People with type 1 diabetes achieved significantly better long-term blood glucose when their levels were monitored by healthcare professionals in real time, via a sensor under the skin, and they received regular advice in their daily lives. This has been shown in a study at the University of Gothenburg.
Balancing insulin therapy in type 1 diabetes and staying as close to normal glucose levels as possible can be a tough challenge. At the same time, it is important to minimize the risks of both acute conditions and long-term complications.
Many adult patients in the Western world have a continuous glucose monitor. However, even when they receive their glucose levels in real time, via smartphone or separate monitor it is normal that blood glucose levels do not stay within set target ranges.
“Type 1 diabetes is demanding for patients, and no two days are the same. Did you sleep well? How stressed are you? Did you run for the bus? Have you been ill? You must be ready to react to many things all the time, without a break, and which can be very tiering,” says Arndís Ólafsdóttir, PhD student at Sahlgrenska Academy at the University of Gothenburg, Diabetes Nurse and one of the leading forces behind the study.
Sensor reading and everyday support
The study, published in The Lancet Regional Health - Europe, tested a systematic, intensive treatment with remote monitoring of glucose levels and weekly healthcare contact. All participants had continuous glucose monitoring for at least three months before the study started.
Blood glucose levels were read via a sensor under the skin every five minutes and they were sent to the hospital every week. If the values were not at levels consistent with a low risk of organ injury, the diabetes nurse analysed the values remotely and contacted the patient for advice and discussion about what was happening in the patient's daily life.
“When we called, we explained what we observed, asked what they needed help with, discussed what had been difficult and how they had tried to solve it. The problems were often linked to insulin dosage, diet or how much they exercised. The conversations could also include what to do if they are going out with colleagues after work, if they are going to a party, all sorts of things,” says Arndís Ólafsdóttir.
The treatment lasted 18 weeks. Out of a total of 117 participants, 59 were randomized to the intensive treatment while 58 were in the control group and received conventional treatment with two visits during the period. Participants came from seven healthcare regions in Sweden and from Oslo in Norway.
Safety and uses
After 18 weeks, the long-term blood glucose in the group with intensive treatment had reduced by over 8 mmol/mol more than in the control group, representing a substantial improvement, almost three times the 3 mmol/mol improvement in long-term blood glucose that is considered to protect organs in the body.
Satisfaction in the group with intensive treatment was higher and the treatment proved to be safe as no serious events of low blood glucose levels and loss of consciousness or so-called diabetic ketoacidosis took place, while one case occurred in the control group.
“This is also a very important aspect of the study as, after all, it makes a big difference that a patient, for example, makes adjustments to an insulin pump remotely with counseling compared to the individual receiving in-person guidance on site in hospital,” says Arndís Ólafsdóttir.
The study could potentially be of great benefit also in other parts of the world, according to Marcus Lind, Professor of Diabetology at the University of Gothenburg, and Principal Investigator of the study.
“For many individuals with type 1 diabetes in different parts of the world, hospitals may be far away or there may be a lack of resources. The fact that effective counseling can be done remotely with real-time sensor transmission of blood glucose levels and insulin adjustments can therefore benefit many,” he says.