IS THE DIFFERENCE REALLY ONLY IN CONTINUOUS GLUCOSE MONITORING?
- Raquel N. Faradji, Mexico
- Raquel N. Faradji, Mexico
- Aili L. Garcia-tuomola, Mexico
- Neftali E. Antonio-villa, Mexico
- Carmen Castillo-galindo, Mexico
- Maricela Vidrio-velázquez, Mexico
- Mayra Valadez-capetillo, Mexico
- Jorge F. Bustamante-martinez, Mexico
- Miguel A. Polanco, Mexico
- Alicia E. Yepez-rodriguez, Mexico
- Guillermo Gonzalez-galvez, Mexico
- Juan R. Madrigal-sanroman, Mexico
- Paloma Almeda-valdes, Mexico
- RENACED-DT1 Renaced-dt1-research-group, Mexico
Abstract
Background and Aims
Insulin pump therapy (CSII) modestly reduces HbA1c compared with multiple daily insulin injections (MDI). Recent evidence suggests that continuous glucose monitoring (CGM), regardless of insulin delivery method, results in HbA1c reductions. The objective is to examine glycemic control via HbA1c in four treatment strategies: CGM+MDI, CGM+CSII, self-monitoring of blood-glucose (SMBG) +MDI and SMBG+CSII in patients of the T1D National Registry in Mexico (RENACED-DT1).
Methods
We included subjects using insulin analogues. Glycemic goal was defined as HbA1c ≤7.0%. Kruskall-Wallis and Dunn-test were used to assess differences in HbA1c between groups. A logistic-regression model evaluated the probability of achieving glycemic goal adjusting for sex, age and time since diagnosis.
Results
603 subjects were included (SMBG+MDI: 474; SMBG+CSII: 18; CGM+MDI: 64; CGM+CSII: 47). Biochemical and anthropometric characteristics are presented in Table 1. The SMBG+CSII (7.35 [6.8-8.2], p<0.01), CGM+MDI (7.75 [7.0-8.5], p<0.001) and CGM+CSII (7.8 [6.8-8.4], p<0.001) showed lower HbA1c compared to SMBG+MDI (8.8 [7.4-10.5]) (Figure 1). There were no differences in HbA1c between CGM+MDI and CGM+CSII groups. The CGM+CSII group had increased probability (OR: 2.27, 95%CI: 1.12, 4.39, p=0.02) of achieving glycemic control compared with SMBG+MDI after adjustment for covariates (Table 2).
Conclusions
The use of CGM+MDI or CSII with or without CGM compared with MDI+SMBG is associated with lower HbA1c. Further research is needed to assess long-term effectiveness, impact of each component in glycemic control and in complications.