Glucose Monitoring Metrics in Individuals with Type 1 Diabetes using Different Treatment Modalities- a Real-World Observational Study

OBJECTIVE This study aimed to investigate the association between continuous glucose monitoring (CGM)-derived glycemic metrics and different insulin treatment modalities using real-world data.

RESEARCH DESIGN AND METHODS A cross-sectional study at Steno Diabetes Center Copenhagen, Denmark, included individuals with type 1 diabetes using CGM. Data from September 2021 to August 2022 were analyzed if CGM was used at least 20% of a 4-week period. Individuals were divided into four groups: multiple daily injection therapy (MDI), insulin pumps with unintegrated CGM (SUP), sensor-augmented pumps with low glucose management (SAP) and automated insulin delivery (AID). The MDI and SUP groups were further subdivided based on CGM alarm features. The primary outcome was percentage of time in range (TIR: 3.9-10.0 mmol/l) for each treatment group. Secondary outcomes included other glucose metrics and HbA1c.

RESULTS Out of 6,314 attendees, 3,184 CGM users were included in the analysis. Among them, 1,622 used MDI, 504 used SUP, 354 used SAP, and 561 used AID. Median TIR was 54.0% for MDI, 54.9% for SUP, 62,9% for SAP and 72,1% for AID users. The proportion of individuals achieving all recommended glycemic targets (TIR >70%, time above range <25%, and time below range <4%) was significantly higher in SAP (OR: 2.4 [95% CI: 1.6-3.5]) and AID (OR: 9.4 [95% CI:6.7-13.0]) compared to MDI without alarm features.

CONCLUSION AID appears superior to other insulin treatment modalities with CGM. Although bias may be present due to indications, AID should be considered the preferred choice for insulin pump therapy.