Reducing hypoglycemia in Type 1 diabetes – is one insulin therapy more effective?

This study examined the effect of insulin delivery and blood glucose monitoring on the frequency of low blood glucose (hypoglycemia).

Hypoglycemia awareness occurs when blood glucose levels drop below 4 mmol/L, leading to symptoms that the patient recognises. This allows them to take corrective measures. Frequent severe episodes of low blood glucose can lead to impaired hypoglycemia awareness. Impaired hypoglycemia awareness is a reduction in the ability to recognise when blood glucose is too low. Both severe hypoglycemia and impaired hypoglycemia awareness can result in patients collapsing. Avoiding hypoglycemia can restore awareness. 

An insulin pump delivers insulin to the patient based on the amount of carbohydrates ingested. A continuous glucose monitor (CGM) measures blood glucose levels continuously. 

This study compared hypoglycemia in different groups of patients. This study involved 96 patients divided into 4 groups. One group had daily injections with a CGM. One group had daily injections with a self-monitor only. One group had an insulin pump with a CGM. One group had an insulin pump with a self-monitor only.

Patients were educated on how to avoid hypoglycemia. Patients recorded blood glucose levels and the frequency of severe hypoglycemia for 24 weeks. Insulin pump therapy was compared to multiple daily injections. Glucose self-monitoring was compared to continuous glucose monitoring.

Hypoglycemia awareness improved in all patients. Severe hypoglycemia occurred less often. The reduction in hypoglycemia did not increase the patient’s HbA1c (average blood glucose levels over the past 3 months). The reduction in hypoglycemia did not differ between the insulin pump therapy group and the daily injection group. The reduction in hypoglycemia did not differ between the CGM group and the self-monitoring group.

This study concluded that hypoglycemia awareness can be improved by using any of the combinations outlined above. Insulin pump therapy is not more effective than multiple daily injections in reducing hypoglycemia. CGM is not more effective than self-glucose monitoring in reducing hypoglycemia.

Continuous glucose monitoring was not performed constantly over the 24 weeks.