Prevention of hypoglycemia by intermittent-scanning continuous glucose monitoring device combined with structured education in patients with type 1 diabetes mellitus: A randomized, crossover trial

Diabetes Res Clin Pract. 2023 Jan:195:110147. doi: 10.1016/j.diabres.2022.110147. Epub 2022 Nov 14.


Aims: We conducted a randomized, crossover trial to compare intermittent-scanning continuous glucose monitoring (isCGM) device with structured education (Intervention) to self-monitoring of blood glucose (SMBG) (Control) in the reduction of time below range.

Methods: This crossover trial involved 104 adults with type 1 diabetes mellitus (T1DM) using multiple daily injections. Participants were randomly allocated to either sequence Intervention/Control or sequence Control/Intervention. During the Intervention period which lasted 84 days, participants used the first-generation FreeStyle Libre (Abbott Diabetes Care, Alameda, CA, USA) and received structured education on how to prevent hypoglycemia based on the trend arrow and by frequent sensor scanning (≥10 times a day). Confirmatory SMBG was conducted before dosing insulin. The Control period lasted 84 days. The primary endpoint was the decrease in the time below range (TBR; <70 mg/dL).

Results: The time below range was significantly reduced in the Intervention arm compared to the Control arm (2.42 ± 1.68 h/day [10.1 %±7.0 %] vs 3.10 ± 2.28 h/day [12.9 %±9.5 %], P = 0.012). The ratio of high-risk participants with low blood glucose index >5 was significantly reduced (8.6 % vs 23.7 %, P < 0.001).

Conclusions: The use of isCGM combined with structured education significantly reduced the time below range in patients with T1DM.

Keywords: Education; Intermittent-scanning continuous glucose monitoring; Randomized trial; Time below range.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Blood Glucose
  • Blood Glucose Self-Monitoring
  • Cross-Over Studies
  • Diabetes Mellitus, Type 1* / drug therapy
  • Humans
  • Hypoglycemia* / prevention & control
  • Hypoglycemic Agents / therapeutic use
  • Insulin


  • Blood Glucose
  • Insulin
  • Hypoglycemic Agents