Continuous glucose monitors (CGMs) can significantly reduce the risk of both nocturnal and daytime hypoglycemia in patients with type 1 diabetes, according to a study published in Diabetes Research and Clinical Practice. Researchers also found that nocturnal hypoglycemia strongly predicts daytime hypoglycemia, highlighting the importance of nighttime glucose control.
Nocturnal Hypoglycemia: A Silent but Serious Threat
Nocturnal hypoglycemia occurs when blood glucose falls below 70 mg/dl during sleep. It’s common in patients who skip dinner, exercise before bed, consume alcohol, or take long-acting insulins like NPH. Alarmingly, many patients sleep through the symptoms—such as sweating, shaking, and rapid heartbeat—making severe events difficult to detect and treat without emergency glucagon kits.
Study Design: CGMs vs. Usual Care
The study (NCT02671968) included 141 adults with type 1 diabetes, comparing a CGM group (n=75) with a control group receiving standard care (n=66). All participants had a high risk for severe hypoglycemia. Over 26 weeks, the primary outcome measured was the change in the number of hypoglycemic episodes (glucose <55 mg/dl).
Key Findings: Reduced Hypoglycemia with CGMs
Lower Hypoglycemia Rates: Patients using CGMs experienced significantly fewer nocturnal hypoglycemia events compared to controls.
Shorter Duration of Low Glucose Events: CGM users had shorter nighttime hypoglycemia episodes (3 minutes vs. 45.1 minutes in controls).
Nocturnal Predicts Daytime Hypoglycemia: For the control group, nighttime hypoglycemia strongly predicted daytime events. This relationship was much weaker in CGM users, suggesting better overall glucose control.
Real-Time Feedback Matters: The CGM’s real-time alerts enabled patients to address nocturnal hypoglycemia earlier, reducing the likelihood of reactive insulin mismanagement and subsequent daytime lows.
Clinical Implications
The study underscores the value of CGMs in managing hypoglycemia for type 1 diabetes patients. By providing real-time glucose data and alerts, CGMs help patients detect and respond to nocturnal lows, ultimately reducing both nighttime and daytime hypoglycemia risk.
Researchers concluded, “CGM systems effectively reduce hypoglycemia duration and severity, offering a vital tool for improving safety and quality of life in type 1 diabetes care.”
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