PMID- 31530662
OWN - NLM
STAT- MEDLINE
DCOM- 20201002
LR  - 20221207
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Linking)
VI  - 43
IP  - 1
DP  - 2020 Jan
TI  - Continuous Glucose Monitoring in People With Type 1 Diabetes on Multiple-Dose 
      Injection Therapy: The Relationship Between Glycemic Control and Hypoglycemia.
PG  - 53-58
LID - 10.2337/dc19-0977 [doi]
AB  - OBJECTIVE: The inverse relationship between overall glucose control and 
      hypoglycemia risk is weakened by the use of real-time continuous glucose 
      monitoring (rtCGM). We assess the relationship between glucose control and 
      hypoglycemia in people with type 1 diabetes using multiple-dose injection (MDI) 
      regimens, including those at highest risk of hypoglycemia. RESEARCH DESIGN AND 
      METHODS: CGM data from the intervention (rtCGM) and control (self-monitored blood 
      glucose [SMBG]) phases of the Multiple Daily Injections and Continuous Glucose 
      Monitoring in Diabetes (DIAMOND) and HypoDE studies were analyzed. The 
      relationship between glucose control (HbA(1c) and mean rtCGM glucose levels) and 
      percentage time spent in hypoglycemia was explored for thresholds of 3.9 mmol/L 
      (70 mg/dL) and 3.0 mmol/L (54 mg/dL), and ANOVA across the range of HbA(1c) and 
      mean glucose was performed. RESULTS: A nonlinear relationship between mean 
      glucose and hypoglycemia was identified at baseline, with the steepest 
      relationship seen at lower values of mean glucose. The use of rtCGM reduces the 
      exposure to hypoglycemia at all thresholds and flattens the relationship between 
      overall glucose and hypoglycemia, with the most marked impact at lower values of 
      mean glucose and HbA(1c). Exposure to hypoglycemia varied at all thresholds 
      across the range of overall glucose at baseline, in the SMBG group, and with 
      rtCGM, but the relationships were weaker in the rtCGM group. CONCLUSIONS: Use of 
      rtCGM can flatten and attenuate the relationship between overall glucose control 
      and hypoglycemia, exerting its greatest impact at lower values of HbA(1c) and 
      mean glucose in people with type 1 diabetes using MDI regimens and at highest 
      risk of hypoglycemia.
CI  - (c) 2019 by the American Diabetes Association.
FAU - Oliver, Nick
AU  - Oliver N
AUID- ORCID: 0000-0003-3525-3633
AD  - Division of Diabetes, Endocrinology and Metabolism, Imperial College London, 
      London, U.K. nick.oliver@imperial.ac.uk.
FAU - Gimenez, Marga
AU  - Gimenez M
AD  - Diabetes Unit, Endocrinology and Nutrition, Institut d'Investigacions Biomediques 
      August Pi i Sunyer, CIBERDEM, Hospital Clinic, Barcelona, Spain.
FAU - Calhoun, Peter
AU  - Calhoun P
AD  - Jaeb Center for Health Research, Tampa, FL.
FAU - Cohen, Nathan
AU  - Cohen N
AD  - Jaeb Center for Health Research, Tampa, FL.
FAU - Moscardo, Vanessa
AU  - Moscardo V
AUID- ORCID: 0000-0002-0149-4669
AD  - Instituto Universitario de Automatica e Informatica Industrial, Universitat 
      Politecnica de Valencia, Valencia, Spain.
FAU - Hermanns, Norbert
AU  - Hermanns N
AUID- ORCID: 0000-0002-2903-2677
AD  - Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany.
AD  - Department of Clinical Psychology and Psychotherapy, University of Bamberg, 
      Bamberg, Germany.
FAU - Freckmann, Guido
AU  - Freckmann G
AD  - Institut fur Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an 
      der Universitat Ulm, Ulm, Germany.
FAU - Reddy, Monika
AU  - Reddy M
AD  - Division of Diabetes, Endocrinology and Metabolism, Imperial College London, 
      London, U.K.
FAU - Heinemann, Lutz
AU  - Heinemann L
AD  - Science Consulting in Diabetes GmbH, Neuss, Germany.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20190917
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - Adult
MH  - Blood Glucose/*analysis/drug effects/metabolism
MH  - Blood Glucose Self-Monitoring
MH  - Diabetes Mellitus, Type 1/*blood/*drug therapy
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Glycated Hemoglobin/analysis/drug effects/metabolism
MH  - Humans
MH  - Hypoglycemia/*blood/chemically induced
MH  - Hypoglycemic Agents/*administration & dosage/adverse effects
MH  - Injections, Subcutaneous
MH  - Insulin/*administration & dosage/adverse effects
MH  - Male
MH  - Middle Aged
EDAT- 2019/09/19 06:00
MHDA- 2020/10/03 06:00
CRDT- 2019/09/19 06:00
PHST- 2019/05/15 00:00 [received]
PHST- 2019/08/27 00:00 [accepted]
PHST- 2019/09/19 06:00 [pubmed]
PHST- 2020/10/03 06:00 [medline]
PHST- 2019/09/19 06:00 [entrez]
AID - dc19-0977 [pii]
AID - 10.2337/dc19-0977 [doi]
PST - ppublish
SO  - Diabetes Care. 2020 Jan;43(1):53-58. doi: 10.2337/dc19-0977. Epub 2019 Sep 17.