OBJECTIVE The inverse relationship between overall glucose control and hypoglycemia risk is weakened by the use of real-time continuous glucose monitoring (rtCGM). We assess the relationship between glucose control and hypoglycemia in people with type 1 diabetes using multiple-dose injection (MDI) regimens, including those at highest risk of hypoglycemia. RESEARCH DESIGN AND METHODS CGM data from the intervention (rtCGM) and control (self-monitored blood glucose [SMBG]) phases of the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) and HypoDE studies were analyzed. The relationship between glucose control (HbA1c and mean rtCGM glucose levels) and percentage time spent in hypoglycemia was explored for thresholds of 3.9 mmol/L (70 mg/dL) and 3.0 mmol/L (54 mg/dL), and ANOVA across the range of HbA1c and mean glucose was performed. RESULTS A nonlinear relationship between mean glucose and hypoglycemia was identified at baseline, with the steepest relationship seen at lower values of mean glucose. The use of rtCGM reduces the exposure to hypoglycemia at all thresholds and flattens the relationship between overall glucose and hypoglycemia, with the most marked impact at lower values of mean glucose and HbA1c. Exposure to hypoglycemia varied at all thresholds across the range of overall glucose at baseline, in the SMBG group, and with rtCGM, but the relationships were weaker in the rtCGM group. CONCLUSIONS Use of rtCGM can flatten and attenuate the relationship between overall glucose control and hypoglycemia, exerting its greatest impact at lower values of HbA1c and mean glucose in people with type 1 diabetes using MDI regimens and at highest risk of hypoglycemia.

中文翻译：

---

在多剂量注射疗法中对1型糖尿病患者进行连续血糖监测：血糖控制与低血糖之间的关系。

目的通过使用实时连续葡萄糖监测（rtCGM），可以减弱总体血糖控制与低血糖风险之间的逆向关系。我们使用多剂量注射（MDI）方案评估了1型糖尿病患者的血糖控制与低血糖之间的关系，其中包括高血糖风险最高的人群。研究设计和方法分析了每日多次注射和糖尿病持续血糖监测（DIAMOND）和HypoDE研究的干预（rtCGM）和对照（自我监测血糖[SMBG]）期的CGM数据。探讨了血糖控制（HbA1c和rtCGM平均血糖水平）与低血糖所花费的时间百分比之间的关系，分别针对3.9 mmol / L（70 mg / dL）和3.0 mmol / L（54 mg / dL）的阈值，在HbA1c和平均葡萄糖范围内进行ANOVA。结果在基线时发现平均血糖与低血糖之间存在非线性关系，而在较低的平均血糖值时则表现出最陡峭的关系。rtCGM的使用可降低所有阈值下的低血糖暴露，并使总体血糖与低血糖之间的关系趋于平坦，在较低的平均血糖和HbA1c值时影响最为明显。在SMBG组和rtCGM组，基线时总血糖范围内，所有阈值的低血糖暴露均发生变化，但rtCGM组的相关性较弱。结论rtCGM的使用可以使总体血糖控制与低血糖之间的关系平坦化并减弱，