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

• Autores: Jean Pierre Riveline, Pauline Schaepelynck, Lucy Chaillous, Eric Renard, Agnès Sola Gazagnes, Alfred Penfornis, Rufi Tubiana, Véronique Sulmont, Bogdan Catargi, Céline Lukas, Régis Radermecker, Charles Thivolet, Françis Moreau, Pierre Yves Benhamou, Bruno Guerci, Anne Marie Leguerrier, Luc Millot, Claude Sachon, Guillaume Charpentier, Hélène Hanaire
• Localización: Diabetes care, ISSN-e 0149-5992, Vol. 35, Nº. 5, 2012, págs. 965-971
• Idioma: inglés
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  • 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. Patients with type 1 diabetes aged 8-60 years with HbA^sub 1c^ ?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). 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; HbA^sub 1c^: 8.9 ± 0.9%). HbA^sub 1c^ 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). 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.