Effectiveness of Continuous Glucose Monitoring in a Clinical Care Environment: Evidence from the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring (JDRF-CGM) trial

• Published in: Diabetes care Vol. 33; no. 1; pp. 17 - 22
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.01.2010
• Subjects: Adolescent; Adult; Biological and medical sciences; Blood Glucose - analysis; Blood sugar monitoring; Child; Dextrose; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - metabolism; Diabetes therapy; Diabetes. Impaired glucose tolerance; Diabetics; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Glucose; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemia - blood; Hypoglycemia - drug therapy; Hypoglycemia - metabolism; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Medical sciences; Metabolic diseases; Miscellaneous; Monitoring, Ambulatory - methods; Original Research; Patient monitoring equipment; Public health. Hygiene; Public health. Hygiene-occupational medicine; Young Adult; Endocrinopathy; Human; Nutrition; Continuous; Diabetes mellitus; Metabolic diseases; Care; Surveillance; Efficiency; Continuous Glucose Monitoring System; Scientific research; Environment; Clinical trial; Child; Endocrinology; Glycemia
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc09-1502

To determine whether continuous glucose monitoring (CGM) is effective in the management of type 1 diabetes when implemented in a manner that more closely approximates clinical practice. After completion of a 6-month randomized controlled trial (RCT) evaluating CGM in children, adolescents, and adults with type 1 diabetes, CGM was initiated in the trial's control group with less intensive training and follow-up than was included in the RCT. Subjects had an outpatient training session, two follow-up phone calls, and outpatient visits at 1, 4, 13, and 26 weeks. For subjects with baseline A1C > or =7.0%, the primary outcome was change in A1C at 6 months. CGM use decreased from a median of 7.0 days/week in the first month in the > or =25-year-old group, 6.3 days/week in the 15-24 year olds, and 6.8 days/week in the 8-14 year olds to 6.5, 3.3, and 3.7 days/week in the 6th month, respectively (P < 0.001 for each age-group). Among subjects with baseline A1C > or =7.0%, CGM use was associated with A1C reduction after 6 months (P = 0.02 adjusted for age-group). Severe hypoglycemia decreased from 27.7 events per 100 person-years in the 6-month control phase of the RCT to 15.0 events per 100 person-years in the 6-month follow-up CGM phase (P = 0.08). Frequent use of CGM in a clinical care setting may improve A1C and reduce episodes of hypoglycemia. However, sustained frequent use of CGM is less likely in children and adolescents than in adults.