Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): a 6-month, prospective, multicentre, randomised controlled trial
This RCT (n=254) found that in an unselected adult type 1 diabetes population, switching from intermittently scanned continuous glucose monitoring to real-time continuous glucose monitoring improved time in range after 6 months of treatment (59.6% vs 51.9%; p<0.0001).
Source:
The Lancet
SPS commentary:
A related Comment notes that the difference in time in range (defined in this study as sensor glucose 3.9–10.0 mmol/L) is clinically relevant as it is thought to result in a 10–25% relative risk reduction in microvascular complications. It is not known if the observed benefits of real-time continuous glucose monitoring (rtCGM) over intermittently scanned continuous glucose monitoring (isCGM) are due to the alerts or to the real-time values of the rtCGM. In addition the results of this study do not inform about whether all patients new to continuous glucose monitoring (CGM) should start rtCGM or if certain patients will have sufficient benefit from isCGM.
The authors note that many quality-of-life aspects of using CGM are not covered in current cost-efficacy analyses, and as a result different interpretations of cost-efficacy analyses might arise across countries and continue to result in erratic reimbursement and frustration. Although the current investigators should be commended for addressing an important clinical question regarding the efficacy of two different CGM systems, the bearing of such findings is short lived, with a new version of isCGM already launched and clinical testing of a new generation of rtCGM ongoing.