Nick Oliver1, Marga Gimenez2, Peter Calhoun3, Nathan Cohen3, Vanessa Moscardo4, Norbert Hermanns5,6, Guido Freckmann7, Monika Reddy8, Lutz Heinemann9. 1. Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, U.K. nick.oliver@imperial.ac.uk. 2. Diabetes Unit, Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERDEM, Hospital Clínic, Barcelona, Spain. 3. Jaeb Center for Health Research, Tampa, FL. 4. Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Valencia, Spain. 5. Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany. 6. Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany. 7. Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany. 8. Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, U.K. 9. Science Consulting in Diabetes GmbH, Neuss, Germany.
Abstract
OBJECTIVE: The inverse relationship between overall glucose control and hypoglycemia risk is weakened by the use of real-time continuous glucose monitoring (rtCGM). We assess the relationship between glucose control and hypoglycemia in people with type 1 diabetes using multiple-dose injection (MDI) regimens, including those at highest risk of hypoglycemia. RESEARCH DESIGN AND METHODS: CGM data from the intervention (rtCGM) and control (self-monitored blood glucose [SMBG]) phases of the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) and HypoDE studies were analyzed. The relationship between glucose control (HbA1c and mean rtCGM glucose levels) and percentage time spent in hypoglycemia was explored for thresholds of 3.9 mmol/L (70 mg/dL) and 3.0 mmol/L (54 mg/dL), and ANOVA across the range of HbA1c and mean glucose was performed. RESULTS: A nonlinear relationship between mean glucose and hypoglycemia was identified at baseline, with the steepest relationship seen at lower values of mean glucose. The use of rtCGM reduces the exposure to hypoglycemia at all thresholds and flattens the relationship between overall glucose and hypoglycemia, with the most marked impact at lower values of mean glucose and HbA1c. Exposure to hypoglycemia varied at all thresholds across the range of overall glucose at baseline, in the SMBG group, and with rtCGM, but the relationships were weaker in the rtCGM group. CONCLUSIONS: Use of rtCGM can flatten and attenuate the relationship between overall glucose control and hypoglycemia, exerting its greatest impact at lower values of HbA1c and mean glucose in people with type 1 diabetes using MDI regimens and at highest risk of hypoglycemia.
OBJECTIVE: The inverse relationship between overall glucose control and hypoglycemia risk is weakened by the use of real-time continuous glucose monitoring (rtCGM). We assess the relationship between glucose control and hypoglycemia in people with type 1 diabetes using multiple-dose injection (MDI) regimens, including those at highest risk of hypoglycemia. RESEARCH DESIGN AND METHODS: CGM data from the intervention (rtCGM) and control (self-monitored blood glucose [SMBG]) phases of the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) and HypoDE studies were analyzed. The relationship between glucose control (HbA1c and mean rtCGM glucose levels) and percentage time spent in hypoglycemia was explored for thresholds of 3.9 mmol/L (70 mg/dL) and 3.0 mmol/L (54 mg/dL), and ANOVA across the range of HbA1c and mean glucose was performed. RESULTS: A nonlinear relationship between mean glucose and hypoglycemia was identified at baseline, with the steepest relationship seen at lower values of mean glucose. The use of rtCGM reduces the exposure to hypoglycemia at all thresholds and flattens the relationship between overall glucose and hypoglycemia, with the most marked impact at lower values of mean glucose and HbA1c. Exposure to hypoglycemia varied at all thresholds across the range of overall glucose at baseline, in the SMBG group, and with rtCGM, but the relationships were weaker in the rtCGM group. CONCLUSIONS: Use of rtCGM can flatten and attenuate the relationship between overall glucose control and hypoglycemia, exerting its greatest impact at lower values of HbA1c and mean glucose in people with type 1 diabetes using MDI regimens and at highest risk of hypoglycemia.
Authors: Kathryn Linton; Roland H Stimson; Anna R Dover; Shareen Forbes; Karen Madill; Roxanne Annoh; Mark W J Strachan; J A McKnight; Rohana J Wright; Fraser W Gibb Journal: J Diabetes Sci Technol Date: 2021-02-19
Authors: Muhammad Al-Dalla Ali; Roland H Stimson; Anna R Dover; Shareen Forbes; Roxanne Annoh; Karen Madill; Fraser W Gibb Journal: BMJ Open Diabetes Res Care Date: 2020-11