c) 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.

Authors+Show Affiliations

Diabetes Research Group, Division of Diabetes and Nutritional Sciences, King's College London School of Medicine, Guy's Hospital, London SE1 1UL, UK. john.pickup@kcl.ac.ukNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21737469

Citation

Pickup, John C., et al. "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." BMJ (Clinical Research Ed.), vol. 343, 2011, pp. d3805.
Pickup JC, Freeman SC, Sutton AJ. 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. BMJ. 2011;343:d3805.
Pickup, J. C., Freeman, S. C., & Sutton, A. J. (2011). 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. BMJ (Clinical Research Ed.), 343, pp. d3805. doi:10.1136/bmj.d3805.
Pickup JC, Freeman SC, Sutton AJ. 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. BMJ. 2011 Jul 7;343:d3805. PubMed PMID: 21737469.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Pickup,John C, AU - Freeman,Suzanne C, AU - Sutton,Alex J, Y1 - 2011/07/07/ PY - 2011/7/9/entrez PY - 2011/7/9/pubmed PY - 2012/3/1/medline SP - d3805 EP - d3805 JF - BMJ (Clinical research ed.) JO - BMJ VL - 343 N2 - OBJECTIVE: To determine the clinical effectiveness of real time continuous glucose monitoring compared with self monitoring of blood glucose in type 1 diabetes. DESIGN: Meta-analysis of randomised controlled trials. DATA SOURCES: 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. Studies reviewed Randomised controlled trials of two or more months' duration in men and non-pregnant women with type 1 diabetes that compared real time continuous glucose monitoring with self monitoring of blood glucose and where insulin delivery was the same in both arms. Analysis Two step meta-analysis of individual patient data with the primary outcome of final glycated haemoglobin (HbA(1c)) 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 HbA(1c) 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 HbA(1c) 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 HbA(1c) 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 HbA(1c) 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 HbA(1c) of about 0.9% (9 mmol/mol) when the baseline HbA(1c) 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. CONCLUSIONS: Continuous glucose monitoring was associated with a significant reduction in HbA(1c) percentage, which was greatest in those with the highest HbA(1c) 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. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/21737469/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_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&amp;pmid=21737469 DB - PRIME DP - Unbound Medicine ER -