Real-Time Continuous Glucose Monitoring Significantly Reduces Severe Hypoglycemia in Hypoglycemia-Unaware Patients With Type 1 Diabetes
- Pratik Choudhary, MBBS, MRCP, MP1,3⇑,
- Sharmin Ramasamy, MBBS, MRCP2,
- Louisa Green, BSC3,
- Geraldine Gallen, RGN3,
- Siobhan Pender, RGN2,
- Anna Brackenridge, MBBS, MRCP, MD2,
- Stephanie A. Amiel, MBBS, MD, FRCP1,3 and
- John C. Pickup, BM, DPhil, FRCP1,2
- 1Division of Diabetes and Nutritional Sciences, King’s College London, London, U.K.
- 2Department of Diabetes, Guy’s and St Thomas’ NHS Foundation Trust, London, U.K.
- 3Department of Diabetes, King’s College Hospital, London, U.K.
- Corresponding author: Pratik Choudhary, .
OBJECTIVE To evaluate the effect of continuous glucose monitoring (CGM) on the frequency of severe hypoglycemia (SH) in patients with established hypoglycemia unawareness.
RESEARCH DESIGN AND METHODS Retrospective audit of 35 patients with type 1 diabetes and problematic hypoglycemia unawareness, despite optimized medical therapy (continuous subcutaneous insulin infusion/multiple daily insulin injections), who used CGM for >1 year.
RESULTS Over a 1-year follow-up period, the median rates of SH were reduced from 4.0 (interquartile range [IQR] 0.75–7.25) episodes/patient-year to 0.0 (0.0–1.25) episodes/patient-year (P < 0.001), and the mean (±SD) rates were reduced from 8.1 ± 13 to 0.6 ± 1.2 episodes/year (P = 0.005). HbA1c was reduced from 8.1 ± 1.2% to 7.6 ± 1.0% over the year (P = 0.005). The mean Gold score, measured in 19 patients, did not change: 5.1 ± 1.5 vs. 5.2 ± 1.9 (P = 0.67).
CONCLUSIONS In a specialist experienced insulin pump center, in carefully selected patients, CGM reduced SH while improving HbA1c but failed to restore hypoglycemia awareness.
- Received April 21, 2013.
- Accepted July 3, 2013.
- © 2013 by the American Diabetes Association.
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