Use of Factory-Calibrated Real-time Continuous Glucose Monitoring Improves Time in Target and HbA1c in a Multiethnic Cohort of Adolescents and Young Adults With Type 1 Diabetes: The MILLENNIALS Study

Thabit, Hood; Navis Prabhu, Joshi; Mubita, Womba; Fullwood, Catherine; Azmi, Shazli; Urwin, Andrea; Doughty, Ian; Leelarathna, Lalantha

Abstract

OBJECTIVE
International type 1 diabetes registries have shown that HbA1c levels are highest in young people with type 1 diabetes; however, improving their glycemic control remains a challenge. We propose that use of the factory-calibrated Dexcom G6 CGM system would improve glycemic control in this cohort.

RESEARCH DESIGN AND METHODS
We conducted a randomized crossover trial in young people with type 1 diabetes (16–24 years old) comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded continuous glucose monitoring (CGM) was worn by each participant for 10 days at the start, week 4, and week 7 of the control period. HbA1c measurements were drawn after enrollment and before and after each treatment period. The primary outcome was time in range 70–180 mg/dL.

RESULTS
Time in range was significantly higher during CGM compared with control (35.7 ± 13.5% vs. 24.6 ± 9.3%; mean difference 11.1% [95% CI 7.0–15.2]; P < 0.001). CGM use reduced mean sensor glucose (219.7 ± 37.6 mg/dL vs. 251.9 ± 36.3 mg/dL; mean difference −32.2 mg/dL [95% CI −44.5 to −20.0]; P < 0.001) and time above range (61.7 ± 15.1% vs. 73.6 ± 10.4%; mean difference 11.9% [95% CI −16.4 to −7.4]; P < 0.001). HbA1c level was reduced by 0.76% (95% CI −1.1 to −0.4) (−8.5 mmol/mol [95% CI −12.4 to −4.6]; P < 0.001). Times spent below range (<70 mg/dL and <54 mg/dL) were low and comparable during both study periods. Sensor wear was 84% during the CGM period.

CONCLUSIONS
CGM use in young people with type 1 diabetes improves time in target and HbA1c levels compared with SMBG.

Citation

Thabit, H., Navis Prabhu, J., Mubita, W., Fullwood, C., Azmi, S., Urwin, A., …Leelarathna, L. (2020). Use of Factory-Calibrated Real-time Continuous Glucose Monitoring Improves Time in Target and HbA1c in a Multiethnic Cohort of Adolescents and Young Adults With Type 1 Diabetes: The MILLENNIALS Study. Diabetes Care, 43(10), 2537–2543. https://doi.org/10.2337/dc20-0736

• Journal Article Type: Article
• Acceptance Date: Jun 29, 2020
• Publication Date: Oct 1, 2020
• Deposit Date: Jun 19, 2024
• Journal: Diabetes Care
• Print ISSN: 0149-5992
• Publisher: American Diabetes Association
• Peer Reviewed: Peer Reviewed
• Volume: 43
• Issue: 10
• Pages: 2537–2543
• DOI: https://doi.org/10.2337/dc20-0736