<b>Objective:</b>
In recent years, a growing number of people with type 1 diabetes have access to
real-time continuous glucose monitoring (rtCGM). Long-term benefits of rtCGM
are unclear due to lack of large studies of long duration. We evaluated whether
real-world rtCGM-use up to 24 months offered benefits, in particular to those
living with impaired awareness of hypoglycemia (IAH).
<p><b>Research Design and
Methods:</b> This 24-month, prospective, observational, cohort
study followed 441<b> </b>adults with
insulin pumps receiving full reimbursement for rtCGM. Forty-two percent had IAH.
Primary endpoint was evolution of HbA<sub>1c</sub>, with secondary endpoints
change in acute hypoglycemia complications, diabetes-related work absenteeism,
and quality of life (QOL) scores. Additionally, we evaluated if people could
achieve glycemic consensus targets during follow-up.</p>
<p><b>Results:</b>
After 24 months, HbA<sub>1c</sub> remained significantly lower compared to
baseline (7.64% [60 mmol/mol] vs 7.37% [57 mmol/mol], p<0.0001). Sustained benefits
were also observed for the score on the hypoglycemia fear survey and hypoglycemia-related
acute complications irrespective of hypoglycemia awareness level. People with IAH
had the strongest improvement, especially for severe hypoglycemia (862 events
year before vs 119 events per 100 patient-years in second year, p<0.0001).
Over 24 months, more people were able to meet hypoglycemia consensus targets at
the expense of slightly less people achieving hyperglycemia consensus targets.
Furthermore, the number of people with HbA<sub>1c</sub> <7% (<53
mmol/mol) without severe hypoglycemia events more than doubled (11.0% vs 25.4%,
p<0.0001).</p>
<p><b>Conclusion:</b>
Use of rtCGM led to sustained improvements in hypoglycemia-related glucose
control over 24 months. Lower fear of hypoglycemia, less acute hypoglycemia-related
events and diabetes-related days off work were observed, particularly in those with
IAH.</p>
The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial
