Continuous glucose monitoring for adults and children with diabetes: summary of updated NICE guidance

Mulvihill, Caroline; Brooks, Augustin; Basudev, Neel; Lincoln, Paul

doi:10.1136/bmj.o2418

Cited by 4 publications

(5 citation statements)

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“…Continuous glucose measurement is now recommended in modern treatment guidelines, especially for patients with type 1 diabetes in children and adults, but also for patients with type 2 diabetes treated with insulin who are not well controlled [ 11 – 13 ]. The National Institute for Health and Care Excellence has evaluated the data for CGM and notes that both HbA1c and other performance measures show clear advantages compared to capillary glucose measurement, with no obvious differences between isCGM and rtCGM [ 12 ]. The performance and safety of the various CGM systems have been investigated and found to be adequate for clinical use, although there may be pros and cons regarding practical use as well as costs [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Associations Between HbA1c and Glucose Time in Range Using Continuous Glucose Monitoring in Type 1 Diabetes: Cross-Sectional Population-Based Study

Eliasson,

Allansson Kjölhede,

Salö

et al. 2024

Diabetes Ther

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Introduction Continuous glucose monitoring (CGM) introduces novel indicators of glycemic control. Methods This cross-sectional study, based on the Swedish National Diabetes Register, examines 27,980 adults with type 1 diabetes. It explores the relationships between HbA1c (glycated hemoglobin) and various CGM-derived metrics, including TIR (time in range, representing the percentage of time within the range of 4–10 mmol/l for 2 weeks), TAR (time above range), TBR (time below range), mean glucose, standard deviation (SD), and coefficient of variation (CV). Pearson correlation coefficients and linear regression models were utilized for estimation. Results The analysis included 46% women, 30% on insulin pump, 7% with previous coronary heart disease and 64% with retinopathy. Mean ± SD values were age 48 ± 18 years, diabetes duration 25 ± 16 years, HbA1c 58.8 ± 12.8 mmol/mol, TIR 58.8 ± 19.0%, TAR 36.3 ± 20.0%, TBR 4.7 ± 5.4%, mean sensor glucose 9.2 ± 2.0 mmol/l, SD 3.3 ± 1.0 mmol/l, and CV 36 ± 7%. The overall association between HbA1c and TIR was − 0.71 (Pearson’s r ), with R 2 0.51 in crude linear regression and 0.57 in an adjusted model. R 2 values between HbA1c and CGM mean glucose were 0.605 (unadjusted) 0.619 (adjusted) and TAR (unadjusted 0.554 and fully adjusted 0.568, respectively), while fully adjusted R 2 values were 0.458, 0.175 and 0.101 between HbA1c and CGM SD, CGM CV and TBR, respectively. Conclusions This descriptive study demonstrates that the degree of association between HbA1c and new and readily available CGM-derived metrics, i.e., time in range (TIR), time above range (TAR), and CGM mean glucose, is robust in assessing the management of individuals with type 1 diabetes in clinical settings. Metrics from CGM that pertain to variability and hypoglycemia exhibit only weak correlations with HbA1c. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-024-01572-z.

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Section: Discussionmentioning

confidence: 99%

Associations Between HbA1c and Glucose Time in Range Using Continuous Glucose Monitoring in Type 1 Diabetes: Cross-Sectional Population-Based Study

Eliasson,

Allansson Kjölhede,

Salö

et al. 2024

Diabetes Ther

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“…In the United States, approval has been granted for liraglutide and extended-release exenatide for pediatric patients aged ≥ 10 years with T2DM [ 30 , 31 ]. Conversely, within the United Kingdom, sole approval is accorded to liraglutide; however, clinicians frequently opt for dulaglutide due to constraints on available alternatives [ 32 ]. In this context, our meta-analysis supports the efficacy and safety of GLP-1 receptor agonists, proffering viable therapeutic options for the amelioration and prevention of complications associated with pediatric T2DM.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of GLP-1 receptor agonists in youth with type 2 diabetes: a meta-analysis

