The Association Between HbA_1c and Time in Hypoglycemia During CGM and Self-Monitoring of Blood Glucose in People With Type 1 Diabetes and Multiple Daily Insulin Injections: A Randomized Clinical Trial (GOLD-4).

Content Provider	Europe PMC
Author	Seyed Ahmadi, Shilan Westman, Klara Pivodic, Aldina Ólafsdóttir, Arndís F. Dahlqvist, Sofia Hirsch, Irl B. Hellman, Jarl Ekelund, Magnus Heise, Tim Polonsky, William Wijkman, Magnus Schwarcz, Erik Lind, Marcus
Copyright Year	2020
Abstract	OBJECTIVEAccording to recent guidelines, individuals with type 1 diabetes should spend <4.0% of time per day with glucose levels <3.9 mmol/L (<70 mg/dL) and <1.0% per day with glucose levels <3.0 mmol/L (<54 mg/dL).RESEARCH DESIGN AND METHODSIn the GOLD randomized crossover trial, 161 individuals with type 1 diabetes treated with multiple daily insulin injections (MDI) were randomized to continuous glucose monitoring (CGM) or conventional therapy with self-monitoring of blood glucose (SMBG) and evaluated over 16 months. We estimated the association between time spent in hypoglycemia and various mean glucose and HbA1c levels.RESULTSTime spent in hypoglycemia (<3.9 mmol/L and <3.0 mmol/L) increased significantly with lower mean HbA1c and mean glucose levels during both CGM and conventional therapy. During CGM, 24 (57.1%) individuals with HbA1c <7.5% (<58 mmol/mol) had <1.0% time spent in hypoglycemia <3.0 mmol/L and 23 (54.8%) had <4.0% time spent in hypoglycemia <3.9 mmol/L. During CGM, mean time spent in hypoglycemia for individuals with mean HbA1c 7.0% (52 mmol/mol) was estimated to be 5.4% for <3.9 mmol/L and 1.5% for <3.0 mmol/L. The corresponding values during SMBG were 9.2% and 3.5%, respectively. Individuals with mean glucose levels of 8 mmol/L spent 4.9% units more time with glucose levels <3.9 mmol/L and 2.8% units more time <3.0 mmol/L during SMBG compared with CGM.CONCLUSIONSReaching current targets for time in hypoglycemia while at the same time reaching HbA1c targets is challenging for patients with type 1 diabetes treated with MDI both with CGM and SMBG monitoring. However, CGM is associated with considerably less time in hypoglycemia than SMBG at a broad range of HbA1c levels and is crucial for patients with MDI treatment if they are to have a chance to approach hypoglycemia targets.
Page Count	8
ISSN	01495992
Volume Number	43
PubMed Central reference number	PMC7440892
Issue Number	9
PubMed reference number	32641374
Journal	Diabetes Care
e-ISSN	19355548
DOI	10.2337/dc19-2606
Language	English
Publisher	American Diabetes Association
Publisher Date	2020-07-08
Access Restriction	Open
Rights License	Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license. © 2020 by the American Diabetes Association
Content Type	Text
Resource Type	Article
Subject	Endocrinology, Diabetes and Metabolism Advanced and Specialized Nursing Internal Medicine