In the January 2020 issue of Diabetes Care, Šoupal et al. (1) provided convincing evidence that continuous glucose monitoring (CGM) by itself is superior to self-monitoring of blood glucose in reducing HbA1c and hypoglycemia, whatever the type of insulin delivery, i.e., continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Although we agree with the conclusions that CGM is superior to self-monitoring of blood glucose in reducing hypoglycemia, with comparable time below range for MDI and CSII (5.5% and 5.3%, respectively, in their article), we would like to draw attention to the fact that not all sensor-augmented pumps are equivalent. Pumps with preventive low–blood glucose suspend management (PLGM) provide important clinical benefits in reducing significantly severe hypoglycemia (2), a condition associated with hypoglycemia unawareness. We compared subjects with type 1 diabetes treated with MDI (n = 95) and CSII users with an Omnipod pump (n = 134) both using FreeStyle Libre CGM system (Abbott Diabetes Care, Witney, U.K.) to individuals equipped with a MiniMed 640G pump (Medtronic, Northridge, CA) with the SmartGuard system (n = 61). As shown in Fig. 1, individuals with PLGM-integrated pumps had a dramatic reduction of hypoglycemia across the different ranges of blood glucose with a mean time below range of 0.9% in contrast to 7.2% for MDI users and 5.6% for CSII users. An important correlation between hypoglycemic events and mean glucose levels can also be observed in subjects with MDI and CSII in contrast to individuals with PLGM-integrated pumps. Although it is a higher-cost alternative, PLGM-integrated pump therapy is clearly indicated in individuals at high risk of severe hypoglycemia. As mentioned previously (3), it is therefore essential to refocus our attention on hypoglycemic outcomes and to correctly address the technological issues for optimal prevention.
Percentage of time below range of CGM values according to mean glucose range of subjects with MDI (open bars, open circles), Omnipod pump users (gray bars, filled circles), and subjects with MiniMed 640G pump with SmartGuard and low blood glucose management system (hatched bars, triangles). Each bar represents the mean ± SEM of values.
Percentage of time below range of CGM values according to mean glucose range of subjects with MDI (open bars, open circles), Omnipod pump users (gray bars, filled circles), and subjects with MiniMed 640G pump with SmartGuard and low blood glucose management system (hatched bars, triangles). Each bar represents the mean ± SEM of values.
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Acknowledgments and Funding. This work was performed with the help of the medical and nursing teams from the University Hospital of Lyon-Sud with funding support from the Auvergne-Rhône-Alpes Region.
Duality of Interest. C.Th. has received travel support for meetings, speaker fees, and honoraria from Abbott Diabetes Care, Janssen, Lilly, Novo Nordisk, Medtronic, Roche Diabetes Care, and Sanofi and is an advisory board member for Insulet and Medtronic. No other potential conflicts of interest relevant to this article were reported.
