Continuous glucose monitoring versus blood glucose monitoring for risk of severe hypoglycaemia and diabetic ketoacidosis in children, adolescents, and young adults with type 1 diabetes: a population-based study
Main finding · Severe hypoglycaemiaResult — go to the resultIncidence rate ratio 0.76 95% CI 0.64–0.91Authors' conclusion
These findings provide evidence that continuous glucose monitoring can reduce severe hypoglycaemia and ketoacidosis risk in young people with type 1 diabetes on insulin therapy. Continuous glucose monitoring metrics might help to identify those at risk for acute diabetes complications.
Study context
- Population
- People with T1D aged 1.5–25.0 years, diabetes duration >1 year, treated Jan 1, 2014–June 30, 2021, observation >120 days in most recent treatment year; 511 diabetes centres in Austria, Germany, Luxembourg and Switzerland (DPV initiative); median age 16.8 years, 53.1% males
- Participants
- 32,117 people
- Exposure
- CGM vs blood glucose monitoring
- CGMn = 10,883
- Blood glucose monitoringn = 21,234reference
- Outcome
- Rates of severe hypoglycaemia and DKA
- Follow-up
- Most recent treatment year
Methodological detailsmulticentre, adjusted for age, sex, diabetes duration, migration background, insulin therapy and treatment period
- Multicentre
- Adjusted for age, sex, diabetes duration, migration background, insulin therapy and treatment period
Main finding
Severe hypoglycaemia
Incidence rate ratio
0.76
95% CI 0.64–0.91
P = 0.0017
By group
CGM
6.74 per 100 patient-years
95% CI 5.90–7.69
Blood glucose monitoring
8.84 per 100 patient-years
CI 8.09–9.66
CGMvs Blood glucose monitoring
IRR 0.76 (95% CI 0.64–0.91); P = 0.0017
As reported in the abstract
Observational data: associations, not effects.
Further findings
Per 100 patient-years
| Outcome | CGM | Blood glucose monitoring | IRR | P value | |
|---|---|---|---|---|---|
| DKA · most recent treatment year | 3.72 (CI 3.32–4.18) | 7.29 (CI 6.83–7.78) | 0.51 (CI 0.44–0.59) | P < 0.0001 | |
| Severe hypoglycaemia by % time below range (<3.9 mmol/L)4.0-7.9%vs <4.0% | 1.69 (95% CI 1.18–2.43) | P = 0.0024 | |||
| Severe hypoglycaemia by % time below range (<3.9 mmol/L)≥8.0%vs <4.0% | 2.38 (95% CI 1.51–3.76) | P < 0.0001 | |||
| Severe hypoglycaemia by glycaemic variability (CV)CV ≥36%vs CV <36% | 1.52 (95% CI 1.06–2.17) | P = 0.022 | |||
| DKA by mean sensor glucose8.3-9.9 mmol/Lvs <8.3 mmol/L | 1.77 (95% CI 0.89–3.51) | P = 0.13 | |||
| DKA by mean sensor glucose10.0-11.6 mmol/Lvs <8.3 mmol/L | 3.56 (95% CI 1.83–6.93) | P < 0.0001 | |||
| DKA by mean sensor glucose≥11.7 mmol/Lvs <8.3 mmol/L | 8.66 (95% CI 4.48–16.75) | P < 0.0001 | |||
| 0.050.21520Incidence rate ratio (log scale) |
Original publication
Continuous glucose monitoring versus blood glucose monitoring for risk of severe hypoglycaemia and diabetic ketoacidosis in children, adolescents, and young adults with type 1 diabetes: a population-based study. Lancet Diabetes Endocrinol. Published 30 March 2023. doi:10.
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