Use of Real Time Continuous Glucose Monitoring (CGM) in Real Life Clinical Practice Compared with Finger-Stick Glucose Monitoring

Background: Studies have shown benefits of CGM in management of type 1 diabetes (T1D), however, it is not yet clear if the benefits are maintained in a real-life clinical practice.

Methods: We evaluated 2 groups of adults (age 18-35 years) with T1D: One using CGM and the other using glucometer. Patients underwent either 2-week blinded CGM or assessment from personal CGM over 2 weeks. Patients also completed questionnaires for demographics, surveys for fear of hypoglycemia (HSF II), hypoglycemic unawareness, and problem areas in diabetes Questionnaire (PAID)). Glycemic control was measured by A1c.

Results: We evaluated 33 patients withT1D (15 using CGM and 18 using glucometer); average age 27 years, duration of diabetes 10 years, years of education 7 years. CGM users had better glycemic control as seen by A1C of 7.5% vs. 8.5 (p<0.05). 40% of patients using CGM had clinically significant hypoglycemia (glucose≤54 for > 15 mins/episode) compared to 66% in glucometer-users (mean duration 18 min/day vs. 27 min/day) (p=ns). CGM users spent longer time in range (70-180 mg/dl) compared to glucometer-users (14 hours/day vs. 12 hours/day). Hypoglycemia unawareness was reported by 44% of CGM users compared to 14% of glucometer-users. More CGM-users reported checking SMBG > 6 times per day, and worried more regarding nocturnal hypoglycemia (81% vs. 57%). Diabetes-related distress was lower in RT-CGM users (PAID score 27 vs. 34).

Conclusion: In a clinical setting, despite more hypoglycemic unawareness and more worry regarding hypoglycemia, T1D patients who used RT-CGM had better glycemic control, higher time spent in range, and lower risk of hypoglycemia compared to glucometer-users.