EASD 2020 Highlights

Conference summaries


T2D TREATMENT

The LIBERATES Trial - improving gLucose control in patIents with diaBEtes following myocardial infArction: the role of a novEl glycaemic monitoring Strategy

Presented by:

Robert Storey, MM; Deborah Stocken, MD; Ramzi Ajjan, MD


  • There was no difference in HbA1c reduction for CGM vs. SMBG.
  • CGM may lead to early increases in TIR compared with SMBG in patients with T2D and ACS treated with insulin.
  • CGM leads to higher treatment satisfaction compared to SMBG.

What do we already know about this topic?

  • Little is known about the full glycaemic profile in patients with type 2 diabetes (T2D) and acute coronary syndrome (ACS).
  • Continuous glucose monitoring (CGM) studies aiming to reduce both hyperglycaemia and hypoglycaemia in ACS patients with T2D are lacking.
  • The role of CGM in improving the quality of life in ACS patients with T2D has not been studied.

How was this study conducted?

  • The LIBERATES trial randomised 141 adult patients with T2D and recent ACS over 18 years of age to either self-monitoring of blood glucose (n = 72, SMBG) or CGM (n = 69).
  • The primary outcome measure was time spent per day in range (glucose ≥3.9 and ≤10 mmol/L) in days 76-91.
  • Secondary outcomes were time in hypoglycaemia and hyperglycaemia in days 76-91, time in range in days 15-30, HbA1c at end of intervention, adverse events, QoL and cost effectiveness.

What does this study add?

  • There was a modest increase with CGM in TIR compared to SMBG of 17-28 min/day at 3 months post ACS, but this failed to reach the posterior cut-off of 80%.
  • Mixed model analysis showed a non-significant increase of 48 min/day in TIR with CGM compared to SMBG at 3 months post ACS.
  • A significant decrease in hypoglycaemia was seen that favoured intervention with CGM vs. SMBG.
  • Changes in HbA1c were similar between groups.
  • There was more awareness of hyperglycaemia and hypoglycaemia in the CGM group, as well as higher scores for convenience, flexibility and understand of diabetes.
  • Preliminary data show a higher MACE rate with CGM, but the number of events was too low and further analysis is required.

Perspectives

How does this study impact clinical practice?

  • Hypoglycaemic reduction in LIBERATES was much more pronounced compared to previous studies.1
  • There was no difference in HbA1c between groups at 3 months., although CGM can be successfully used to reduce HbA1c in patients with T2D and recent ACS with a lower risk of hypoglycaemia vs. SMBG.
  • CGM may result in an early increase at day 30 in TIR compared with SMBG in insulin-treated individuals with recent ACS.
  • CGM is associated with higher treatment satisfaction vs. SMBG.


References

References


  1. Aleppo G, Ruedy KJ, Riddlesworth TD, et al. REPLACE-BG: a randomized trial comparing continuous glucose monitoring with and without routine blood glucose monitoring in adults with well-controlled type 1 diabetes. Diabetes Care. 2017 Apr;40(4):538-45.

 

Related content

  • Haak T, Hanaire H, Ajjan R, et al. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther. 2017 Feb;8(1):55-73.


Acknowledgements

This is a highlights summary of an oral session given at the EASD 2020 Virtual Meeting and presented by:

Robert Storey, MMD
Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK

Deborah Stocken, MD
Leeds Institute for Clinical Trials Research, University of Leeds, UK

Ramzi Ajjan, MD
University of Leeds and Leeds Teaching Hospitals Trust, UK

The presenting authors of the original session had no part in the creation of this conference highlights summary. 

The content is produced by Infomedica. The summary text was drafted by Patrick Moore, PhD, and reviewed by Marco Gallo, MD, an independent external expert, and approved by Florian Toti, MD, the scientific editor of the program.


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Expert commentary by Elizabeth O. Buschur, MD

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