Type 2 Diabetes and the Use of Real-Time Continuous Glucose Monitoring

Abstract

The role of continuous glucose monitoring (CGM) in type 1 diabetes is well established in improving glycemic control and reducing hypoglycemia. Type 2 diabetes (T2D) is more prevalent than type 1 diabetes and management of type 2 diabetes is more heterogeneous, requiring treatment ranging from lifestyle modification to oral medications to intensive insulin therapy. Recent randomized controlled trials in intensively insulin treated type 2 diabetes demonstrated the efficacy and safety of rtCGM in reducing glycated hemoglobin without increasing hypoglycemia. Though evidence is limited, early studies have indicated a role for rtCGM in selected patients with non-insulin requiring T2D to improve glycemic control and/or reduce hypoglycemia. Based on literature review, we summarized current data on the use of rtCGM in T2D management, and provided future research direction to generate more evidence on the utility of CGM in this population.

The northeast glucose drift: Stratification of post-breakfast dysglycemia among predominantly Hispanic/Latino adults at-risk or with type 2 diabetes

“…34 In the U.S. and elsewhere, the use of CGM has been recently included in guidance for selected patients with T2D, including those not on insulin. 35 These findings, supported by our observations in this study, suggest the potential of monitoring breakfast glucose response for early detection of T2D.…”

Characterising frailty, metrics of continuous glucose monitoring, and mortality hazards in older adults with type 2 diabetes on insulin therapy (HARE): a prospective, observational cohort study

“…However, the use of CGMs in patients with type 2 diabetes is poorly defined despite evidence suggesting improvement in patients' treatment adherence and lifestyle. 17 In a study by Toschi and colleagues, 18 specific CGM metrics, including glucose variability and the glucose management indicator, 19 were found to be informative in identifying older adults with type 1 diabetes at high risk of hypoglycaemia. 20 Whether those indicators are useful and provide prognostic information on survival in patients with type 2 diabetes is unknown.…”

Use of continuous glucose monitor as a motivational device for lifestyle modifications to improve glycaemic control in patients with type 2 diabetes treated with non-insulin therapies

“…Most of the studies demonstrating the benefits of CGM use have included patients with T1D and T2D who are on intensive insulin therapy1–4; however, limited evidence is available for patients on either non-insulin therapies or basal insulin. In the first RCT to study the efficacy of CGM use in patients with poorly controlled T2D in primary care clinics treated with basal insulin without prandial insulin, Martens et al randomised 175 adults to either CGM or SMBG 9.…”

“…Continuous glucose monitoring (CGM) devices have made a significant impact among rapidly advancing diabetes technologies. The efficacy of CGM to improve glycaemic control in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) who are on intensive insulin therapy (basal and prandial) has been well established in several recent studies 1–4. Currently, major US professional society guidelines recommend CGM use in T2D for individuals who are on intensive insulin therapy 5–7.…”