Yugar,

Sedenho-Prado,

da Silva Ferreira

et al. 2024

Diabetol Metab Syndr

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Background Glucagon-like peptide 1 receptor agonists have been proven to be effective in adults with diabetes and children with obesity. However, children with type 2 diabetes constitute an underrepresented subpopulation with limited treatment options. This meta-analysis aimed to determine more precise estimates of the efficacy and safety of glucagon-like peptide-1 agonists in pediatric type 2 diabetes mellitus. Methods Three databases were searched (PubMed, Embase, and Cochrane Central Register of Controlled Trials) for trials published until the end of March 2024. The search indexing terms included 3 categories: [1] type 2 diabetes mellitus [2], youth, and [3] glucagon-like peptide-1 receptor agonist (GLP-1 RA). Randomized controlled trials in youth with type 2 diabetes (age ≤ 18 years) that assessed anthropometric and metabolic parameters were included. A total of 1119 nonduplicate studies were retrieved, and 137 full-text articles were screened. The data were analyzed using mean differences (MDs) with 95% CIs and odds ratios (ORs) with 95% CIs. For outcomes with low heterogeneity, a fixed-effects model was used. Otherwise, we applied a random effects model. Our outcomes were Hb1Ac, fasting blood glucose (FBG), blood pressure, weight, and side effects. Results Five studies comprehending 415 children and adolescents were included. On average, GLP-1 RA reduced HbA1c levels (-1.01%; 95% CI, -1.26 to -0.76), fasting blood glucose levels (-1.88 mmol/L; 95% CI, -2.51 to -1.26), and body weight (-1.6 kg; 95% CI, -2.83 to -0.36). No significant reductions in systolic blood pressure (MD -0.19 mmHg; 95% CI, -3.9 to 3.52 mmHg) or diastolic blood pressure (MD 0.3 mmHg; 95% CI, -2.33 to 2.93 mmHg) were observed. Despite a higher incidence of side effects, withdrawal rates from the studies remained low. Conclusions Within this specific population, GLP-1 RAs exhibit a notable association with substantial reductions in HbA1c, FBG, and body weight. The administration of these medications is concurrent with an elevated incidence of side effects, which are predominantly gastrointestinal and tolerable. Trial registration PROSPERO identifier: CRD42023393020.

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“…The overall MARD has been reported to be reliable in most commercially available CGM systems at 8–10%, and 10% for Dexcom G6 [ 12 , 22 ]. Nowadays, the International Society for Pediatric and Adolescent Diabetes, the American Diabetes Association, and the National Institute for Health and Care Excellence recommend CGM as the preferred option for glucose monitoring in their consensus guidelines for children and adults with diabetes mellitus [ 23 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Continuous Glucose Monitoring: A Possible Aid for Detecting Hypoglycemic Events during Insulin Tolerance Tests

Sim

Ahn

2023

Sensors

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The combined pituitary function test evaluates the anterior pituitary gland, while the insulin tolerance test evaluates growth hormone deficiencies. However, successful stimulation requires achieving an appropriate level of hypoglycemia. Close medical supervision for glucose monitoring is required during hypoglycemia induction and the test is often very tedious. In addition, a capillary blood sugar test (BST) and serum glucose levels may differ greatly. An alternative approach may be utilizing a continuous glucose-monitoring (CGM) system. We provide three cases in which CGM was successfully used alongside a standard BST and serum glucose levels during the combined pituitary function test to better detect and induce hypoglycemia. Three participants who were diagnosed with multiple pituitary hormone deficiencies during childhood were re-evaluated in adulthood; a Dexcom G6 CGM was used. The CGM sensor glucose and BST levels were simultaneously assessed for glycemic changes and when adequate hypoglycemia was reached during the combined pituitary function test. The CGM sensor glucose, BST, and serum glucose levels showed similar glucose trends in all three patients. A Bland–Altman analysis revealed that the CGM underestimated the BST values by approximately 9.68 mg/dL, and a Wilcoxon signed-rank test showed that the CGM and BST measurements significantly differed during the stimulation test (p = 0.003). Nevertheless, in all three cases, the CGM sensor mimicked the glycemic variability changes in the BST reading and assisted in monitoring appropriate hypoglycemia nadir. Thus, CGM can be used as a safe aid for clinicians to use during insulin tolerance tests where critical hypoglycemia is induced.

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Continuous glucose monitoring for adults and children with diabetes: summary of updated NICE guidance

Cited by 4 publications

References 0 publications

Associations Between HbA1c and Glucose Time in Range Using Continuous Glucose Monitoring in Type 1 Diabetes: Cross-Sectional Population-Based Study

Associations Between HbA1c and Glucose Time in Range Using Continuous Glucose Monitoring in Type 1 Diabetes: Cross-Sectional Population-Based Study

The efficacy and safety of GLP-1 receptor agonists in youth with type 2 diabetes: a meta-analysis

Continuous Glucose Monitoring: A Possible Aid for Detecting Hypoglycemic Events during Insulin Tolerance Tests

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