Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes

Abstract

Continuous Glucose Monitoring (CGM) has been demonstrated to be clinically valuable, reducing risks of hypoglycemia and hyperglycemia, glycemic variability (GV), and improving patient quality of life for a wide range of patient populations and clinical indications. Use of CGM can help reduce HbA1c and mean glucose. One CGM device, with accuracy (%MARD) of approximately 10%, has recently been approved for selfadjustment of insulin dosages (nonadjuvant use) and approved for reimbursement for therapeutic use in the United States. CGM had previously been used off-label for that purpose. CGM has been demonstrated to be clinically useful in both type 1 and type 2 diabetes for patients receiving a wide variety of treatment regimens. CGM is beneficial for people using either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). CGM is used both in retrospective (professional, masked) and real-time (personal, unmasked) modes: both approaches can be beneficial. When CGM is used to suspend insulin infusion when hypoglycemia is detected until glucose returns to a safe level (low-glucose suspend), there are benefits beyond sensor-augmented pump (SAP), with greater reduction in the risk of hypoglycemia. Predictive low-glucose suspend provides greater benefits in this regard. Closed-loop control with insulin provides further improvement in quality of glycemic control. A hybrid closed-loop system has recently been approved by the U.S. FDA. Closed-loop control using both insulin and glucagon can reduce risk of hypoglycemia even more. CGM facilitates rigorous evaluation of new forms of therapy, characterizing pharmacodynamics, assessing frequency and severity of hypo-and hyperglycemia, and characterizing several aspects of GV.

Evaluation of the FreeStyle® Libre Flash Glucose Monitoring System in Children and Adolescents with Type 1 Diabetes

“…However, there is a time lag between subcutaneous glucose and capillary BG concentrations due to the transport of glucose from the vascular to the interstitial space resulting in a difference in measured glucose level [15, 16]. CGM systems have been shown to improve glycaemic control and HbA1c, and to reduce the risk of hypoglycaemia [17]. However, CGM is expensive and not widely available due to limited reimbursement [18].…”

Flash Glucose Monitoring: The Future Is Here

“…33 Last but not least, flash glucose monitoring data may become available as ''continuous'' like CGMs and by using Bluetooth technology, data could be made available on the pumps or smart phones and possibly be used to drive insulin delivery like in the artificial pancreas. 32,34,35 We thank Abbott Diabetes Care for thinking ''outside the box'' and launching the first no calibration (factory calibrated) 14-day on-demand sensor. The science behind the factory calibration of flash glucose monitoring was discussed in detail by Hoss et al in this supplement.…”

Technology in Diabetes Treatment: Update and Future

“…It reflects in a much better way intra-and interday glycemic excursions that may lead to acute events (such as hypoglycemia) or postprandial hyperglycemia, which have been linked to both microvascular and macrovascular complications (28). Additionally and beyond the effects of the meta-analysis of Zhu et al (29), Rodbard (30) reported that CGM has been demonstrated to be useful in reducing the risks of hypo-and hyperglycemia too, improving glycemic variability and increasing patients' quality of life in both type 1 and type 2 diabetes (30). Additionally and beyond the effects of the meta-analysis of Zhu et al (29), Rodbard (30) reported that CGM has been demonstrated to be useful in reducing the risks of hypo-and hyperglycemia too, improving glycemic variability and increasing patients' quality of life in both type 1 and type 2 diabetes (30).…”