Combined continuous glucose monitoring and subcutaneous insulin infusion versus self‐monitoring of blood glucose with optimized multiple injections in people with type 1 diabetes: A randomized crossover trial

Aim To investigate the efficacy of a combination of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) versus an optimized degludec‐based multiple daily injections (MDI) regimen + self‐monitoring of blood glucose (SMBG) in people with type 1 diabetes with regard to optimizing glucose control. Material and methods The trial included 28 individuals who underwent a 4‐week run‐in phase, and were then randomized 1:1 to: (a) CSII + CGM followed by MDI + SMBG or (b) an MDI basal‐bolus regimen followed by CSII + CGM. Results In patients randomized to the CSII + CGM → MDI + SMBG arm, a significant reduction in glycated haemoglobin (HbA1c) versus baseline was found at the end of the first phase (CSII + CGM) without significant variation in the following MDI + SMBG phase. In the arm randomized to the MDI + SMBG → CSII + CGM sequence, a significant improvement in HbA1c was observed in the first phase (MDI + SMBG), together with a further decrease in the following CSII + CGM phase. In the comparison of the two treatments using a mixed linear model, CSII + CGM was superior to MDI + SMBG with respect to change in HbA1c ( P = 0.001). Conclusions This study suggests that CSII + CGM improves glycaemic control without relevant safety issues in type 1 diabetes, in comparison with MDI + SMBG.