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- Title
Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial.
- Authors
Laffel, Lori M.; Kanapka, Lauren G.; Beck, Roy W.; Bergamo, Katherine; Clements, Mark A.; Criego, Amy; DeSalvo, Daniel J.; Goland, Robin; Hood, Korey; Liljenquist, David; Messer, Laurel H.; Monzavi, Roshanak; Mouse, Thomas J.; Prahalad, Priya; Sherr, Jennifer; Simmons, Jill H.; Wadwa, R. Paul; Weinstock, Ruth S.; Willi, Steven M.; Miller, Kellee M.
- Abstract
<bold>Importance: </bold>Adolescents and young adults with type 1 diabetes exhibit the worst glycemic control among individuals with type 1 diabetes across the lifespan. Although continuous glucose monitoring (CGM) has been shown to improve glycemic control in adults, its benefit in adolescents and young adults has not been demonstrated.<bold>Objective: </bold>To determine the effect of CGM on glycemic control in adolescents and young adults with type 1 diabetes.<bold>Design, Setting, and Participants: </bold>Randomized clinical trial conducted between January 2018 and May 2019 at 14 endocrinology practices in the US including 153 individuals aged 14 to 24 years with type 1 diabetes and screening hemoglobin A1c (HbA1c) of 7.5% to 10.9%.<bold>Interventions: </bold>Participants were randomized 1:1 to undergo CGM (CGM group; n = 74) or usual care using a blood glucose meter for glucose monitoring (blood glucose monitoring [BGM] group; n = 79).<bold>Main Outcomes and Measures: </bold>The primary outcome was change in HbA1c from baseline to 26 weeks. There were 20 secondary outcomes, including additional HbA1c outcomes, CGM glucose metrics, and patient-reported outcomes with adjustment for multiple comparisons to control for the false discovery rate.<bold>Results: </bold>Among the 153 participants (mean [SD] age, 17 [3] years; 76 [50%] were female; mean [SD] diabetes duration, 9 [5] years), 142 (93%) completed the study. In the CGM group, 68% of participants used CGM at least 5 days per week in month 6. Mean HbA1c was 8.9% at baseline and 8.5% at 26 weeks in the CGM group and 8.9% at both baseline and 26 weeks in the BGM group (adjusted between-group difference, -0.37% [95% CI, -0.66% to -0.08%]; P = .01). Of 20 prespecified secondary outcomes, there were statistically significant differences in 3 of 7 binary HbA1c outcomes, 8 of 9 CGM metrics, and 1 of 4 patient-reported outcomes. The most commonly reported adverse events in the CGM and BGM groups were severe hypoglycemia (3 participants with an event in the CGM group and 2 in the BGM group), hyperglycemia/ketosis (1 participant with an event in CGM group and 4 in the BGM group), and diabetic ketoacidosis (3 participants with an event in the CGM group and 1 in the BGM group).<bold>Conclusions and Relevance: </bold>Among adolescents and young adults with type 1 diabetes, continuous glucose monitoring compared with standard blood glucose monitoring resulted in a small but statistically significant improvement in glycemic control over 26 weeks. Further research is needed to understand the clinical importance of the findings.<bold>Trial Registration: </bold>ClinicalTrials.gov Identifier: NCT03263494.
- Subjects
BLOOD sugar monitoring; TYPE 1 diabetes; DISEASES in older people; GLYCEMIC control; BLOOD sugar measurement; PATIENT monitoring equipment; BLOOD sugar monitors; BLOOD sugar analysis; HYPERGLYCEMIA prevention; RESEARCH; HYPERGLYCEMIA; MOBILE apps; RESEARCH methodology; HYPOGLYCEMIC agents; EVALUATION research; MEDICAL cooperation; COMPARATIVE studies; RANDOMIZED controlled trials; HYPOGLYCEMIA; RESEARCH funding; DIABETIC acidosis
- Publication
JAMA: Journal of the American Medical Association, 2020, Vol 323, Issue 23, p2388
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2020.6940