Using a continuous glucose monitor (CGM), a skin-mounted sensor that allows real-time blood sugar checks without drawing blood, helps lower the risk of complications and death in patients with Type 1 diabetes, according to a new study.
Samsung Medical Center said Monday that a joint research team led by Professors Kim Jae-hyeon and Kim Ji-yoon of the Division of Endocrinology and Metabolism, along with Dr. Kim Seo-hyeon of the Samsung Advanced Institute for Health Sciences and Technology, reached these findings by analyzing cohort data from the National Health Insurance Service to examine the effect of CGM on the risk of complications and death in adult patients with Type 1 diabetes.
The team analyzed the risk of diabetes complications and death based on CGM use among 17,018 adult patients with Type 1 diabetes who had received at least three doses of ultra-rapid-acting insulin between 2019 and 2022. The results showed that the 8,509 patients in the CGM group had roughly a 60% lower risk of diabetic ketoacidosis (DKA) compared with the 8,509 patients in the non-user group, and 57% and 72% lower risks of end-stage renal disease (kidney disease) and cardiovascular disease, respectively. The overall risk of death was also 62% lower in the CGM group. Diabetic ketoacidosis is an acute diabetes complication that occurs when the body faces an absolute shortage of insulin and uses fat instead of glucose as an energy source, causing an acidic substance called "ketones" to build up excessively in the blood. Without timely and appropriate treatment, it can lead to death.
In this study, there was no significant difference in the risk of severe hypoglycemia depending on CGM use. However, when the analysis was limited to the CGM group, the frequency of severe hypoglycemia was found to have dropped 61.5% after CGM use. The frequency of hospitalizations and emergency room visits related to diabetic ketoacidosis and cardiovascular disease also fell 60% and 50%, respectively. This suggests that adult patients with Type 1 diabetes who use a CGM can significantly lower their risk of diabetes-related complications and death. Similar results were confirmed not only in adults but also in studies of pediatric and adolescent patients. The team examined the risk of acute complications based on CGM use among 3,765 patients with Type 1 diabetes under age 19 who received ultra-rapid-acting insulin treatment during the same period.
The results showed that the 2,313 patients in the CGM group had 56% lower risk of diabetic ketoacidosis and 52% lower risk of severe hypoglycemia compared with the 1,452 patients in the non-user group. Comparing before and after CGM use, the frequency of diabetic ketoacidosis and severe hypoglycemia fell 64% and 57%, respectively, showing a trend similar to that in adults. The two studies confirmed the clinical usefulness of CGM use across all ages, from children and adolescents to adults. The findings are considered a meaningful achievement in that they demonstrated that health insurance-based CGM support policies and systematic diabetes education programs can lead to improved prognoses for actual diabetes patients.
Professor Kim Ji-yoon said, "Through a large-scale nationwide study, we confirmed that using a continuous glucose monitor goes beyond simple monitoring and is associated, along with improved blood sugar levels, with a reduced risk of acute complications requiring emergency room visits, as well as chronic complications such as end-stage renal disease, cardiovascular disease, and death. This may be a result of systematic education through a home medical care pilot project for Type 1 diabetes, in addition to the use of a continuous glucose monitor."
Professor Kim Jae-hyeon, who led the research, expressed hope, saying, "This study suggests that continuous glucose monitors are an important means of lowering patients' risk of death and preventing complications in Type 1 diabetes management. If expanded health insurance support and structured diabetes education are carried out together going forward, they could be a great help in improving patients' long-term prognosis."
Meanwhile, the paper analyzing the effect of CGM use on the risk of complications and death in adult patients with Type 1 diabetes was published in the latest issue of "Diabetologia," the official journal of the European Association for the Study of Diabetes. The results of the study on pediatric and adolescent patients were published in the latest issue of the "Diabetes & Metabolism Journal," the official journal of the Korean Diabetes Association.
