title: Efficacy of self-monitoring of blood glucose versus retrospective continuous glucose monitoring in improving glycaemic control in diabetic kidney disease patients.
abstract: OBJECTIVE
  Patients with diabetic kidney disease (DKD) on anti-diabetic agents, are at greater risk of glycemic variations, both hypoglycemia and hyperglycemia. We aimed to compare glycemic control (using HbA1c) and hypoglycemia incidence in patients with Stage 3 DKD (eGFR 30-60 mL/min per 1.73 m2), receiving retrospective CGM-guided anti-diabetic therapy versus self-monitoring of blood glucose (SMBG) over 3 months.
  
  
  METHODS
  Thirty patients with HbA1c >8% were randomized to 6-day retrospective CGM or SMBG. In the CGM group, CGM was worn at the beginning and 6 weeks. HbA1c, assessment of hypoglycaemia events (self-reported and BG < 4 mmol/L from CGM/SMBG data) and medication adjustment were performed at baseline and 3 months. All patients received education on hypoglycaemia avoidance.
  
  
  RESULTS
  Fourteen patients were allocated to CGM and 16 to SMBG. Mean (±SD) eGFR was 42.9 ± 10.3 mL/min. Majority (86.7%) of patients had diabetes duration >10 years and on insulin therapy (90%). HbA1c improved significantly from baseline 9.9 ± 1.2 to 9.0 ± 1.5% (P < 0.001) at 3 months, with no difference between CGM (9.8 ± 1.2 to 8.8 ± 1.8%, P = 0.009) or SMBG (9.9 ± 1.3 to 9.1 ± 1.1%, P = 0.007) groups (P = 0.869 between groups). In the CGM group, percentage duration in hyperglycaemia (BG > 10 mmol/L) reduced from baseline 65.4 ± 22.4% to 54.6 ± 23.6% (P = 0.033) at 6 weeks, with a non-significant rise in percentage duration in hypoglycaemia from 1.2 ± 2.2% to 4.0 ± 7.0% (P = 0.176). There was no difference in self-reported and documented hypoglycaemia events.
  
  
  CONCLUSIONS
  In a pilot study of DKD patients, short-term episodic use of CGM reduced time spent in hyperglycaemia range without significantly increasing time-exposure to hypoglycaemia. However, both CGM and SMBG were equally effective in improving glycaemic control.
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
authors.forename: Ester
authors.initials: E
authors.lastname: Yeoh
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
authors.forename: Boon Khim
authors.initials: BK
authors.lastname: Lim
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
authors.forename: Sharon
authors.initials: S
authors.lastname: Fun
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
authors.forename: Julia
authors.initials: J
authors.lastname: Tong
authors.affiliation: Department of Renal Medicine, Khoo Teck Puat Hospital, Singapore.
authors.forename: Lee Ying
authors.initials: LY
authors.lastname: Yeoh
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
authors.forename: Chee Fang
authors.initials: CF
authors.lastname: Sum
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
authors.forename: Tavintharan
authors.initials: T
authors.lastname: Subramaniam
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
authors.forename: Su Chi
authors.initials: SC
authors.lastname: Lim
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012648:Self Care / Q000295:instrumentation / Q000379:methods*; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: continuous glucose monitoring; diabetic nephropathy; glycaemic control; hypoglycaemia; self-monitoring of blood glucose