Simple Post-Processing of Continuous Glucose Monitoring Measurements Improves Endpoints in Clinical Trials

Use of Personal Continuous Glucose Monitoring Device Is Associated With Reduced Risk of Hypoglycemia in a 16-Week Clinical Trial of People With Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion

AIMS

Continuous glucose monitoring (CGM) has the potential to promote diabetes self-management at home with a better glycemic control as outcome. Investigation of the effect of CGM has typically been carried out based on randomized controlled trials with prespecified CGM devices on CGM-naïve participants. The aim of this study was to investigate the effect on glycemic control in people using their personal CGM before and during the trial.

MATERIALS AND METHODS

Data from the Onset 5 trial of 472 people with type 1 diabetes using either their personal CGM (n = 117) or no CGM (n = 355) and continuous subcutaneous insulin infusion in a 16-week treatment period were extracted. Change from baseline in glycated hemoglobin A1c (HbA_1c), number of hypoglycemic episodes, and CGM metrics at the end of treatment were analyzed with analysis of variance repeated-measures models.

RESULTS

Use of personal CGM compared with no CGM was associated with a reduction in risk of documented symptomatic hypoglycemia (event rate ratio: 0.82; 95% CI: 0.69-0.97) and asymptomatic hypoglycemia (event rate ratio: 0.72; 95% CI: 0.53-0.97), reduced time spent in hypoglycemia (P = .0070), and less glycemic variability (P = .0043) without a statistically significant increase in HbA_1c (P = .2028).

CONCLUSIONS

Results indicate that use of personal CGM compared with no CGM in a population of type 1 diabetes is associated with a safer glycemic control without a statistically significantly deteriorated effect on HbA_1c, which adds to the evidence about the real-world use of CGM, where device type is not prespecified, and users are not CGM naïve.

Analysis of "Simple Post-Processing of Continuous Glucose Monitoring Measurements Improves Endpoints in Clinical Trials"

Jensen et al used continuous glucose monitoring (CGM) data of the Dexcom G4 Platinum (DG4P) sensor obtained in a clinical efficacy and safety study of Novo Nordisk's new insulin Fiasp® to calculate the CGM time delay versus plasma glucose (PG) and self-measured blood glucose (SMBG) measurements (9-10 min). Shifting the CGM signal by 9 min backward in time versus PG and SMBG data improved the analytical accuracy of the DG4P sensor and the reliability of clinical research endpoint (hypoglycemia, postprandial glucose increments) detection. Since this method takes advantage of post-processing of CGM data, it is particularly suited for the optimization of data processing in clinical studies. In contrast, real-time corrections of time delays need predictive algorithms.