A randomised controlled trial to compare minimally invasive glucose monitoring devices with conventional monitoring in the management of insulin-treated diabetes mellitus (MITRE)

• Published in: Health technology assessment (Winchester, England) England), 2009-05, Vol.13 (28), p.iii-iv
• Main Authors: Newman, S P, Cooke, D, Casbard, A, Walker, S, Meredith, S, Nunn, A, Steed, L, Manca, A, Sculpher, M, Barnard, M, Kerr, D, Weaver, J, Ahlquist, J, Hurel, S J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood Glucose - analysis; continuous-glucose-monitoring; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - physiopathology; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - physiopathology; diabetes-mellitus; Female; Glycated Hemoglobin A - analysis; Humans; hyperglycaemia; hypoglycaemia; insulin; Male; Middle Aged; Monitoring, Physiologic - instrumentation; Outcome Assessment (Health Care); Patients - psychology; Technology Assessment, Biomedical; United Kingdom - epidemiology
• ISSN: 1366-5278; 2046-4924
• DOI: 10.3310/hta13280

To evaluate whether the additional information provided by minimally invasive glucose monitors results in improved glycaemic control in people with poorly controlled insulin-requiring diabetes, and to assess the acceptability and health economic impact of the devices. A four-arm randomised controlled trial was undertaken. Participants were recruited from secondary care diabetes clinics in four hospitals in England. 404 people aged over 18 years with insulin-treated diabetes mellitus (types 1 or 2) for at least 6 months who were receiving two or more injections of insulin daily were eligible. Participants had to have had two glycosylated haemoglobin (HbA1c) values > or = 7.5% in the last 15 months. Participants were randomised to one of four groups. Two groups received minimally invasive glucose monitoring devices [GlucoWatch Biographer or MiniMed Continuous Glucose Monitoring System (CGMS)]. These groups were compared with an attention control group (standard treatment with nurse feedback sessions at the same frequency as those in the device groups) and a standard control group (reflecting common practice in the clinical management of diabetes in the UK). Change in HbA1c from baseline to 3, 6, 12 and 18 months was the primary indicator of short- to long-term efficacy in this study. Perceived acceptability of the devices was assessed by use and a self-report questionnaire. A health economic analysis was also performed. At 18 months all groups demonstrated a decline in HbA1c levels from baseline. Mean percentage changes in HbA1c were -1.4 for the GlucoWatch group, -4.2 for the CGMS group, -5.1 for the attention control group and -4.9 for the standard care control group. At 18 months the relative percentage reduction in HbA1c in each of the intervention arms was less than that in the standard care control group. In the intention to treat analysis no significant differences were found between any of the groups at any of the assessment times. There was no evidence that the additional information provided by the devices resulted in any change in the number or nature of treatment recommendations offered by the nurses. The health economics analysis indicated no advantage in the groups who received the devices; a lower cost and higher benefit were found for the attention control arm. Assessment of device use and acceptability indicated a decline in use of both devices, which was most marked in the GlucoWatch group by 18 months (20% still using GlucoWatch versus 57%