Intermittently scanned continuous glucose monitoring (isCGM) can help reduce hypoglycemia unawareness and the number of hypoglycemic episodes in patients with type 1 diabetes (T1D), according to new research published in the journal Diabetes Research and Clinical Practice.1 The authors noted that isCGM can also be cost-saving compared to self-monitoring of blood glucose and real-time CGM (rtCGM).
CGM technology has led to improvements in diabetes management for many patients. Research has shown that the devices significantly improve glycemic control, average blood glucose levels, and HbA1c levels.2 One form of the technology is isCGM, which has proven to be beneficial for various patient populations, such as those who have prediabetes or have difficulty performing fingersticks.3 While studies have shown that rtCGM reduces hypoglycemia unawareness, there is a lack of data on if isCGM can also help in this respect.
Key Takeaways
- A study found that using intermittently scanned continuous glucose monitoring (isCGM) led to a 45.8% reduction in hypoglycemia unawareness in patients with type 1 diabetes (T1D) over a 2-year follow-up period.
- Patients using isCGM showed significant improvements in glycemic parameters, including reduced glucose variability, time in low glucose range, and the number and duration of hypoglycemic episodes.
- The study also highlighted a reduction in hypoglycemia-related fear among patients using isCGM, alongside a decrease in total insulin doses, suggesting an overall enhancement in the quality of life and diabetes management for these patients.
“Hypoglycemia is an important barrier for glycemic control in people with type 1 diabetes,” the authors wrote. “Impaired awareness of hypoglycemia (IAH) is very prevalent condition on these patients and is associated with a higher risk for severe hypoglycemia conferring a burden of mortality, morbidity and costs…[However] previous studies have been unable to demonstrate a reduction in [hypoglycemia unawareness] by using isCGM.”
READ MORE: Examining GLP-1 Trends in T2D, Risk of Obesity-Related Malignancies
Investigators from the Diabetes and Metabolism Research Unit at the Vall d’Hebron Research Institute in Barcelona, Spain, conducted a study to evaluate the impact of real-world use of isCGM on hypoglycemia and its impaired recognition in subjects with T1D. The real-world, observational, prospective pilot study included 2 years of follow-up, and used the Clarke questionnaire to evaluate hypoglycemia unawareness and the Hypoglycemia Fear Survey to assess psychological aspects related to hypoglycemia.
The study cohort included 60 patients over the age of 16 years old who had T1D and frequent hypoglycemic events that were seen at the hospital between October and December 2021. All patients used the isCGM type Abbott FreeStyle Libre 2 on a continuous basis for 2 years and received diabetes education under a structured program on the use of CGM, how to prevent and treat hypoglycemic episodes, and dietetic information.
Investigators found that after 2 years of follow-up, patients using isCGM had reduced glucose variability, time in low glucose range, time in very low glucose range, less events related to low glucose levels, and a shorter duration of hypoglycemic episodes. These improvements were seen at 1-year follow-up and persisted through the 2-year follow-up.
Additionally, patients using isCGM had a 45.8% reduction in hypoglycemia unawareness from baseline, as well as a reduction in hypoglycemia fear. The study also showed that patients had a reduction in total insulin dose.
Study limitations include that the education patients received through the study likely had an impact on the reduction of hypoglycemia unawareness, that only patients with a percentage of use of over 70 % were included, and that there was a lack of specific information on physical activity.
“In this real-world study with 2-years follow-up we found that the use of with alarms in people with T1D significantly improve the glucometric parameters, in particular in glycemic variability and those related to hypoglycemia,” the authors concluded. “In this later point, it should be underlined the significant reduction of time spent in hypoglycemia, the duration of severe hypoglycemia episodes and a decrease in the number of nocturnal hypoglycemia episodes.”
READ MORE: Continuous Glucose Monitoring Resource Center
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References
1. Ortiz-Zúñiga A, Amigó J, Sánchez M, et al. Impact in real-world of intermittent-scanned continuous glucose monitoring with alarms on hypoglycemia and its recognition in type 1 diabetes. Diabetes Res Clin Pract. 2024, 111786, ISSN 0168-8227. https://doi.org/10.1016/j.diabres.2024.111786.
2. Manov AE, Chauhan S, Dhillon G, et al. The Effectiveness of Continuous Glucose Monitoring Devices in Managing Uncontrolled Diabetes Mellitus: A Retrospective Study. Cureus. 2023 Jul 27;15(7):e42545. doi: 10.7759/cureus.42545. PMID: 37637581; PMCID: PMC10460137.
3. Edelman SV, Argento NB, Pettus J, et al. Clinical Implications of Real-time and Intermittently Scanned Continuous Glucose Monitoring. Diabetes Care. 2018 Nov;41(11):2265-2274. doi: 10.2337/dc18-1150. PMID: 30348844.
