Assessment of Patient-Led or Physician-Driven Continuous Glucose Monitoring in Patients With Poorly Controlled Type 1 Diabetes Using Basal-Bolus Insulin.

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Assessment of Patient-Led or Physician-Driven Continuous Glucose Monitoring in Patients With Poorly Controlled Type 1 Diabetes Using Basal-Bolus Insulin Regimens Featured Article: Jean-Pierre Riveline, M.D., Pauline Schaepelynck, M.D., Lucy Chaillous, M.D., Ph.D., Eric Renard, M.D., Ph.D., Agnès Sola-Gazagnes, M.D., Alfred Penfornis, M.D., Ph.D., Nadia Tubiana-Rufi, M.D., Véronique Sulmont, M.D., Bogdan Catargi, M.D., Ph.D., Céline Lukas, M.D., Régis P. Radermecker, M.D., Charles Thivolet, M.D., Ph.D., François Moreau, M.D., Pierre-Yves Benhamou, M.D., Ph.D., Bruno Guerci, M.D., Ph.D., Anne-Marie Leguerrier, M.D., Luc Millot, M.D., Claude Sachon, M.D., Guillaume Charpentier, M.D., Hélène Hanaire, M.D., For The EVADIAC Sensor Study Goup Diabetes Care Volume 35: 965-971 May, 2012

Study Objectives The benefits of real-time continuous glucose monitoring (CGM) have been demonstrated in patients with type 1 diabetes Aim was to compare the effect of two modes of use of CGM, patient-led or physician-driven, in subjects with poorly controlled type 1 diabetes Riveline J et al. Diabetes Care 2012;35:965-971

Study Design 197 patients with type 1 diabetes aged 8–60 years with HbA1c > 8% randomly assigned to: Patient-led CGM Physician-driven CGM Conventional self-monitoring of blood glucose Glucose control outcomes assessed at 1 year Riveline J et al. Diabetes Care 2012;35:965-971

One-year CGM in type 1 diabetic patients Table 1- Characteristics of patients with type 1 diabetes screened for inclusion in the study Data are mean 6 SD unless otherwise indicated. †P , 0.05 for comparison between FAS groups. ‡P , 0.05 for comparison between FAS population and screenfailure population. xPatients with $1 episodes of severe hypoglycemia during previous year. A severe episode of hypoglycemia was defined as an event requiring assistance from another person Riveline J et al. Diabetes Care 2012;35:965-971

Figure 1- HbA1c change from baseline (M0) at 3, 6, 9, and 12 months in groups 1, 2, and 3. Values are means (95% CIs). The data correspond well to the estimated mean and CI of the model. *P , 0.05 for comparisons between the two experimental groups and the control group at each time point. M, month. Riveline J et al. Diabetes Care 2012;35:965-971

Table 2- Glycemic stability, hypoglycemia, and diabetic ketoacidosis *All adjusted using the Hochberg procedure. xSD of 8-point daily blood glucose profile (mg/dL), values aremeans (95%CIs). {A severe episode of hypoglycemia was defined as an event requiring assistance from another person to administer carbohydrate/glucagon. Riveline J et al. Diabetes Care 2012;35:965-971

Conclusions Both patient-led and physician-driven CGM provide similar long-term improvement in glucose control in patients with poorly controlled type 1 diabetes Physician-driven CGM mode used fewer sensors. Riveline J et al. Diabetes Care 2012;35:965-971