Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections

Roy W. Beck, Tonya D. Riddlesworth, Katrina Ruedy, Andrew Ahmann, Stacie Haller, Davida Kruger, Janet B. McGill, William Polonsky, David Price, Stephen Aronoff, Ronnie Aronson, Elena Toschi, Craig Kollman, Richard Bergenstal

Research output: Contribution to journalArticle

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Abstract

Background: Continuous glucose monitoring (CGM), which studies have shown is beneficial for adults with type 1 diabetes, has not been well-evaluated in those with type 2 diabetes receiving insulin. Objective: To determine the effectiveness of CGM in adults with type 2 diabetes receiving multiple daily injections of insulin. Design: Randomized clinical trial. (The protocol also included a type 1 diabetes cohort in a parallel trial and subsequent second trial.) (ClinicalTrials.gov: NCT02282397) Setting: 25 endocrinology practices in North America. Patients: 158 adults who had had type 2 diabetes for a median of 17 years (interquartile range, 11 to 23 years). Participants were aged 35 to 79 years (mean, 60 years [SD, 10]), were receiving multiple daily injections of insulin, and had hemoglobin A1c (HbA1c) levels of 7.5% to 9.9% (mean, 8.5%). Intervention: Random assignment to CGM (n = 79) or usual care (control group, n = 79). Measurements: The primary outcome was HbA1c reduction at 24 weeks. Results: Mean HbA1c levels decreased to 7.7% in the CGM group and 8.0% in the control group at 24 weeks (adjusted difference in mean change, -0.3% [95% CI, -0.5% to 0.0%]; P = 0.022). The groups did not differ meaningfully in CGM-measured hypoglycemia or quality-of-life outcomes. The CGM group averaged 6.7 days (SD, 0.9) of CGM use per week. Limitation: 6-month follow-up. Conclusion: A high percentage of adults who received multiple daily insulin injections for type 2 diabetes used CGM on a daily or near-daily basis for 24 weeks and had improved glycemic control. Because few insulin-treated patients with type 2 diabetes currently use CGM, these results support an additional management method that may benefit these patients.

Original languageEnglish (US)
Pages (from-to)365-374
Number of pages10
JournalAnnals of Internal Medicine
Volume167
Issue number6
DOIs
StatePublished - Sep 19 2017

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Type 2 Diabetes Mellitus
Patient Care
Insulin
Glucose
Injections
Hemoglobins
Type 1 Diabetes Mellitus
Control Groups
Endocrinology
North America
Hypoglycemia
Randomized Controlled Trials
Quality of Life

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Beck, R. W., Riddlesworth, T. D., Ruedy, K., Ahmann, A., Haller, S., Kruger, D., ... Bergenstal, R. (2017). Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections. Annals of Internal Medicine, 167(6), 365-374. https://doi.org/10.7326/M16-2855

Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections. / Beck, Roy W.; Riddlesworth, Tonya D.; Ruedy, Katrina; Ahmann, Andrew; Haller, Stacie; Kruger, Davida; McGill, Janet B.; Polonsky, William; Price, David; Aronoff, Stephen; Aronson, Ronnie; Toschi, Elena; Kollman, Craig; Bergenstal, Richard.

In: Annals of Internal Medicine, Vol. 167, No. 6, 19.09.2017, p. 365-374.

Research output: Contribution to journalArticle

Beck, RW, Riddlesworth, TD, Ruedy, K, Ahmann, A, Haller, S, Kruger, D, McGill, JB, Polonsky, W, Price, D, Aronoff, S, Aronson, R, Toschi, E, Kollman, C & Bergenstal, R 2017, 'Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections', Annals of Internal Medicine, vol. 167, no. 6, pp. 365-374. https://doi.org/10.7326/M16-2855
Beck, Roy W. ; Riddlesworth, Tonya D. ; Ruedy, Katrina ; Ahmann, Andrew ; Haller, Stacie ; Kruger, Davida ; McGill, Janet B. ; Polonsky, William ; Price, David ; Aronoff, Stephen ; Aronson, Ronnie ; Toschi, Elena ; Kollman, Craig ; Bergenstal, Richard. / Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections. In: Annals of Internal Medicine. 2017 ; Vol. 167, No. 6. pp. 365-374.
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abstract = "Background: Continuous glucose monitoring (CGM), which studies have shown is beneficial for adults with type 1 diabetes, has not been well-evaluated in those with type 2 diabetes receiving insulin. Objective: To determine the effectiveness of CGM in adults with type 2 diabetes receiving multiple daily injections of insulin. Design: Randomized clinical trial. (The protocol also included a type 1 diabetes cohort in a parallel trial and subsequent second trial.) (ClinicalTrials.gov: NCT02282397) Setting: 25 endocrinology practices in North America. Patients: 158 adults who had had type 2 diabetes for a median of 17 years (interquartile range, 11 to 23 years). Participants were aged 35 to 79 years (mean, 60 years [SD, 10]), were receiving multiple daily injections of insulin, and had hemoglobin A1c (HbA1c) levels of 7.5{\%} to 9.9{\%} (mean, 8.5{\%}). Intervention: Random assignment to CGM (n = 79) or usual care (control group, n = 79). Measurements: The primary outcome was HbA1c reduction at 24 weeks. Results: Mean HbA1c levels decreased to 7.7{\%} in the CGM group and 8.0{\%} in the control group at 24 weeks (adjusted difference in mean change, -0.3{\%} [95{\%} CI, -0.5{\%} to 0.0{\%}]; P = 0.022). The groups did not differ meaningfully in CGM-measured hypoglycemia or quality-of-life outcomes. The CGM group averaged 6.7 days (SD, 0.9) of CGM use per week. Limitation: 6-month follow-up. Conclusion: A high percentage of adults who received multiple daily insulin injections for type 2 diabetes used CGM on a daily or near-daily basis for 24 weeks and had improved glycemic control. Because few insulin-treated patients with type 2 diabetes currently use CGM, these results support an additional management method that may benefit these patients.",
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