title: Assessment of patient-led or physician-driven continuous glucose monitoring in patients with poorly controlled type 1 diabetes using basal-bolus insulin regimens: a 1-year multicenter study.
abstract: OBJECTIVE
  The benefits of real-time continuous glucose monitoring (CGM) have been demonstrated in patients with type 1 diabetes. Our aim was to compare the effect of two modes of use of CGM, patient led or physician driven, for 1 year in subjects with poorly controlled type 1 diabetes.
  
  
  METHODS
  Patients with type 1 diabetes aged 8-60 years with HbA(1c) ≥ 8% were randomly assigned to three groups (1:1:1). Outcomes for glucose control were assessed at 1 year for two modes of CGM (group 1: patient led; group 2: physician driven) versus conventional self-monitoring of blood glucose (group 3: control).
  
  
  RESULTS
  A total of 257 subjects with type 1 diabetes underwent screening. Of these, 197 were randomized, with 178 patients completing the study (age: 36 ± 14 years; HbA(1c): 8.9 ± 0.9%). HbA(1c) improved similarly in both CGM groups and was reduced compared with the control group (group 1 vs. group 3: -0.52%, P = 0.0006; group 2 vs. group 3: -0.47%, P = 0.0008; groups 1 + 2 vs. group 3: -0.50%, P < 0.0001). The incidence of hypoglycemia was similar in the three groups. Patient SF-36 questionnaire physical health score improved in both experimental CGM groups (P = 0.004). Sensor consumption was 34% lower in group 2 than in group 1 (median [Q1-Q3] consumption: group 1: 3.42/month [2.20-3.91] vs. group 2: 2.25/month [1.27-2.99], P = 0.001).
  
  
  CONCLUSIONS
  Both patient-led and physician-driven CGM provide similar long-term improvement in glucose control in patients with poorly controlled type 1 diabetes, but the physician-driven CGM mode used fewer sensors.
authors.affiliation: Department of Diabetes and Endocrinology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France. riveline.jeanpierre@neuf.fr
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Riveline
authors.forename: Pauline
authors.initials: P
authors.lastname: Schaepelynck
authors.forename: Lucy
authors.initials: L
authors.lastname: Chaillous
authors.forename: Eric
authors.initials: E
authors.lastname: Renard
authors.forename: Agnès
authors.initials: A
authors.lastname: Sola-Gazagnes
authors.forename: Alfred
authors.initials: A
authors.lastname: Penfornis
authors.forename: Nadia
authors.initials: N
authors.lastname: Tubiana-Rufi
authors.forename: Véronique
authors.initials: V
authors.lastname: Sulmont
authors.forename: Bogdan
authors.initials: B
authors.lastname: Catargi
authors.forename: Céline
authors.initials: C
authors.lastname: Lukas
authors.forename: Régis P
authors.initials: RP
authors.lastname: Radermecker
authors.forename: Charles
authors.initials: C
authors.lastname: Thivolet
authors.forename: François
authors.initials: F
authors.lastname: Moreau
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Benhamou
authors.forename: Bruno
authors.initials: B
authors.lastname: Guerci
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Leguerrier
authors.forename: Luc
authors.initials: L
authors.lastname: Millot
authors.forename: Claude
authors.initials: C
authors.lastname: Sachon
authors.forename: Guillaume
authors.initials: G
authors.lastname: Charpentier
authors.forename: Hélène
authors.initials: H
authors.lastname: Hanaire
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010820:Physicians; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin