Impact of a Novel Diabetes Support System on a Cohort of Individuals With Type 1 Diabetes Treated With Multiple Daily Injections: A Multicenter Randomized Study.

Abstract

OBJECTIVE:

Achieving optimal glycemic control for many individuals with type 1 diabetes (T1D) remains challenging, even with the advent of newer management tools, including continuous glucose monitoring (CGM). Modern management of T1D generates a wealth of data; however, use of these data to optimize glycemic control remains limited. We evaluated the impact of a CGM-based decision support system (DSS) in patients with T1D using multiple daily injections (MDI).

RESEARCH DESIGN AND METHODS:

The studied DSS included real-time dosing advice and retrospective therapy optimization. Adults and adolescents (age >15 years) with T1D using MDI were enrolled at three sites in a 14-week randomized controlled trial of MDI + CGM + DSS versus MDI + CGM. All participants (N = 80) used degludec basal insulin and Dexcom G5 CGM. CGM-based and patient-reported outcomes were analyzed. Within the DSS group, ad hoc analysis further contrasted active versus nonactive DSS users.

RESULTS:

No significant differences were detected between experimental and control groups (e.g., time in range [TIR] +3.3% with CGM vs. +4.4% with DSS). Participants in both groups reported lower HbA1c (-0.3%; P = 0.001) with respect to baseline. While TIR may have improved in both groups, it was statistically significant only for DSS; the same was apparent for time spent <60 mg/dL. Active versus nonactive DSS users showed lower risk of and exposure to hypoglycemia with system use.

CONCLUSIONS:

Our DSS seems to be a feasible option for individuals using MDI, although the glycemic benefits associated with use need to be further investigated. System design, therapy requirements, and target population should be further refined prior to use in clinical care.

• Authors: Alessandro Bisio, Stacey Anderson, Lisa Norlander, Grenye O'Malley, Jessica Robic, Selassie Ogyaadu, Liana Hsu, Camilla Levister, Laya Ekhlaspour, David W Lam, Carol Levy, Bruce Buckingham, Marc D Breton
• Journal: Diabetes care (Diabetes Care) Vol. 45 Issue 1 Pg. 186-193 (01 01 2022) ISSN: 1935-5548 [Electronic] United States
• PMID: 34794973 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: © 2021 by the American Diabetes Association.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin

Topics

• Adolescent
• Adult
• Blood Glucose
• Blood Glucose Self-Monitoring (methods)
• Diabetes Mellitus, Type 1 (drug therapy)
• Glycated Hemoglobin (analysis)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin (therapeutic use)
• Retrospective Studies