Intermittently scanned continuous glucose monitoring compared with blood glucose monitoring is associated with lower HbA1c and a reduced risk of hospitalisation for diabetes-related complications in adults with type 2 diabetes on insulin therapies

IF 8.4 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetologia Pub Date : 2024-10-26 DOI:10.1007/s00125-024-06289-z

David Nathanson, Katarina Eeg-Olofsson, Tim Spelman, Erik Bülow, Mattias Kyhlstedt, Fleur Levrat-Guillen, Jan Bolinder

{"title":"Intermittently scanned continuous glucose monitoring compared with blood glucose monitoring is associated with lower HbA1c and a reduced risk of hospitalisation for diabetes-related complications in adults with type 2 diabetes on insulin therapies","authors":"David Nathanson, Katarina Eeg-Olofsson, Tim Spelman, Erik Bülow, Mattias Kyhlstedt, Fleur Levrat-Guillen, Jan Bolinder","doi":"10.1007/s00125-024-06289-z","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Aims/hypothesis</h3><p>We assessed the impact of initiating intermittently scanned continuous glucose monitoring (isCGM) compared with capillary blood glucose monitoring (BGM) on HbA<sub>1c</sub> levels and hospitalisations for diabetes-related complications in adults with insulin-treated type 2 diabetes in Sweden.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This retrospective comparative cohort study included adults with type 2 diabetes who had a National Diabetes Register initiation date for isCGM after 1 June 2017. Prescribed Drug Register records identified subgroups treated with multiple daily insulin injections (T2D-MDI) or basal insulin (T2D-B), with or without other glucose-lowering drugs. The National Patient Register provided data on hospitalisation rates.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We identified 2876 adults in the T2D-MDI group and 2292 in the T2D-B group with an isCGM index date after 1 June 2017, matched with 33,584 and 43,424 BGM control participants, respectively. The baseline-adjusted difference in the change in mean HbA<sub>1c</sub> for isCGM users vs BGM control participants in the T2D-MDI cohort was −3.7 mmol/mol (−0.34%) at 6 months, and this was maintained at 24 months. The baseline-adjusted difference in the change in HbA<sub>1c</sub> for isCGM users vs BGM control participants in the T2D-B cohort was −3.5 mmol/mol (−0.32%) at 6 months, and this was also maintained at 24 months. Compared with BGM control participants, isCGM users in the T2D-MDI cohort had a significantly lower RR of admission for severe hypoglycaemia (0.51; 95% CI 0.27, 0.95), stroke (0.54; 95% CI 0.39, 0.73), acute non-fatal myocardial infarction (0.75; 95% CI 0.57, 0.99) or hospitalisation for any reason (0.84; 95% CI 0.77, 0.90). isCGM users in the T2D-B cohort had a lower RR of admission for heart failure (0.63; 95% CI 0.46, 0.87) or hospitalisation for any reason (0.76; 95% CI 0.69, 0.84).</p><h3 data-test=\"abstract-sub-heading\">Conclusions/interpretation</h3><p>This study shows that Swedish adults with type 2 diabetes on insulin who are using isCGM have a significantly reduced HbA<sub>1c</sub> and fewer hospital admissions for diabetes-related complications compared with BGM control participants.</p><h3 data-test=\"abstract-sub-heading\">Graphical Abstract</h3>\n","PeriodicalId":11164,"journal":{"name":"Diabetologia","volume":"8 1","pages":""},"PeriodicalIF":8.4000,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetologia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00125-024-06289-z","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Aims/hypothesis

We assessed the impact of initiating intermittently scanned continuous glucose monitoring (isCGM) compared with capillary blood glucose monitoring (BGM) on HbA_1c levels and hospitalisations for diabetes-related complications in adults with insulin-treated type 2 diabetes in Sweden.

Methods

This retrospective comparative cohort study included adults with type 2 diabetes who had a National Diabetes Register initiation date for isCGM after 1 June 2017. Prescribed Drug Register records identified subgroups treated with multiple daily insulin injections (T2D-MDI) or basal insulin (T2D-B), with or without other glucose-lowering drugs. The National Patient Register provided data on hospitalisation rates.

