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Miller KM, Kanapka LG, Rickels MR, Ahmann AJ, Aleppo G, Ang L, Bhargava A, Bode BW, Carlson A, Chaytor NS, Gannon G, Goland R, Hirsch IB, Kiblinger L, Kruger D, Kudva YC, Levy CJ, McGill JB, O'Malley G, Peters AL, Philipson LH, Philis-Tsimikas A, Pop-Busui R, Salam M, Shah VN, Thompson MJ, Vendrame F, Verdejo A, Weinstock RS, Young L, Pratley R. Benefit of Continuous Glucose Monitoring in Reducing Hypoglycemia Is Sustained Through 12 Months of Use Among Older Adults with Type 1 Diabetes. Diabetes Technol Ther 2022; 24:424-434. [PMID: 35294272 PMCID: PMC9208859 DOI: 10.1089/dia.2021.0503] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective: To evaluate glycemic outcomes in the Wireless Innovation for Seniors with Diabetes Mellitus (WISDM) randomized clinical trial (RCT) participants during an observational extension phase. Research Design and Methods: WISDM RCT was a 26-week RCT comparing continuous glucose monitoring (CGM) with blood glucose monitoring (BGM) in 203 adults aged ≥60 years with type 1 diabetes. Of the 198 participants who completed the RCT, 100 (98%) CGM group participants continued CGM (CGM-CGM cohort) and 94 (98%) BGM group participants initiated CGM (BGM-CGM cohort) for an additional 26 weeks. Results: CGM was used a median of >90% of the time at 52 weeks in both cohorts. In the CGM-CGM cohort, median time <70 mg/dL decreased from 5.0% at baseline to 2.6% at 26 weeks and remained stable with a median of 2.8% at 52 weeks (P < 0.001 baseline to 52 weeks). Participants spent more time in range 70-180 mg/dL (TIR) (mean 56% vs. 64%; P < 0.001) and had lower hemoglobin A1c (HbA1c) (mean 7.6% [59 mmol/mol] vs. 7.4% [57 mmol/mol]; P = 0.01) from baseline to 52 weeks. In BGM-CGM, from 26 to 52 weeks median time <70 mg/dL decreased from 3.9% to 1.9% (P < 0.001), TIR increased from 56% to 60% (P = 0.006) and HbA1c decreased from 7.5% (58 mmol/mol) to 7.3% (57 mmol/mol) (P = 0.025). In BGM-CGM, a severe hypoglycemic event was reported for nine participants while using BGM during the RCT and for two participants during the extension phase with CGM (P = 0.02). Conclusions: CGM use reduced hypoglycemia without increasing hyperglycemia in older adults with type 1 diabetes. These data provide further evidence for fully integrating CGM into clinical practice. Clinicaltrials.gov (NCT03240432).
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Affiliation(s)
| | - Lauren G. Kanapka
- Jaeb Center for Health Research, Tampa, Florida, USA
- Address correspondence to: Lauren G. Kanapka, MSc, Jaeb Center for Health Research, 15310 Amberly Drive, #350, Tampa, FL 33647, USA
| | - Michael R. Rickels
- Rodebaugh Diabetes Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew J. Ahmann
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon, USA
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lynn Ang
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anuj Bhargava
- Iowa Diabetes and Endocrinology Research Center, Des Moines, Iowa, USA
| | - Bruce W. Bode
- Formally Atlanta Diabetes Associates, Atlanta, Georgia, USA
| | - Anders Carlson
- Park Nicollet International Diabetes Center, Minneapolis, Minnesota, USA
| | - Naomi S. Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Gail Gannon
- Kovler Diabetes Center, University of Chicago, Chicago, Illinois, USA
| | - Robin Goland
- Naomi Berri Diabetes Center, Columbia University, New York, New York, USA
| | - Irl B. Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
| | - Lisa Kiblinger
- Formally Atlanta Diabetes Associates, Atlanta, Georgia, USA
| | | | | | - Carol J. Levy
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Janet B. McGill
- Division of Endocrinology, Metabolism & Lipid Research, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grenye O'Malley
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anne L. Peters
- Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | | | | | - Rodica Pop-Busui
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Maamoun Salam
- Division of Endocrinology, Metabolism & Lipid Research, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael J. Thompson
- Department of Endocrinology-Diabetes, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Francesco Vendrame
- Division of Endocrinology, Diabetes, and Metabolism at the University of Miami School of Medicine, University of Miami, Miami, Florida, USA
| | | | - Ruth S. Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Laura Young
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Richard Pratley
- AdventHealth Translation Research Institute, Orlando, Florida, USA
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