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Continuous Glucose ...
Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in Adults With Type 1 Diabetes Treated With Multiple Daily Insulin Injections The GOLD Randomized Clinical Trial
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- Lind, Marcus, 1976 (author)
- University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine,NU Hospital Group,Univ Gothenburg, Dept Mol & Clin Med, Gothenburg, Sweden.;NU Hosp Grp, Dept Med, Uddevalla, Sweden.
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- Polonsky, W. (author)
- University of California, San Diego,Univ Calif San Diego, La Jolla, CA 92093 USA.
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- Hirsch, I. B. (author)
- University of Washington,Univ Washington, Sch Med, Seattle, WA USA.
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- Heise, T. (author)
- PROFIL Institut für Stoffwechselforschung GmbH,Profil, Neuss, Germany.
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- Bolinder, J. (author)
- Karolinska Institutet,Karolinska Institute,Karolinska University Hospital,Karolinska Univ Hosp Huddinge, Karolinska Inst, Dept Med, Stockholm, Sweden.
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- Dahlqvist, S. (author)
- NU Hospital Group,NU Hosp Grp, Dept Med, Uddevalla, Sweden.
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- Schwarz, E. (author)
- Örebro University,Univ Orebro, Fac Med & Hlth, Dept Internal Med, Orebro, Sweden.
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- Frid, Anders (author)
- Lund University,Lunds universitet,Institutionen för kliniska vetenskaper, Malmö,Medicinska fakulteten,Department of Clinical Sciences, Malmö,Faculty of Medicine,Skåne University Hospital,Skane Univ Hosp, Dept Clin Sci, Div Endocrinol, Malmo, Sweden.;Lund Univ, Lund, Sweden.
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Frid, A. (author)
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- Wedel, Hans (author)
- University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för hälsometri,Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics,Univ Gothenburg, Hlth Metr Sahlgrenska Acad, Gothenburg, Sweden.
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- Ahlén, Elsa, 1990 (author)
- University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine,NU Hospital Group,Univ Gothenburg, Dept Mol & Clin Med, Gothenburg, Sweden.;NU Hosp Grp, Dept Med, Uddevalla, Sweden.
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- Nystrom, T. (author)
- Karolinska Institutet,Karolinska Institute,Stockholm South General Hospital,Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden.
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- Hellman, Jarl (author)
- Uppsala universitet,Uppsala University,Klinisk diabetologi och metabolism
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- Olafsdottir, Arndis Finna (author)
- NU Hosp Grp, Dept Med, Uddevalla, Sweden.
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(creator_code:org_t)
- American Medical Association (AMA), 2017
- 2017
- English.
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In: Jama-Journal of the American Medical Association. - : American Medical Association (AMA). - 0098-7484 .- 1538-3598. ; 317:4, s. 379-387
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Abstract
Subject headings
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- IMPORTANCE The majority of individuals with type 1 diabetes do not meet recommended glycemic targets. OBJECTIVE To evaluate the effects of continuous glucose monitoring in adults with type 1 diabetes treated with multiple daily insulin injections. DESIGN, SETTING, AND PARTICIPANTS Open-label crossover randomized clinical trial conducted in 15 diabetes outpatient clinics in Sweden between February 24, 2014, and June 1, 2016 that included 161 individuals with type 1 diabetes and hemoglobin A(1c) (HbA(1c)) of at least 7.5%(58 mmol/mol) treated with multiple daily insulin injections. INTERVENTIONS Participants were randomized to receive treatment using a continuous glucose monitoring system or conventional treatment for 26 weeks, separated by a washout period of 17 weeks. MAIN OUTCOMES AND MEASURES Difference in HbA(1c) between weeks 26 and 69 for the 2 treatments. Adverse events including severe hypoglycemia were also studied. RESULTS Among 161 randomized participants, mean age was 43.7 years, 45.3% were women, and mean HbA(1c) was 8.6%(70 mmol/mol). A total of 142 participants had follow-up data in both treatment periods. Mean HbA(1c) was 7.92%(63 mmol/mol) during continuous glucose monitoring use and 8.35%(68 mmol/mol) during conventional treatment (mean difference, -0.43% [95% CI, -0.57% to -0.29%] or -4.7 [-6.3 to -3.1 mmol/mol]; P < .001). Of 19 secondary end points comprising psychosocial and various glycemic measures, 6 met the hierarchical testing criteria of statistical significance, favoring continuous glucose monitoring compared with conventional treatment. Five patients in the conventional treatment group and 1 patient in the continuous glucose monitoring group had severe hypoglycemia. During washout when patients used conventional therapy, 7 patients had severe hypoglycemia. CONCLUSIONS AND RELEVANCE Among patients with inadequately controlled type 1 diabetes treated with multiple daily insulin injections, the use of continuous glucose monitoring compared with conventional treatment for 26 weeks resulted in lower HbA(1c). Further research is needed to assess clinical outcomes and longer-term adverse effects.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
Keyword
- blood-glucose
- treatment satisfaction
- severe hypoglycemia
- swedish
- version
- pump therapy
- association
- reduction
- frequency
- General & Internal Medicine
- lonsky wh
- 1995
- diabetes care
- v18
- p754
Publication and Content Type
- ref (subject category)
- art (subject category)
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Lind, Marcus, 19 ...
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Polonsky, W.
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Hirsch, I. B.
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Heise, T.
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Bolinder, J.
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Dahlqvist, S.
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Schwarz, E.
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Frid, Anders
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Frid, A.
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Wedel, Hans
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Ahlén, Elsa, 199 ...
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Nystrom, T.
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Hellman, Jarl
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Olafsdottir, Arn ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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MEDICAL AND HEAL ...
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University of Gothenburg
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Lund University
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Uppsala University
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Karolinska Institutet