Remedy changes in folks with kind 1 diabetes with impaired hypoglycemia consciousness on a number of day by day injections utilizing real-time steady glucose monitoring: a mechanistic evaluation of the HypoDE examine

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BMJ Open Diabetes Res Care. 2021 Apr; 9 (1): e001848. doi: 10.1136 / bmjdrc-2020-001848.

ABSTRACT

INTRODUCTION: Studies have shown a beneficial effect of real-time continuous glucose monitoring (rtCGM) on clinical outcomes. The aim of this analysis was to find out which therapy adjustments were made by people with type 1 diabetes with impaired hypoglycemia awareness while using rtCGM in order to reduce the number of low-glucose events observed in the HypoDE (Hypoglycemia in Germany) study .

RESEARCH DESIGN AND METHODS: In the multicenter randomized controlled trial in people with type 1 diabetes with multiple daily injections with limited awareness of hypoglycemia, participants recorded their diabetes therapy in 7-day logbooks at baseline and after 6 months of follow-up . They used rtCGM, or blood sugar self-monitoring, for therapy adjustments. This mechanistic analysis examined changes in various aspects of therapy.

RESULTS: The logbooks were completed by 70 participants in the rtCGM group and 65 participants in the control group. Participants in the rtCGM group kept their total carbohydrate consumption, daily insulin doses, and distribution constant throughout the study. However, they reported an increased intake of rescue carbohydrates (0.8 ± 0.6 (mean ± SD) versus 1.0 ± 0.8 intake / day; baseline-adjusted difference between groups 0.3 intake (0.1-0, 5), p = 0.031). The glucose threshold at which the uptake of rescue carbohydrates was initiated was increased from 71 ± 13 mg / dl (3.9 ± 0.7 mmol / l) to 79 ± 14 mg / dl (4.4 ± 0.8 mmol / l ) increased (adjusted between the group differences +7.6) mg / dl (2.4-12.8) (+0.4 mmol / l (0.1-0.7)); p = 0.005) in the rtCGM group. A regression analysis showed that follow-up events with low glucose were associated with group assignment (p <0.001), low glucose events at baseline (p = 0.016), and rescue threshold (p = 0.001).

CONCLUSIONS: Subjects with limited awareness of hypoglycemia made no significant adjustments to insulin therapy. However, they were more active in preventing hypoglycemia by taking rescue carbohydrates earlier and more frequently.

TEST REGISTRATION NUMBER: NCT02671968.

PMID: 33863716 | DOI: 10.1136 / bmjdrc-2020-001848