Sara Charleer1,2, Chantal Mathieu1, Frank Nobels3, Christophe De Block4, Regis P Radermecker5, Michel P Hermans6, Youri Taes7, Chris Vercammen8, Guy T'Sjoen9, Laurent Crenier10, Steffen Fieuws11, Bart Keymeulen12, Pieter Gillard1. 1. Department of Endocrinology, University Hospitals Leuven-Katholieke Universiteit Leuven, Leuven, Belgium. 2. PhD Fellowship Strategic Basic Research of the Research Foundation-Flanders (Fonds Wetenschappelijk Onderzoek), Brussels, Belgium. 3. Department of Endocrinology, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium. 4. Department of Endocrinology, Diabetology and Metabolism, University of Antwerp-Antwerp University Hospital, Antwerp, Belgium. 5. Department of Diabetes, Nutrition and Metabolic Disorders, Centre Hospitalier Universitaire Liege-Liege University, Liege, Belgium. 6. Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc-Université Catholique de Louvain, Brussels, Belgium. 7. Department of Endocrinology, Algemeen Ziekenhuis Sint-Jan Brugge AV, Bruges, Belgium. 8. Department of Endocrinology, Imelda Hospital Bonheiden, Bonheiden, Belgium. 9. Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. 10. Department of Endocrinology, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium. 11. Department of Public Health and Primary Care, I-BioStat, KU Leuven-University of Leuven and Universiteit Hasselt, Leuven, Belgium. 12. Diabeteskliniek, University Hospital Brussels-Vrije Universiteit Brussel, Brussels, Belgium.
Abstract
Context: 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. Objective: To assess impact of RT-CGM in real-world settings on glycemic control, hospital admissions, work absenteeism, and quality of life (QOL). Design: Prospective, observational, multicenter, cohort study. Participants: A total of 515 adults with T1D on continuous subcutaneous insulin infusion (CSII) therapy starting in the Belgian RT-CGM reimbursement program. Intervention: Initiation of RT-CGM reimbursement. Main Outcome Measure: Hemoglobin A1c (HbA1c) evolution from baseline to 12 months. Results: 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. Conclusion: 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.
Context: 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. Objective: To assess impact of RT-CGM in real-world settings on glycemic control, hospital admissions, work absenteeism, and quality of life (QOL). Design: Prospective, observational, multicenter, cohort study. Participants: A total of 515 adults with T1D on continuous subcutaneous insulin infusion (CSII) therapy starting in the Belgian RT-CGM reimbursement program. Intervention: Initiation of RT-CGM reimbursement. Main Outcome Measure: Hemoglobin A1c (HbA1c) evolution from baseline to 12 months. Results: 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. Conclusion: 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.
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