Continuous Glucose Monitoring Provides Real-World Benefits to Diabetes Patients
By Will Boggs MD
NEW YORK (Reuters Health) - Real-time continuous glucose monitoring (RT-CGM) provides numerous clinical benefits and improves quality of life, researchers from Belgium report.
"Here, within a strict budget, diabetes specialists of one of the 17 specialized centers were free in selecting any patient with type 1 diabetes on continuous subcutaneous insulin infusion (CSII),” Dr. Pieter Gillard from University Hospitals Leuven, in Belgium, told Reuters Health by email. “This made it possible to select motivated patients who they believed would benefit the most from RT-CGM. It shows that CGM reimbursement in the right patient population (using RT-CGM more than 70% of the time) has positive effects on glycemic control, quality of life, hospital admissions for acute diabetes complications, and work absenteeism.”
The Belgian healthcare authority authorized the reimbursement, starting in September 2014, of RT-CGM for type 1 diabetes patients using CSII and treated in selected specialized diabetes centers.
Dr. Gillard and colleagues in the RESCUE trial investigated the effect of RT-CGM reimbursement on hemoglobin A1c, admissions for acute diabetes complications, quality of life (QOL), and hypoglycemia under real-world conditions in the first two years of the program.
The analysis, published online January 12 in the Journal of Clinical Endocrinology and Metabolism, involved 515 patients with type 1 diabetes and CSII who benefited from the new RT-CGM reimbursement authorization.
Mean HbA1c was significantly lower at 12 months (7.4%) than at baseline (7.7%), and the percentage of patients who achieved HbA1c <7% increased from 23% at baseline to 33% at 12 months.
Acute hospitalization rates for severe hypoglycemia and/or ketoacidosis declined from 16% the year before RT-CGM initiation to 4% during the year in the program, a significant change.
The average number of days of diabetes-related hospital admissions per 100 patient-years declined significantly from 54 at baseline to 18 after introduction of RT-CGM reimbursement, and fewer patients reported diabetes-related work absenteeism with fewer absenteeism days.
All but one general QOL measure improved significantly after 12 months of reimbursement, and QOL improvements were greatest in patients who had problems with hypoglycemia and less substantial in patients with insufficient and variable glycemic control as their indications for implementing RT-CGM.
“In this single, largest prospective real-world study, we show that patients with type 1 diabetes using RT-CGM have a clear health benefit,” Dr. Gillard concluded. “Our findings thus support the use of RT-CGM under real-world conditions.”
He added, “Since the introduction and reimbursement of the FreeStyle Libre (FSL; Abbott Diabetes Care, Alameda, CA), more and more patients with type 1 diabetes switched to this system. Since studies investigated RT-CGM in comparison with SMBG, it is currently not known if RT-CGM offers the same benefits compared to FSL. Comparative studies are therefore required to understand which system (i.e., FSL or RT-CGM) offers the most benefit to which patients.”
J Clin Endocrinol Metabol 2018.
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