Continuous glucose monitoring and risks of acute and chronic diabetes-related complications and mortality in adults with type 1 diabetes: a nationwide cohort study

초록

Aims/hypothesis We investigated the association between continuous glucose monitoring (CGM) and acute and chronic diabetes-related complications and mortality risk in adults with type 1 diabetes. Methods This study included adults with type 1 diabetes who received intensive insulin therapy, based on data from the Korean National Health Insurance Service Cohort (2016-2022). The primary outcomes were diabetic ketoacidosis (DKA), severe hypoglycaemia (SH), end-stage kidney disease (ESKD), cardiovascular disease (CVD) and all-cause mortality. Between-group analyses (comparing outcomes between CGM users and non-users) were conducted using Cox proportional hazards regression models, and within-group analyses (comparing outcomes before and after CGM initiation) were performed using paired t tests. Results A total of 17,018 individuals (8509 CGM users and 8509 non-users) were included. CGM users had lower rates of DKA (adjusted hazard ratio [aHR] 0.40; 95% CI 0.33, 0.48), ESKD (aHR 0.43; 95% CI 0.32, 0.56), CVD (aHR 0.28; 95% CI 0.23, 0.33) and all-cause mortality (aHR 0.38; 95% CI 0.32, 0.46) than non-users. The aHR for SH was comparable between the two groups (aHR 0.92; 95% CI 0.77, 1.10 for users vs non-users). However, among CGM users, the mean frequency of SH decreased by 61.5% after CGM initiation (p<0.001). The frequencies of DKA and CVD-related hospitalisation or emergency department visits also decreased by 60.0% and 50.0%, respectively (p<0.001 for both). Conclusions/interpretation In this nationwide cohort study of adults with type 1 diabetes, CGM users had lower rates of both acute and chronic diabetes-related complications and all-cause mortality compared with non-users.

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