Jun 3 2021
According to a study performed by Kaiser Permanente, the use of continuous glucose monitors is linked to improved blood sugar control and fewer emergency department visits for hypoglycemia, specifically for patients suffering from insulin-treated type 2 diabetes. The study was published in the JAMA journal on June 2nd, 2021.
Image Credit: Kaiser Permanente.
Continuous glucose monitors have previously been demonstrated to enhance glucose control for patients suffering from type 1 diabetes. And today, these monitors have become the standard of care for these people.
“The improvement in blood sugar control was comparable to what a patient might experience after starting a new diabetes medication,” stated Andrew J. Karter, PhD, the study lead author and a senior research scientist from the Kaiser Permanente Northern California Division of Research.
The comparative, retrospective analysis involved a total of 5,673 patients suffering from type 1 diabetes and 36,080 patients suffering from type 2 diabetes who were treated with insulin and were self-monitoring their blood sugar levels.
From January 2015 to December 2019, at the suggestion of their physicians, 3,462 individuals with type 1 diabetes and 344 patients with type 2 diabetes started using continuous glucose monitors.
The researchers used statistical methods that simulated randomization in a clinical trial and assessed before-and-after results among patients who started using a continuous glucose monitor and subsequently compared these outcomes with the results among patients who did not use the monitor.
Such analyses demonstrated that continuous glucose monitors were linked to reduced HbA1c levels. HbA1c is a laboratory test used for diagnosing and treating diabetes that quantifies blood sugar levels.
In addition, the continuous glucose monitors reduced hospitalizations for very low blood sugar, or hypoglycemia, and also reduced visits to the emergency departments. Hypoglycemia raises the risk for falls, dementia, cardiovascular disease, and even death.
Blood sugar levels that go too low can be dangerous. This study shows that continuous glucose monitors helped people stay close to their glucose targets without going too low.
Richard Dlott, MD, Study Senior Author and Endocrinologist, The Permanente Medical Group
Dr Dlott is also the medical director of population care for The Permanente Medical Group.
For many years, diabetic patients have checked their blood sugar levels using finger sticks.
Since 2017, Medicare has covered the expenses of continuous glucose monitors for diabetic patients who met specific qualifications (at present, nearly all patients with type 1 diabetes meet these qualifications).
A thin metallic sensor is used by continuous glucose monitors to identify blood sugar levels just within the skin. Every 5 minutes, this metallic sensor sends blood sugar readings to a smartphone or receiver. A prescription is required to use these continuous glucose monitors.
The new study looked at diabetic patients who began using continuous glucose monitors as recommended by their physicians.
To qualify the Medicare guidelines, patients should generally use an insulin pump or inject themselves three or more insulin shots daily, carry out blood glucose testing four or more times a day, and reliably communicate with a diabetes team every three to six months.
Selective prescribing of continuous glucose monitors may partially explain the benefits we saw in these patients with type 2 diabetes. Doctors appeared to have preferentially prescribed monitors to patients with a history of hypoglycemia or at high risk of hypoglycemia.
Andrew J. Karter, PhD, Study Lead Author and Senior Research Scientist, The Kaiser Permanente Northern California Division of Research
Karter is also the associate director for the Health Delivery Systems Center for Diabetes Translational Research, which is sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases.
The subsequent step is to find out if there are other individuals who are suffering from type 2 diabetes and whose blood sugar levels would be better and more safely regulated with continuous glucose monitors, added the researchers.
This study found that patients who used continuous glucose monitors had very good results compared to those who continued only with intermittent testing using finger sticks. We now need to determine whether there are other patients who might also benefit, even if they don’t meet all of the Medicare criteria. The newest technology isn’t always better for everybody. We need to identify the people who are most likely to benefit.
Richard Dlott, MD, Study Senior Author and Endocrinologist, The Permanente Medical Group
The research work was funded by an independent investigator award from Dexcom and funding from the National Institute of Diabetes and Digestive and Kidney Diseases.
The study co-authors include Melissa M. Parker, MS, and Howard H. Moffet, MPH, from the Division of Research, and Lisa K. Gilliam, MD, PhD, from The Permanente Medical Group.
Journal Reference:
Karter, A. J., et al. (2021) Association of Real-time Continuous Glucose Monitoring With Glycemic Control and Acute Metabolic Events Among Patients With Insulin-Treated Diabetes. JAMA. doi.org/10.1001/jama.2021.6530.