Randomized comparison of self-monitored blood glucose (BGM) versus continuous glucose monitoring (CGM) data to optimize glucose control in type 2 diabetes

• Published in: Journal of diabetes and its complications Vol. 36; no. 3; p. 108106
• Main Authors: Bergenstal, Richard M., Mullen, Deborah M., Strock, Ellie, Johnson, Mary L., Xi, Min X.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022; Elsevier Limited
• Subjects: Adult; Blood Glucose; Blood glucose monitoring; Blood Glucose Self-Monitoring; Clinical decision making; Continuous glucose monitoring; Diabetes; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2 - drug therapy; GLP-1 receptor agonists; Glucose; Glucose monitoring; Glycated Hemoglobin A - analysis; Humans; Hypoglycemia; Hypoglycemic Agents - adverse effects; Insulin; Insulin - adverse effects; Patients; Type 2 diabetes; Type 2 diabetes; Continuous glucose monitoring; Blood glucose monitoring
• ISSN: 1056-8727; 1873-460X; 1873-460X
• DOI: 10.1016/j.jdiacomp.2021.108106

Evaluate whether structured BGM testing (BGM) or real-time CGM (CGM) lead to improved glucose control (A1c). Determine which approach optimized glucose control more effectively. trial of three type 2 diabetes (T2D) therapies ± metformin: (1) sulfonylurea (SU), (2) incretin (DPP4 inhibitor or GLP-1 agonist), or (3) insulin. After a baseline CGM, 114 adult subjects were randomized to either BGM (4 times daily) or CGM (24/7) for 16 weeks with therapies adjusted every 4 weeks. A1c means decreased from 8.19 to 7.07 (1.12% difference) with CGM (n = 59) and 7.85 to 7.03 (0.82% difference) with BGM (n = 55) (p < 0.001). BGM and CGM groups showed significant improvements in time in range and glucose variability—with no significant difference between the two groups. Clinically important hypoglycemia (<50 mg/dL) was significantly reduced for the CGM group compared with BGM (p < 0.01), particularly in subjects taking insulin or therapies with higher hypoglycemic risk (SU). In T2D, structured, consistent use of glucose data regardless of device (structured BGM or CGM) leads to improvements in A1c control. CGM is more effective than BGM in minimizing hypoglycemia particularly for those using higher hypoglycemic risk therapies. •In T2D, structured, consistent use of glucose data regardless of the device (structured BGM or CGM) lead to improved A1c control.•CGM + AGP report is more effective than BGM in minimizing hypoglycemia particularly when using higher hypoglycemic risk therapies.•Only CGM use led to a reduction in hypoglycemia rates in insulin and SU treatment groups.