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Tytuł:
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Impact of blinded retrospective continuous glucose monitoring on clinical decision making and glycemic control in persons with type 2 diabetes on insulin therapy.
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Autorzy:
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Ribeiro RT; APDP - Diabetes Portugal, Lisbon, Portugal; iBiMED, Dep of Medical Sciences, University of Aveiro, Portugal; CEDOC, NOVA University of Lisbon, Portugal. Electronic address: .
Andrade R; APDP - Diabetes Portugal, Lisbon, Portugal.
Nascimento do Ó D; APDP - Diabetes Portugal, Lisbon, Portugal.
Lopes AF; APDP - Diabetes Portugal, Lisbon, Portugal.
Raposo JF; APDP - Diabetes Portugal, Lisbon, Portugal; CEDOC, NOVA University of Lisbon, Portugal; Dep of Public Health, NOVA Medical School, NOVA University of Lisbon, Portugal.
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Źródło:
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Nutrition, metabolism, and cardiovascular diseases : NMCD [Nutr Metab Cardiovasc Dis] 2021 Apr 09; Vol. 31 (4), pp. 1267-1275. Date of Electronic Publication: 2020 Dec 31.
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Typ publikacji:
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Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 2005- : Amsterdam : Elsevier
Original Publication: [Heidelberg] : Springer International, c1991-
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MeSH Terms:
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Blood Glucose Self-Monitoring*
Clinical Decision-Making*
Glycemic Control*/adverse effects
Blood Glucose/*drug effects
Diabetes Mellitus, Type 2/*drug therapy
Hypoglycemic Agents/*therapeutic use
Insulin/*therapeutic use
Adolescent ; Adult ; Aged ; Biomarkers/blood ; Blood Glucose/metabolism ; Decision Making, Shared ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/diagnosis ; Female ; Glycated Hemoglobin/metabolism ; Humans ; Hypoglycemia/blood ; Hypoglycemia/etiology ; Hypoglycemia/prevention & control ; Hypoglycemic Agents/adverse effects ; Insulin/adverse effects ; Male ; Middle Aged ; Patient Satisfaction ; Predictive Value of Tests ; Prospective Studies ; Retrospective Studies ; Risk Reduction Behavior ; Time Factors ; Treatment Outcome ; Young Adult
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Contributed Indexing:
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Keywords: Devices; Education; Lifestyle; Psychological aspects; Self-management
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Molecular Sequence:
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ClinicalTrials.gov NCT04141111
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Substance Nomenclature:
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0 (Biomarkers)
0 (Blood Glucose)
0 (Glycated Hemoglobin A)
0 (Hypoglycemic Agents)
0 (Insulin)
0 (hemoglobin A1c protein, human)
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Entry Date(s):
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Date Created: 20210222 Date Completed: 20210405 Latest Revision: 20221207
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Update Code:
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20240105
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DOI:
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10.1016/j.numecd.2020.12.024
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PMID:
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33612381
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Background and Aims: Blinded retrospective continuous glucose monitoring (rCGM) provides detailed information about real-life glycaemic profile. In persons with type 2 diabetes without adequate glycaemic control, the structured introduction of rCGM may be beneficial to sustain improvements in diabetes management.
Methods and Results: 102 individuals with insulin-treated type 2 diabetes, age less than 66 years old and HbA1c >7.5%, were recruited. Participants performed a 7-day blinded rCGM (iPro2) every four months for one year. Biochemical, anthropometric, and rCGM data was collected. Participants' and healthcare professionals' perceptions were assessed. 90 participants completed the protocol. HbA1c was 9.1 ± 0.1% one year prior to enrolment and 9.4 ± 0.1% at enrolment (p < 0.01). With the rCGM-based intervention, a decrease in HbA1c was achieved at 4 months (8.4 ± 0.1%, p < 0.0001), and 12 months (8.1 ± 0.1%, p < 0.0001). A significant increase in time-in-range was observed (50.8 ± 2.4 at baseline vs 61.5 ± 2.2% at 12 months, for 70-180 mg/dL, p < 0.001), with no difference in exposure time to hypoglycaemia. After 12 months, there was an increase in self-reported diabetes treatment satisfaction (p < 0.05).
Conclusion: In persons with type 2 diabetes and poor metabolic control, specific data from blinded rCGM informed therapeutic changes and referral to targeted education consultations on nutrition and insulin administration technique. Therapeutic changes were made more frequently and targeted to changes in medication dose, timing, and/or type, as well as to lifestyle. Together, these brought significant improvements in clinical outcomes, effective shared decision-making, and satisfaction with treatment.
Registration Number: NCT04141111.
Competing Interests: Declaration of competing interest The authors declare no conflict of interest.
(Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)
