Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Diabetes Care. 2023 Nov 1;46(11):1958-1964. doi: 10.2337/dc23-1137.
This study aimed to investigate the association between continuous glucose monitoring (CGM)-derived glycemic metrics and different insulin treatment modalities using real-world data.
A cross-sectional study at Steno Diabetes Center Copenhagen, Denmark, included individuals with type 1 diabetes using CGM. Data from September 2021 to August 2022 were analyzed if CGM was used for at least 20% of a 4-week period. Individuals were divided into four groups: multiple daily injection (MDI) therapy, insulin pumps with unintegrated CGM (SUP), sensor-augmented pumps with low glucose management (SAP), and automated insulin delivery (AID). The MDI and SUP groups were further subdivided based on CGM alarm features. The primary outcome was percentage of time in range (TIR: 3.9-10.0 mmol/L) for each treatment group. Secondary outcomes included other glucose metrics and HbA1c.
Out of 6,314 attendees, 3,184 CGM users were included in the analysis. Among them, 1,622 used MDI, 504 used SUP, 354 used SAP, and 561 used AID. Median TIR was 54.0% for MDI, 54.9% for SUP, 62,9% for SAP, and 72,1% for AID users. The proportion of individuals achieving all recommended glycemic targets (TIR >70%, time above range <25%, and time below range <4%) was significantly higher in SAP (odds ratio [OR] 2.4 [95% CI 1.6-3.5]) and AID (OR 9.4 [95% CI 6.7-13.0]) compared with MDI without alarm features.
AID appears superior to other insulin treatment modalities with CGM. Although bias may be present because of indications, AID should be considered the preferred choice for insulin pump therapy.
本研究旨在使用真实世界数据探讨连续血糖监测（CGM）衍生的血糖指标与不同胰岛素治疗方式之间的关联。
在丹麦的 Steno 糖尿病中心进行了一项横断面研究，纳入了使用 CGM 的 1 型糖尿病患者。如果 CGM 在至少 4 周的 20%时间内使用，则分析 2021 年 9 月至 2022 年 8 月的数据。将个体分为四组：多次每日注射（MDI）治疗、未集成 CGM 的胰岛素泵（SUP）、带低血糖管理的传感器增强型泵（SAP）和自动胰岛素输送（AID）。MDI 和 SUP 组进一步根据 CGM 报警特征进行细分。主要结局是每种治疗组的时间在范围内（TIR：3.9-10.0mmol/L）的百分比。次要结局包括其他血糖指标和 HbA1c。
在 6314 名与会者中，有 3184 名 CGM 用户纳入分析。其中，1622 名使用 MDI，504 名使用 SUP，354 名使用 SAP，561 名使用 AID。MDI 使用者的 TIR 中位数为 54.0%，SUP 使用者为 54.9%，SAP 使用者为 62.9%，AID 使用者为 72.1%。与无报警特征的 MDI 相比，SAP（优势比 [OR]2.4 [95%CI1.6-3.5]）和 AID（OR9.4 [95%CI6.7-13.0]）使用者达到所有推荐血糖目标（TIR>70%、血糖高于范围<25%和血糖低于范围<4%）的比例显著更高。
AID 似乎优于其他 CGM 胰岛素治疗方式。尽管由于适应证存在偏倚，但 AID 应被视为胰岛素泵治疗的首选。
