Clinical Use of Continuous Glucose Monitoring in Adults with Type 2 Diabetes

Abstract

Background: Hemoglobin A1c is an excellent population health measure for the risk of vascular complications in diabetes, while continuous glucose monitoring (CGM) is a tool to help personalize a diabetes treatment plan. The value of CGM in individuals with type 1 diabetes (T1D) has been well demonstrated when compared with utilizing self-monitoring of blood glucose (SMBG) to guide treatment decisions.CGM is a tool for patients and clinicians to visualize the important role that diet, exercise, stress management, and the appropriate selection of diabetes medications can have in managing type 2 diabetes (T2D). Several diabetes organizations have recently reviewed the literature on the appropriate use of CGM in diabetes management and concluded CGM may be a useful educational and management tool particularly for patients on insulin therapy. The indications for using CGM either as a clinic-based loaner distribution model for intermittent use (professional CGM) or a CGM system owned by the patient and used at home with real-time glucose reading (personal CGM) are only beginning to be addressed in T2D. Most summaries of CGM studies conclude that having a standardized glucose pattern report, such as the ambulatory glucose profile (AGP) report, should help facilitate effective shared decision-making sessions.The future of CGM indications for the use of CGM is evolving rapidly. In some instances, CGM is now approved for making medication adjustments without SMBG confirmation and it appears that some forms of CGM will be approved for use in the Medicare population in the United States in the near future. Many individuals with T1D and T2D and their care teams will come to depend on CGM as a key tool for diabetes management.

Effectiveness and acceptability of continuous glucose monitoring for type 2 diabetes management: A narrative review

“…The reported high acceptance of CGM as a useful therapeutic and educational tool 15,18,38,54,57,58 should be considered in the context of the relatively limited feedback alternatives provided by standard diabetes self-management strategies that rely on 3-or 6-monthly HbA1c measures and SMBGL 5,37 . The latter only provides a snapshot of current glucose levels and lacks the sensitivity to detect small changes or specific glucose responses to food or activity.…”

Flash Glucose Monitoring: The Future Is Here

“…20 As described by Carlson et al in this supplement, AGP with CGM or flash glucose monitoring use in adults with T2D has significant benefits. 21 CGM and flash glucose monitoring use in the pediatric population is another hot topic. Prevention of hypoglycemia is important not only for pediatric patients with T1D but also other associated disorders that may cause hypoglycemia such as adrenal insufficiency, glycogen storage disorders, and cystic fibrosis.…”

Tracking the Sugar Rush: Incorporating Continuous Glucose Monitoring Into Multisite Early Clinical Research With Type 2 Diabetes Subjects

“…Consequently, for analysis purposes midnight (00:00 hours) was set as the start of day 1, and daily glucose was defined as midnight to midnight, as reported by others. 10 The device has a mean absolute relative difference of 15.6% compared to venous blood glucose reference standard of measurement. Examples of typical CGM profiles and the cohort average glucose concentrations are shown in Figure 1.…”

“…Moreover, the American Association of Clinical Endocrinologists recommends CGM for patients at risk of hypoglycemia, T2DM patients with unappreciated hyperglycemia, and individuals using intensive insulin therapy regardless of diabetes type. 10,11 The US Food and Drug Administration recently granted the use of a CGM device to replace fingerstick self-monitoring blood glucose (SMBG) measurements for treatment decisions (ie, daily insulin dose). 12 Although CGM can improve the lives of both type 1 and type 2 diabetes mellitus patients, another area benefiting from CGM technology is therapeutic drug development.…”