Assessment of Patient-Led or Physician-Driven Continuous Glucose Monitoring in Patients With Poorly Controlled Type 1 Diabetes Using Basal-Bolus Insulin Regimens: A 1-year multicenter study

• Published in: Diabetes care Vol. 35; no. 5; pp. 965 - 971
• Main Authors: Riveline, Jean-Pierre, Schaepelynck, Pauline, Chaillous, Lucy, Renard, Eric, Sola-Gazagnes, Agnès, Penfornis, Alfred, Tubiana-Rufi, Nadia, Sulmont, Véronique, Catargi, Bogdan, Lukas, Céline, Radermecker, Régis P, Thivolet, Charles, Moreau, François, Benhamou, Pierre-Yves, Guerci, Bruno, Leguerrier, Anne-Marie, Millot, Luc, Sachon, Claude, Charpentier, Guillaume, Hanaire, Hélène
• Format: Journal Article Web Resource
• Language: English
• Published: United States American Diabetes Association 01.05.2012
• Subjects: Adolescent; Adult; Analysis; blood; blood glucose; Blood Glucose - analysis; Blood Glucose Self-Monitoring; Blood Glucose Self-Monitoring - methods; Blood sugar; Blood sugar monitoring; Care and treatment; Child; clinical examination; Clinical medicine; Dextrose; Diabetes; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1/blood/drug therapy; Diabetes therapy; Diabetics; disease incidence; drug therapy; Endocrinologie, métabolisme & nutrition; Endocrinology, metabolism & nutrition; Female; Glucose; Glycated Hemoglobin; Glycated Hemoglobin - metabolism; glycemic control; glycohemoglobin; Hemoglobin A, Glycosylated/metabolism; Human health and pathology; Human health sciences; Humans; Hypoglycemia; Hypoglycemic Agents; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - therapeutic use; insulin-dependent diabetes mellitus; Life Sciences; Male; Medical research; Medicine, Experimental; metabolism; methods; Middle Aged; monitoring; Original Research; patient care; Patient monitoring equipment; patients; Pharmaceutical industry; Physicians; questionnaires; Sciences de la santé humaine; screening; Sensors; Studies; therapeutic use; Young Adult; France; United States
• ISSN: 0149-5992; 1935-5548; 1935-5548; 0149-5992
• DOI: 10.2337/dc11-2021

OBJECTIVE: The benefits of real-time continuous glucose monitoring (CGM) have been demonstrated in patients with type 1 diabetes. Our aim was to compare the effect of two modes of use of CGM, patient led or physician driven, for 1 year in subjects with poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS: Patients with type 1 diabetes aged 8–60 years with HbA1c ≥8% were randomly assigned to three groups (1:1:1). Outcomes for glucose control were assessed at 1 year for two modes of CGM (group 1: patient led; group 2: physician driven) versus conventional self-monitoring of blood glucose (group 3: control). RESULTS: A total of 257 subjects with type 1 diabetes underwent screening. Of these, 197 were randomized, with 178 patients completing the study (age: 36 ± 14 years; HbA1c: 8.9 ± 0.9%). HbA1c improved similarly in both CGM groups and was reduced compared with the control group (group 1 vs. group 3: –0.52%, P = 0.0006; group 2 vs. group 3: –0.47%, P = 0.0008; groups 1 + 2 vs. group 3: –0.50%, P < 0.0001). The incidence of hypoglycemia was similar in the three groups. Patient SF-36 questionnaire physical health score improved in both experimental CGM groups (P = 0.004). Sensor consumption was 34% lower in group 2 than in group 1 (median [Q1–Q3] consumption: group 1: 3.42/month [2.20–3.91] vs. group 2: 2.25/month [1.27–2.99], P = 0.001). CONCLUSIONS: Both patient-led and physician-driven CGM provide similar long-term improvement in glucose control in patients with poorly controlled type 1 diabetes, but the physician-driven CGM mode used fewer sensors.