Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections A Randomized Trial

作者：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

来源：Annals of Internal Medicine, 2017, 167(6): 365-+.

DOI：10.7326/M16-2855

• HEMOGLOBIN A1C
• HYPOGLYCEMIA
• MELLITUS
• SATISFACTION
• REDUCTION
• FREQUENCY
• THERAPY
• IMPACT
• ADULTS
• LIFE

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 (HbA(1c)) 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 HbA(1c) 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 CGMmeasured 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.

• 出版日期2017-9-19