It is generally well-accepted that diabetes technology use can help people with diabetes optimize their glycemic control. In fact, our first-ever survey study also supported this notion, showing that those with a lower A1c level were more likely to make use of continuous glucose monitoring (CGM) or insulin pump technology.

Now, a new study published online this morning in the journal Diabetes Care, a publication by the American Diabetes Association (ADA), reports new data on the value of implementing CGM and/or insulin pump technology as it relates to diabetes management in adult patients with type 1 diabetes.

Study Design

The research effort was a part of the COMISAIR (Comparison of Different Treatment Modalities for Type 1 Diabetes, Including Sensor-Augmented Insulin Regimens) study, with the just-released data being a part of the 3-year follow-up on the original investigation.

A total of 94 adults with type 1 diabetes were recruited for the study. All participants were at least 18 years old, had diagnosed type 1 diabetes for a minimum of two years, and had A1c levels between 7% and 10% at the beginning of the study.

The research subjects were assigned to one of four different treatment groups:

CGM + MDI (multiple daily injections)

CGM + insulin pump

SMBG (self-monitoring of blood glucose) + MDI

SMBG + insulin pump

Over the 3-year study period, patients underwent a total of fifteen clinical visits. Numerous parameters, including A1c, glycemic variability, and time-in-range were evaluated.

Study Outcomes

At the conclusion of the study, both groups utilizing CGM technology had significantly lower A1c levels as compared to the other two groups. Here are the A1c outcomes for each respective treatment group:

CGM + MDI: mean A1c = 7.0%

CGM + insulin pump: mean A1c = 6.9%

SMBG + MDI: mean A1c = 8.0%

SMBG + insulin pump: mean A1c = 7.7%

Notably, although the A1c levels among insulin pump users were marginally lower as compared to those utilizing MDI therapy, the researchers noted that these differences were not statistically significant.

In addition to significant A1c improvements among CGM users, the data also revealed improvements to the following parameters in this group:

Average sensor glucose

Glycemic variability

Time-in-range

Improvements in glycemic variability were also noted for those implementing insulin pump + SMBG therapy.

Discussion

Overall, this 3-year trial demonstrated that CGM use was significantly more important for glycemic control improvements among patients with type 1 diabetes than insulin delivery method. The study authors summarize:

Use of rtCGM among adults with type 1 diabetes treated with MDI or CSII therapywas associated with 3 years of sustained improvements from baseline in A1c, glycemic variability, and time in range, with significantly greater reductions in time spent below range (<70 mg/dL)… Importantly, we observed comparable improvements in both the rtCGM+CSII and rtCGM+MDI groups, suggesting equivalent efficacy regardless of the insulin delivery method used… In individuals with type 1 diabetes with suboptimal glycemic control, rtCGM was superior to SMBG in reducing A1c, hypoglycemia, and the other endpoints regardless of the insulin delivery method; both methods provided comparable glycemic benefits. Our findings may provide guidance to clinicians when discussing treatment/monitoring options with their [patients].

Insulin pump technology has a considerably longer history than CGM use and is believed by many to be an important component of successful type 1 diabetes management. As CGM use emerges to potentially be of more value to patients, and with other studies calling the benefit of insulin pump technology into question, will we see a shift in the provider guidance and insurance coverage policies in the near future? How may this affect patients?

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Read more about A1c, American Diabetes Association (ADA), continuous glucose monitor (CGM), diabetes management, insulin, insulin pumps, Intensive management, low blood sugar (hypoglycemia).