Assessment of Patient-Led or Physician-Driven Continuous Glucose Monitoring in Patients With Poorly Controlled Type 1 Diabetes Using Basal-Bolus Insulin Regimens

A 1-year multicenter study

  1. for the EVADIAC Sensor Study Group
  1. 1Department of Diabetes and Endocrinology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
  2. 2Université Pierre et Marie Curie-Paris 6, UMRS 872, Paris, France
  3. 3Service de Nutrition-Endocrinologie-Maladies Métaboliques, University Hospital Sainte Marguerite, Marseille, France
  4. 4Institut du thorax, Service d'endocrinologie-diabétologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
  5. 5Department of Endocrinology, Diabetes, and Nutrition and Centres d’Investigation Clinique INSERM 1001, Montpellier University Hospital, Montpellier, France
  6. 6Service de Diabétologie, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Hôtel-Dieu, Paris, France
  7. 7Department of Endocrinology-Metabolism and Diabetology-Nutrition, University Hospital of Besançon and EA 3920, University of Franche-Comte, Besançon, France
  8. 8Service Endocrinologie et Centres d’Investigation Clinique, Hôpital Robert Debré, APHP, Paris, France
  9. 9Service de pédiatrie A, American Memorial Hospital, Centre Hospitalier Universitaire de Reims, Reims, France
  10. 10Department of Endocrinology, Centre Hospitalier Universitaire Bordeaux, Pessac, France
  11. 11Service d'endocrinologie, Centre Hospitalier Universitaire de Reims, Reims, France
  12. 12Division of Diabetes, Nutrition, and Metabolic Disorders, Department of Medicine, Centre Hospitalier Universitaire Sart Tilman, University of Liège, Liège, Belgium
  13. 13Department of Endocrinology, Diabetes, and Nutrition, Hopital Lyon-Sud, HCL, Université Lyon 1, INSERM 1060, Lyon, France
  14. 14Department of Endocrinology and Diabetology, University Hospital, Strasbourg, France
  15. 15Department of Endocrinology, Pôle DigiDune, Grenoble University Hospital, Joseph-Fourier University, Grenoble, France
  16. 16Université de Nancy I et service de diabétologie, maladies métaboliques et maladies de la nutrition, Hôpitaux de Brabois, hôpital d'adultes, Centre Hospitalier Universitaire de Nancy, Nancy, France
  17. 17Unité d'Endocrinologie, Département de Médecine, Hôpital Sud, Centre Hospitalier Universitaire Rennes, Rennes, France
  18. 18Department of Endocrinology, Diabetes, and Metabolism, University Hospital, Saint-Etienne, France
  19. 19Service de Diabétologie-Métabolisme Groupe Hospitalier Pitié-Salpêtrière, Paris, France
  20. 20Pôle Cardio-Vasculaire et Métabolique, Service de Diabetologie, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France
  1. Corresponding author: Jean-Pierre Riveline, riveline.jeanpierre{at}neuf.fr.

Abstract

OBJECTIVE The benefits of real-time continuous glucose monitoring (CGM) have been demonstrated in patients with type 1 diabetes. Our aim was to compare the effect of two modes of use of CGM, patient led or physician driven, for 1 year in subjects with poorly controlled type 1 diabetes.

RESEARCH DESIGN AND METHODS Patients with type 1 diabetes aged 8–60 years with HbA1c ≥8% were randomly assigned to three groups (1:1:1). Outcomes for glucose control were assessed at 1 year for two modes of CGM (group 1: patient led; group 2: physician driven) versus conventional self-monitoring of blood glucose (group 3: control).

RESULTS A total of 257 subjects with type 1 diabetes underwent screening. Of these, 197 were randomized, with 178 patients completing the study (age: 36 ± 14 years; HbA1c: 8.9 ± 0.9%). HbA1c improved similarly in both CGM groups and was reduced compared with the control group (group 1 vs. group 3: −0.52%, P = 0.0006; group 2 vs. group 3: −0.47%, P = 0.0008; groups 1 + 2 vs. group 3: −0.50%, P < 0.0001). The incidence of hypoglycemia was similar in the three groups. Patient SF-36 questionnaire physical health score improved in both experimental CGM groups (P = 0.004). Sensor consumption was 34% lower in group 2 than in group 1 (median [Q1–Q3] consumption: group 1: 3.42/month [2.20–3.91] vs. group 2: 2.25/month [1.27–2.99], P = 0.001).

CONCLUSIONS Both patient-led and physician-driven CGM provide similar long-term improvement in glucose control in patients with poorly controlled type 1 diabetes, but the physician-driven CGM mode used fewer sensors.

This Article

  1. Diabetes Care
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