In the January 2020 issue of Diabetes Care, Šoupal et al. (1) provided convincing evidence that continuous glucose monitoring (CGM) by itself is superior to self-monitoring of blood glucose in reducing HbA_1c and hypoglycemia, whatever the type of insulin delivery, i.e., continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Although we agree with the conclusions that CGM is superior to self-monitoring of blood glucose in reducing hypoglycemia, with comparable time below range for MDI and CSII (5.5% and 5.3%, respectively, in their article), we would like to draw attention to the fact that not all sensor-augmented pumps are equivalent. Pumps with preventive low–blood glucose suspend management (PLGM) provide important clinical benefits in reducing significantly severe hypoglycemia (2), a condition associated with hypoglycemia unawareness. We compared subjects with type 1 diabetes treated with MDI (n = 95) and CSII users with an Omnipod pump (n = 134) both using FreeStyle Libre CGM system (Abbott Diabetes Care, Witney, U.K.) to individuals equipped with a MiniMed 640G pump (Medtronic, Northridge, CA) with the SmartGuard system (n = 61). As shown in Fig. 1, individuals with PLGM-integrated pumps had a dramatic reduction of hypoglycemia across the different ranges of blood glucose with a mean time below range of 0.9% in contrast to 7.2% for MDI users and 5.6% for CSII users. An important correlation between hypoglycemic events and mean glucose levels can also be observed in subjects with MDI and CSII in contrast to individuals with PLGM-integrated pumps. Although it is a higher-cost alternative, PLGM-integrated pump therapy is clearly indicated in individuals at high risk of severe hypoglycemia. As mentioned previously (3), it is therefore essential to refocus our attention on hypoglycemic outcomes and to correctly address the technological issues for optimal prevention.

中文翻译：

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评论Šoupal等。持续监测血糖比通过胰岛素输送方法对成人T1D患者的血糖结果的影响更大：COMISAIR研究进行了3年的随访。2020年糖尿病护理； 43：37–43

在2020年1月的《糖尿病护理》中，Šoupal等人。（1）提供了令人信服的证据，连续血糖监测（CGM）本身在降低HbA _1c方面优于血糖自我监测和低血糖症，无论采用哪种胰岛素输送方式，即连续皮下注射胰岛素（CSII）或每日多次注射（MDI）。尽管我们同意CGM在降低低血糖方面优于血糖自我监测的结论，但可比时间低于MDI和CSII的范围（在其文章中分别为5.5％和5.3％），但我们还是要引起注意并非所有传感器增强泵都是等效的。具有预防性低血糖悬浮液管理（PLGM）的泵在降低严重的低血糖症（2）方面具有重要的临床益处（2），这种状况与低血糖症意识不足有关。我们比较了接受MDI（n = 95）治疗的1型糖尿病患者和使用Omnipod泵（n= 134）都采用自由式自由报CGM系统（雅培糖尿病护理，威特尼，英国）配备有MiniMed 640G泵（美敦力，北岭，CA）来的SmartGuard系统（个人ñ= 61）。如图1所示，具有PLGM集成泵的个体在不同血糖范围内的低血糖显着降低，平均时间低于0.9％，而MDI用户和CSII用户的平均时间分别为7.2％和5.6％。与具有PLGM集成泵的个体相比，在MDI和CSII的受试者中还可以观察到降血糖事件和平均葡萄糖水平之间的重要关联。尽管这是一种成本较高的替代方法，但PLGM集成泵疗法在具有严重低血糖高危风险的个体中已明确指出。如前所述（3），因此至关重要的是将我们的注意力重新集中在降糖效果上，并正确解决技术问题以实现最佳预防。