Ólafsdóttir Arndís F, Bolinder Jan, Heise Tim, Polonsky William, Ekelund Magnus, Wijkman Magnus, Pivodic Aldina, Ahlén Elsa, Schwarcz Erik, Nyström Thomas, Hellman Jarl, Hirsch Irl B, Lind Marcus
Department of Medicine, NU-Hospital Group, Uddevalla, Sweden.
Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
Diabetes Obes Metab. 2021 Feb;23(2):619-630. doi: 10.1111/dom.14257. Epub 2020 Dec 10.
To identify responders to continuous glucose monitoring (CGM) in relation to reductions in HbA1c and percentage of time spent in hypoglycaemia after initiation of CGM for individuals with type 1 diabetes treated with multiple daily insulin injections.
We analysed data from 142 participants in the GOLD randomized clinical trial. We evaluated how many lowered their HbA1c by more than 0.4% (>4.7 mmol/mol) or decreased the time spent in hypoglycaemia over 24 hours by more than 20 or 30 minutes, and which baseline variables were associated with those improvements.
Lower reduction of HbA1c was associated with greater reduction of hypoglycaemia (r = -0.52; P < .0001). During CGM, 47% of participants lowered their HbA1c values by more than 0.4% (>4.7 mmol/mol) than with self-measurement of blood glucose, and 47% decreased the time spent in hypoglycaemia by more than 20 minutes over 24 hours. Overall, 78% either reduced their HbA1c by more than 0.4% (>4.7 mmol/mol) or the time spent in hypoglycaemia by more than 20 minutes over 24 hours, but only 14% improved both. Higher HbA1c, a lower percentage of time at less than 3.0 or 3.9 mmol/L, a lower coefficient of variation (CV) and a higher percentage of time above 13.9 mmol/L (P = .016) were associated with greater HbA1c reduction during CGM. The variables associated with a greater reduction of time in hypoglycaemia were female sex, greater time with glucose levels at less than 3.0 mmol/L, higher CV, and higher hypoglycaemia confidence as evaluated by a hypoglycaemic confidence questionnaire.
The majority of people with type 1 diabetes managed by multiple daily insulin injections benefit from CGM; some experienced reduced HbA1c while others reduced the time spent in hypoglycaemia. These factors need to be considered by healthcare professionals and decision-makers for reimbursement and diabetes guidelines.
确定在开始持续葡萄糖监测（CGM）后，与1型糖尿病患者糖化血红蛋白（HbA1c）降低以及低血糖持续时间百分比相关的CGM反应者，这些患者接受每日多次胰岛素注射治疗。
我们分析了GOLD随机临床试验中142名参与者的数据。我们评估了有多少人将HbA1c降低超过0.4%（>4.7 mmol/mol）或24小时内低血糖持续时间减少超过20或30分钟，以及哪些基线变量与这些改善相关。
HbA1c降低幅度较小与低血糖降低幅度较大相关（r = -0.52；P <.0001）。在CGM期间，47%的参与者HbA1c值比自我血糖测量降低超过0.4%（>4.7 mmol/mol），47%的参与者24小时内低血糖持续时间减少超过20分钟。总体而言，78%的参与者要么HbA1c降低超过0.4%（>4.7 mmol/mol），要么24小时内低血糖持续时间减少超过20分钟，但只有14%的参与者两者都有改善。较高的HbA1c、低于3.0或3.9 mmol/L的时间百分比较低、变异系数（CV）较低以及高于13.9 mmol/L的时间百分比较高（P = .016）与CGM期间HbA1c降低幅度较大相关。与低血糖持续时间减少幅度较大相关的变量包括女性、血糖水平低于3.0 mmol/L的时间较长、CV较高以及通过低血糖信心问卷评估的低血糖信心较高。
大多数接受每日多次胰岛素注射治疗的1型糖尿病患者从CGM中获益；一些患者HbA1c降低，而另一些患者低血糖持续时间减少。医疗保健专业人员和决策者在报销和糖尿病指南制定时需要考虑这些因素。
