Real-time continuous glucose monitoring (CGM) significantly reduces severe hypoglycemia in hypoglycemia-unaware patients with type 1 diabetes.
In hypoglycemia unaware patients, CGM provides the required information needed for enhanced decision making support to improve glycemic control and help eliminate severe hypoglycemia. In this observational study, severe hypoglycemia incidents were reduced by 93% in adults with hypoglycemia unawareness using RT-CGM.
Objective To evaluate the effect of continuous glucose monitoring (CGM) on the frequency of severe hypoglycemia (SH) in patients with established hypoglycemia unawareness.
Research and Design Methods We conducted a retrospective audit of 35 patients with type 1 diabetes and problematic hypoglycemia unawareness, despite optimized medical therapy (continuous subcutaneous insulin infusion/multiple daily insulin injections), who used CGM for >1 year.
Results Over a 1-year follow-up period, the median rates of SH were reduced from 4.0 (interquartile range [IQR] 0.75-7.25) episodes/patient-year to 0.0 (0.0-1.25) episodes/patient-year (P < 0.001), and the mean (±SD) rates were reduced from 8.1 ± 13 to 0.6 ± 1.2 episodes/year (P = 0.005). HbA1c was reduced from 8.1 ± 1.2% to 7.6 ± 1.0% over the year (P = 0.005). The mean Gold score, measured in 19 patients, did not change: 5.1 ± 1.5 vs. 5.2 ± 1.9 (P = 0.67).
Conclusions In a specialist experienced insulin pump center, in carefully selected patients, CGM reduced SH while improving HbA1c but failed to restore hypoglycemia awareness.
Source: Choudhary P, Ramasamy S, Green L et al. Real-Time Continuous Glucose Monitoring Significantly Reduces Severe Hypoglycemia in Hypoglycemia-Unaware Patients With Type 1 Diabetes. Diabetes Care. 2013;36(12):4160-4162.
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