Department of Endocrinology, University Hospitals Leuven-Katholieke Universiteit Leuven, Leuven, Belgium.
PhD Fellowship Strategic Basic Research of the Research Foundation-Flanders (Fonds Wetenschappelijk Onderzoek), Brussels, Belgium.
J Clin Endocrinol Metab. 2018 Mar 1;103(3):1224-1232. doi: 10.1210/jc.2017-02498.
Randomized controlled trials evaluating real-time continuous glucose monitoring (RT-CGM) patients with type 1 diabetes (T1D) show improved glycemic control, but limited data are available on real-world use.
To assess impact of RT-CGM in real-world settings on glycemic control, hospital admissions, work absenteeism, and quality of life (QOL).
Prospective, observational, multicenter, cohort study.
A total of 515 adults with T1D on continuous subcutaneous insulin infusion (CSII) therapy starting in the Belgian RT-CGM reimbursement program.
Initiation of RT-CGM reimbursement.
Hemoglobin A1c (HbA1c) evolution from baseline to 12 months.
Between September 1, 2014, and December 31, 2016, 515 adults entered the reimbursement system. Over this period, 417 (81%) patients used RT-CGM for at least 12 months. Baseline HbA1c was 7.7 ± 0.9% (61 ± 9.8 mmol/mol) and decreased to 7.4 ± 0.8% (57 ± 8.7 mmol/mol) at 12 months (P < 0.0001). Subjects who started RT-CGM because of insufficient glycemic control showed stronger decrease in HbA1c at 4, 8, and 12 months compared with patients who started because of hypoglycemia or pregnancy. In the year preceding reimbursement, 16% of patients were hospitalized for severe hypoglycemia or ketoacidosis in contrast to 4% (P < 0.0005) the following year, with decrease in admission days from 54 to 18 per 100 patient years (P < 0.0005). In the same period, work absenteeism decreased and QOL improved significantly, with strong decline in fear of hypoglycemia.
Sensor-augmented pump therapy in patients with T1D followed in specialized centers improves HbA1c, fear of hypoglycemia, and QOL, whereas work absenteeism and admissions for acute diabetes complications decreased.
评估实时连续血糖监测（RT-CGM）在 1 型糖尿病（T1D）患者中的随机对照试验显示出改善的血糖控制，但关于真实世界应用的数据有限。
评估 RT-CGM 在真实环境中对血糖控制、住院、旷工和生活质量（QOL）的影响。
前瞻性、观察性、多中心、队列研究。
共有 515 名在比利时 RT-CGM 报销计划中开始接受连续皮下胰岛素输注（CSII）治疗的 T1D 成年患者。
启动 RT-CGM 报销。
从基线到 12 个月时血红蛋白 A1c（HbA1c）的变化。
2014 年 9 月 1 日至 2016 年 12 月 31 日期间，515 名成年人进入报销系统。在此期间，417 名（81%）患者至少使用 RT-CGM 12 个月。基线 HbA1c 为 7.7 ± 0.9%（61 ± 9.8 mmol/mol），12 个月时降至 7.4 ± 0.8%（57 ± 8.7 mmol/mol）（P < 0.0001）。由于血糖控制不足而开始使用 RT-CGM 的患者，在 4、8 和 12 个月时 HbA1c 的下降幅度大于因低血糖或妊娠而开始使用 RT-CGM 的患者。在报销前的一年中，有 16%的患者因严重低血糖或酮症酸中毒住院，而次年这一比例为 4%（P < 0.0005），每 100 名患者年的住院天数从 54 天减少到 18 天（P < 0.0005）。在同一时期，旷工减少，生活质量显著改善，对低血糖的恐惧明显下降。
在专门中心接受治疗的 T1D 患者使用传感器增强型泵治疗可改善 HbA1c、对低血糖的恐惧和生活质量，而旷工和因急性糖尿病并发症住院的情况则减少。