Results

We identified 2876 adults in the T2D-MDI group and 2292 in the T2D-B group with an isCGM index date after 1 June 2017, matched with 33,584 and 43,424 BGM control participants, respectively. The baseline-adjusted difference in the change in mean HbA_1c for isCGM users vs BGM control participants in the T2D-MDI cohort was −3.7 mmol/mol (−0.34%) at 6 months, and this was maintained at 24 months. The baseline-adjusted difference in the change in HbA_1c for isCGM users vs BGM control participants in the T2D-B cohort was −3.5 mmol/mol (−0.32%) at 6 months, and this was also maintained at 24 months. Compared with BGM control participants, isCGM users in the T2D-MDI cohort had a significantly lower RR of admission for severe hypoglycaemia (0.51; 95% CI 0.27, 0.95), stroke (0.54; 95% CI 0.39, 0.73), acute non-fatal myocardial infarction (0.75; 95% CI 0.57, 0.99) or hospitalisation for any reason (0.84; 95% CI 0.77, 0.90). isCGM users in the T2D-B cohort had a lower RR of admission for heart failure (0.63; 95% CI 0.46, 0.87) or hospitalisation for any reason (0.76; 95% CI 0.69, 0.84).

Conclusions/interpretation

This study shows that Swedish adults with type 2 diabetes on insulin who are using isCGM have a significantly reduced HbA_1c and fewer hospital admissions for diabetes-related complications compared with BGM control participants.

Graphical Abstract

Abstract Image

查看原文本刊更多论文

与血糖监测相比，间歇性扫描连续葡萄糖监测可降低 HbA1c，并降低接受胰岛素治疗的成人 2 型糖尿病患者因糖尿病相关并发症住院的风险

目的/假设我们评估了与毛细血管血糖监测（BGM）相比，启动间歇扫描连续血糖监测（isCGM）对瑞典接受胰岛素治疗的成人 2 型糖尿病患者 HbA1c 水平和糖尿病相关并发症住院治疗的影响。方法这项回顾性比较队列研究纳入了国家糖尿病登记册启动日期在 2017 年 6 月 1 日之后的成人 2 型糖尿病患者。处方药登记记录确定了每日多次胰岛素注射（T2D-MDI）或基础胰岛素（T2D-B）治疗的亚组，无论是否使用其他降糖药物。全国患者登记册提供了住院率数据。结果我们在T2D-MDI组和T2D-B组中分别发现了2876名成人和2292名成人，其isCGM指数日期均在2017年6月1日之后，并分别与33584名和43424名BGM对照参与者进行了匹配。经基线调整后，T2D-MDI队列中isCGM使用者与BGM对照组参与者的平均HbA1c变化差异在6个月时为-3.7 mmol/mol（-0.34%），这一差异在24个月时保持不变。在 T2D-B 队列中，经基线调整后，isCGM 使用者与 BGM 对照组参与者的 HbA1c 变化差异在 6 个月时为-3.5 mmol/mol (-0.32%)，这一差异在 24 个月时也保持不变。与 BGM 对照组参与者相比，T2D-MDI 队列中的 isCGM 使用者因严重低血糖（0.51；95% CI 0.27，0.95）、中风（0.54；95% CI 0.39，0.73）、急性非致命性心肌梗死入院的 RR 明显较低。T2D-B队列中的isCGM使用者因心力衰竭入院的RR较低（0.63；95% CI 0.46，0.87）或因任何原因住院（0.76；95% CI 0.69，0.84）。结论/解释本研究显示，与 BGM 对照组参与者相比，使用 isCGM 的瑞典 2 型糖尿病成人胰岛素患者的 HbA1c 显著降低，因糖尿病相关并发症入院的人数也更少。图文摘要

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Diabetologia 医学-内分泌学与代谢

CiteScore

18.10

自引率

2.40%

发文量

193

审稿时长

1 months

期刊介绍： Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.