Impact of Continuous Sugar Monitoring on Haemoglobin A1c Levels in Type 1 Diabetics

Study Overview

A study conducted in 2017 investigated the effects of continuous sugar monitoring on haemoglobin A1c (HbA1c) levels among individuals with type 1 diabetes. The findings indicated that continuous monitoring resulted in a more significant reduction in HbA1c levels compared to traditional blood sugar meters alone. While previous research has highlighted the benefits of continuous monitoring for blood sugar control, many studies have primarily focused on its use alongside automatic insulin pumps rather than manual insulin injections, which are more common among type 1 diabetics.

Research Methodology

Published in the Journal of the American Medical Association, the 2017 study included adult participants aged 26 to 73 who had been diagnosed with type 1 diabetes. All participants had been on daily insulin injections for at least one year, had not utilized a continuous blood sugar monitor in the past three months, and had an HbA1c level between 7.5% and 10.0%—indicating their blood sugar control over the preceding two to three months.

During the pre-trial screening, participants were required to use a continuous sugar monitor for at least 12 out of 14 days, calibrate the device at least twice daily, and check their blood sugar levels using the provided traditional meters and test strips at least three times daily. Those who did not follow these guidelines were excluded from the study. Eligible participants were subsequently randomized into either the continuous monitoring (CM) group or the control group.

Study Groups and Procedures

Participants in the CM group used a continuous sugar monitor daily, calibrated the device twice daily, and compared its readings with those from traditional meters before administering insulin. In contrast, the control group monitored their blood sugar levels at least four times a day using traditional meters. The continuous sugar monitors provided readings from body tissue every five minutes, while the traditional meters required manual testing using test strips.

The study spanned 24 weeks, with participant assessments occurring at 4, 12, and 24 weeks for both groups. The CM group had additional visits after the first week, while the control group was monitored during weeks 11 and 23 using a continuous monitor. HbA1c levels were measured at screening and again at 12 and 24 weeks.

Assessment of Efficacy and Safety

Efficacy was evaluated based on changes in HbA1c levels, the percentage of participants achieving HbA1c levels below 7.0%, and the duration spent within specific blood sugar ranges. Other factors included awareness of low blood sugar, frequency of self-testing, and participant satisfaction with continuous monitoring devices. Safety assessments focused on incidents of severely low blood sugar, severe adverse events, and occurrences of diabetic ketoacidosis.

Trial Outcomes

Out of the participants, 102 in the CM group and 53 in the control group completed the trial. By the end of the 24 weeks, the average number of blood sugar tests conducted was 3.6 tests per day for the CM group and 4.6 tests per day for the control group, down from an average of 5.1 tests per day during screening.

The CM group experienced an average reduction in HbA1c of 1.0% after 24 weeks compared to 0.4% in the control group. Additionally, the percentage of participants with HbA1c levels below 7.0% increased from 14% to 18% in the CM group, while remaining unchanged in the control group.

The CM group also reported spending more time within the target blood sugar range of 70 to 180 mg/dL, averaging an additional 76 minutes per day by the end of the study. In contrast, the control group’s time spent in this range did not change. Both groups saw similar outcomes regarding total insulin injected and awareness of low blood sugar, with only two individuals in each group experiencing severely low blood sugar.

Conclusion

The study concluded that continuous sugar monitoring significantly lowers haemoglobin A1c levels compared to traditional blood sugar meters. Furthermore, it is associated with extended periods of stable blood sugar levels, reduced time spent in low blood sugar ranges, and decreased variability in blood sugar levels. These results suggest that continuous monitoring may be advantageous for type 1 diabetics who require daily insulin injections. High compliance rates among participants lend credibility to these findings, and further research is recommended to explore these benefits in individuals with more severe cases of type 1 diabetes.

Author Information

Written by: Raishard Haynes, MBS