The use of real time continuous glucose monitoring or flash glucose monitoring in the management of diabetes: A consensus view of Italian diabetes experts using the Delphi method

Abstract

Until recently, in Italy, the use of continuous glucose monitoring (CGM) systems has been limited, but is now rapidly increasing, including the so-called real-time CGM (rtCGM) and the intermittently viewed CGM (iCGM), also called Flash Glucose Monitoring (FGM). These technologies overcome many of the limitations of self-monitoring of blood glucose (SMBG) by fingerprick and allow to go beyond HbA1c to check glucose control in diabetes. However, standardized protocols for applying and interpreting rtCGM and FGM data are lacking. In this paper, we delineate a consensus amongst Italian diabetes physicians on the attributes of rtCGM and FGM technologies, and introduce a consistent approach for their use by Italian healthcare professionals. Most experts consider rtCGM and FGM as two separate categories of interstitial subcutaneous fluid (ISF) sensing technologies, and see them as superior to SMBG. Furthermore, there is strong consensus that rtCGM and FGM reduce hypoglycemia risk, increase the amount of time in the target glucose range and augment treatment satisfaction. However, there is still no agreement on the indication of the FGM for subjects who suffer asymptomatic hypoglycemia. Consensus on the role of education in initiating and optimizing use of rtCGM/FGM and about the interpretation of glucose trends was near unanimous, whereas no consensus was reached on the statement that there are no disadvantages/risks of rtCGM/FGM. Some issues remain in rtCGM/FGM management: a) risk of excessive correction of high or low glucose; b) risk of alert fatigue leading to alert silencing or rtCGM termination; c) allergic reaction to the adhesive keeping rtCGM or FGM sensors in place. The panel almost unanimously agreed that sensor accuracy depends on multiple variables, that alarm setting should be individualized, and that global jo urnal homep age: www.el sevie r.co m/locate/nm cd glycemic profile represent an useful tool in interpreting glucose data. More clinical studies and a wider use of these devices will increase the efficacy and effectiveness of continuous glucose monitoring in Italy.

Exploring Parental Experiences of Using a Do-It-Yourself Solution for Continuous Glucose Monitoring Among Children and Adolescents With Type 1 Diabetes: A Qualitative Study

“…These participants were highly motivated and most of them were highly educated; they were also from a less deprived socioeconomic position and all were of New Zealand European ethnicity. In addition, as with other CGM data, overall parental technology satisfaction (as measured by DTSQs) was also seen with the use of MM-CGM, 32-35 although DTSQs prior to use were not measured for comparison. This could be another limitation point as well as the self-reported improvement in the glycemic control.…”

Cutaneous Complications With Continuous or Flash Glucose Monitoring Use: Systematic Review of Trials and Observational Studies

“…Crucial for perspective on this topic is the clearly increasing rates of CGM use worldwide 6,13 and the overall high satisfaction seen with users of CGM/FGM in the available literature. 76,77 These factors combined with our review findings would suggest that the perceived benefits to the user largely outweigh the downsides of cutaneous complications. Further solutions for prevention and management of cutaneous issues are required, 20 as the next generation of CGM still largely relies on both adhesive use and penetrating the skin barrier.…”

Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis

“…It is worth noting that the impact of FGM technology is influenced by the characteristics of training performed in the included studies, and effective training is considered by diabetes experts as a key factor in exploiting diabetes technologies. 6 Indeed, in an untrained patient with stable glycemia, there is no difference between obtaining the current glucose levels by using FGM or SMBG. 3 Relevant to this concept, a reference to the interpretation of FGM data was reported only in three studies, 17 19 20 while the majority of the other papers described a training merely on scanning and sensor change or no training for interpretation of glucose sensor data.…”