New glucose monitoring system leads to better blood sugar control in diabetes: Lancet

The new glucose monitoring system that includes automated insulin titration guidance under medical supervision leads to better blood sugar control in diabetes.

In patients with type 2 diabetes, insulin therapy is most effective when the dosage titrations are done regularly and frequently. But this is seldom practical for most clinicians, resulting in an insulin titration gap. A recent study published in the journal Lancet has found that a combination of automated insulin titration guidance with support from health-care professionals facilitates safe and effective insulin titration. The combination also offered superior glycaemic control compared with support from health-care professionals alone.

Richard M Bergenstal, International Diabetes Center, Minneapolis, USA, and colleagues evaluated the effectiveness and safety of a novel system (d-Nav Insulin Guidance System) that measures, records, and analyzes scheduled fingerstick blood glucose levels and uses an algorithm to recommend insulin dose adjustments directly to patients. About 180, type 2 diabetes patients were randomized to receive usual support from healthcare professionals with or without using the new system.

The primary objective was to compare average change in HbA _1c from baseline to 6 months. Safety was assessed by the frequency of hypoglycaemic events. The primary objective and safety were assessed in the intention-to-treat population.

Key findings of the study include:

• Eligible patients had glycosylated hemoglobin (HbA_1c) levels between 7.5% and 11.0%, despite the use of a stable insulin regimen (long-acting, biphasic, or basal-bolus, with or without other medications) for at least 3 months.


• At baseline, the mean HbA_1c level was about 8.6% in both groups.


• After 6 months, the mean HbA_1c level declined by 1.0% in the intervention group and by 0.3% in the control group — a significant difference.


• No difference was noted in the frequency of hypoglycemic events.


• On average, the system algorithm adjusted insulin doses 1.1 times weekly.


• At study's end, total daily insulin doses for system users were more than 60% higher than those for control patients.

"The system now needs to be evaluated across large health-care systems to confirm these findings and study cost-effectiveness," concluded the authors.

For detailed study log on to https://doi.org/10.1016/S0140-6736(19)30368-X