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

Abstract

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.

Keywords: Continuous glucose monitoring; Professional use; Type 2 diabetes.

Conflict of interest statement

R.M.B. received research support, acted as a consultant, or served on the scientific advisory board for Abbott Diabetes Care, DexCom, Eli Lilly, Glooko, Hygieia, Johnson & Johnson, Medtronic, Novo Nordisk, Roche, and Sanofi. R.M.B.'s employer, non-profit Health Partners Institute, contracts for his services and no personal income goes to Dr. Bergenstal. He has inherited Merck stock. He is a volunteer for ADA and JDRF.

Figures

FIG. 1.

AGP CGM Report (Ambulatory Glucose Profile – Continuous Glucose Monitoring Report).