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The DIaMonD study
Coverage from the American Diabetes Association 76th Scientific Sessions

'Profound' Finding on Continuous Glucose Monitoring

Andrew J. Ahmann, MD

Technology in diabetes has increased steadily over recent years. We have improvement in technology, better acceptance of technology, and better evidence of its benefits. One question that has remained, particularly regarding continuous glucose monitoring, is:

Is it just as effective in those who are using multiple daily injections—which is the majority of patients with type 1 diabetes—compared with those using the insulin pump?

The DIaMonD study

With that question in mind, the DIaMonD study looked at about 150 people with type 1 diabetes who had previously been checking their blood sugar levels multiple times per day and using multiple daily injections, not insulin pumps. They were randomly assigned to use either continuous glucose monitoring or to continue with their previous method of self-monitored blood glucose determination.

What we found was very profound. There was significant improvement in both groups, probably because of the study effect, but there was much better improvement in those who had continuous glucose monitoring, where the differential hemoglobin A1c was more than 0.6%. It really confirmed the impression that continuous glucose monitoring can greatly benefit those with type 1 diabetes who are taking injections rather than insulin pump therapy.

Does this change the way we practice? Do we change where we introduce continuous glucose monitoring, which has become a particularly improved technology in terms of its reliability of results and its convenience of use?

What we found was very profound

I think we will find that continuous glucose monitoring may take an earlier role in many patients. Whereas it was assumed in many patients that you would either start a pump first and continuous glucose monitoring later, or you would start a pump with the continuous glucose monitor, not very often would you do the continuous glucose monitoring first. I think that will change.

There are many reasons to have patients do continuous glucose monitoring first, particularly if that is their preference. They learn a lot from what they see in terms of what happens with food, what happens with activity, and what happens with their insulin injections. Then, they can later determine whether an insulin pump is something that will benefit them further in terms of their flexibility of therapy and their ability to adjust for exercise and other activities.

My guess is that continuous glucose monitoring is justified to be used alone with multiple daily insulin injections. Many people will start to use it quite early in diabetes, particularly for the diabetes education component, so that they better understand their disease and better understand all the things that affect their glucose control.

What we did not discuss so far is quality of life. There are pretty good indications that continuous glucose monitoring appears to be improving quality of life. I hope that that will become evident through the science as well.
Source: Medscape Diabetes & Endocrinology 2016
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