Multicenter Randomized Trial of Intermittently Scanned Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Individuals With Type 2 Diabetes and Recent-Onset Acute Myocardial Infarction: Results of the LIBERATES Trial

   Objective Analyse the impact of modern glucose-monitoring strategies on glycemic and patient-related outcomes in individuals with type 2 diabetes (T2D) and recent myocardial infarction (MI), and also assess cost effectiveness.  Research design and methods LIBERATES was a multicentre, two-arm randomised trial comparing self-monitoring of blood glucose (SMBG) with intermittently scanned continuous glucose monitoring (isCGM), also known as flash CGM, in individuals with T2D and recent MI, treated with insulin and/or sulphonylurea prior to hospital admission.  The primary outcome measure was time in range (TIR; glucose 3.9-10 mmol/l)/day on days 76-90 post randomisation. Secondary and exploratory outcomes included time in hypoglycemia, hemoglobin (Hb)A1c, clinical outcome, quality of life (QoL) and cost effectiveness.  Results  Of 141 participants aged [median 63 IQR (53, 70) years, 73% males] randomised, isCGM was associated with increased TIR by 17mins/day (95% credible interval -105, +153mins/day) with 59% probability for a benefit. Users of isCGM showed lower hypoglycemic exposure ( Combined glycemic emergencies/mortality occurred in 4 isCGM and 7 SMBG study participants. QoL measures marginally favoured isCGM and the intervention proved to be cost-effective.  Conclusions Compared with SMBG, isCGM in T2D individuals with MI marginally increases TIR and significantly reduces hypoglycemic exposure while equally improving HbA1c, explaining its cost-effectiveness. Studies are required to understand whether these glycemic differences translate into longer term clinical benefit. </p

Funnel plots of behavioural and pharmacological studies.

<p>Funnel plots of behavioural and pharmacological studies.</p

Study flow diagram.

<p>Study flow diagram.</p

Meta-analysis of pharmacological interventions.

<p>Meta-analysis of pharmacological interventions.</p

Pharmacological Intervention Categories.

<p>Pharmacological Intervention Categories.</p

Characteristics of Included Studies.

<p>Characteristics of Included Studies.</p

Meta-analysis of behavioural interventions.

<p>Meta-analysis of behavioural interventions.</p

Results of Subgroup Analyses.

<p>Results of Subgroup Analyses.</p