Comparing Patch vs. Pen Bolus Insulin Delivery in Type 2 Diabetes Using Continuous Glucose Monitoring Metrics and Profiles [poster]
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Patients with T2D (N=97, A1c ≥7.5% on basal insulin) used DexCom G4 CGM in a substudy of a large RCT (N=278) to evaluate bolus insulin delivery by patch (Calibra Medical) vs. pen (Novolog Flexpen®) using an SMBG-based titration algorithm. There was a significant improvement (p<0.0001) in A1c and all CGM metrics at week 24, but no difference between groups (Table). CGM profiles (Figure) demonstrate it is possible to optimize basal-bolus therapy, dramatically increasing time-in-target range (70-180 mg/dL) with minimal significant hypoglycemia (<54 mg/dL) while achieving a flat bedtime to AM glucose profile. This is one of the first trials to clearly demonstrate how using CGM metrics and CGM profiles in T2D can provide a more clinically relevant comparison of different approaches to optimizing glucose management.