The Effects of RT-CGM on Glycemia and QoL in Patients With T1DM and IHA

Amsterdam UMC, location VUmc52 enrolled

Overview

The purpose of this study is to determine what the effects are of real-time continuous glucose monitoring on glycemia and quality of life in patients with type 1 diabetes mellitus and impaired hypoglycemia awareness.

The investigators hypothesize that the use of RT-CGM, relative to a control intervention using masked CGM, will result in improvement of various measures of glycemia and indicators of quality of life, reduce the occurrence of hypoglycemia and hyperglycemia and restore hypoglycemia awareness in T1DM patients with IHA. We will test this hypothesis by addressing the following research questions: What is the effect of 16 weeks of RT-CGM use, versus 16 weeks of CGM use, in patients with T1DM and IHA on 1. (primary objective:) time spent in euglycemia 2. (secondary objectives:) * (diabetes-specific) markers of QoL, covering diabetes-related emotional distress (PAID-5), fear of hypoglycemia (HFS-2), self-efficacy (CIDS), health status (EQ5D) and emotional well-being (WHO-5) * other glycemia variables, including HbA1c and time spent in hypo- and - hyperglycemia ranges * the incidence and duration of hypoglycemic episodes * changes in hypoglycemia awareness score according to Gold et al., 3. (tertiary objectives:) * measures of glucose variability * the autonomic nervous system balance * the duration of wear of the RT-CGM device * patients' therapy adjustments during the interventions * hypoglycemia awareness scores according to Clarke et al. * satisfaction with use of CGM * the number of contact moments not planned according to the study schedule * absence of work of patient (and spouse) * the global estimated costs of use of health care

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Type 1 Diabetes Mellitus Hypoglycemia Unawareness

Interventions

Real-time continuous glucose monitorDEVICE

Active Comparator: MiniMed Paradigm® Veo™-system Placebo Comparator: iPro™2 Continuous Glucose Monitor (masked)

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * T1DM, diagnosed according to ADA criteria regardless duration * Use of multiple daily injections of insulin (with a basal insulin injection and bolus injections) or continuous subcutaneous insulin infusion * Any HbA1c * Age between 18 and 70 years old (inclusive) * IHA according to the questionnaire by Gold et al. * Performing at least 3 SMBG/day or 21 SMBG/week Exclusion Criteria: * Type 2 diabetes mellitus * History of (recent) major renal, liver, or (ischemic) heart disease (including cardiac conduction disorders) * Current untreated proliferative diabetic retinopathy * Current (treatment for) malignancy * Current use of non-selective beta-blockers * Current psychiatric disorders, including schizophrenia, bipolar disorder, anorexia nervosa or bulimia nervosa * Substance abuse or alcohol abuse (men \>21 units/week, women \>14 units/week) * Current pregnancy or intention to conceive * Current use of RT-CGM other than for short term (i.e. diagnostic use or use shorter than 3 consecutive months) * Hearing or vision impairment hindering perceiving of glucose display and alarms, or otherwise incapable of using a (RT-)CGM, in the opinion of the investigator * Poor commandment of the Dutch language or any (mental) disorder that precludes full understanding of the purpose and instructions of the study * Participation in another clinical study * Known or suspected allergy to trial product or related products

Locations (1)

VU University Medical Center

Amsterdam, North Holland, Netherlands

Outcomes

Primary Outcomes

Time spent in the euglycemic range

The mean difference in time spent in the euglycemic range (interstitial glucose \>3.9-\<10.0 mmol/L), expressed as hours/day between the two 16-week intervention periods, i.e. RT-CGM versus masked CGM in patients with T1DM and IHA.

Time frame: 45 weeks

Secondary Outcomes

Quality of life

(diabetes-specific) markers of QoL, covering diabetes-related emotional distress (PAID-5), fear of hypoglycemia (HFS-2), self-efficacy (CIDS), health status (EQ5D) and emotional well-being (WHO-5)

Time frame: 45 weeks

Glycemia variables

Other glycemia variables, including HbA1c and time spent in hypo- and hyperglycemia ranges

Time frame: 45 weeks

Hypoglycemic episodes

The incidence and duration of hypoglycemic episodes

Time frame: 45 weeks

Changes in hypoglycemia awareness score

Changes in hypoglycemia awareness score according to Gold et al.

Time frame: 45 weeks

Data from ClinicalTrials.gov

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