Effectiveness and acceptability of continuous glucose monitoring for type 2 diabetes management: A narrative review

Pennie J Taylor, Campbell H Thompson, Grant D Brinkworth, Pennie J Taylor, Campbell H Thompson, Grant D Brinkworth

Abstract

The present narrative review discusses the role of continuous glucose monitoring (CGM) in glycemic and weight control, and lifestyle behavior adherence in adults with type 2 diabetes. A literature search from January 2001 to November 2017 was carried out (MEDLINE, CINAHL, Web of Science and Scopus). Eligible studies were trials evaluating the use of CGM with the aim of achieving glucose control or lifestyle-related treatment adherence over a period of ≥8 weeks in adults with type 2 diabetes compared with usual care or another comparison intervention, or observational trials reporting CGM user experience. A total of 5,542 participants were recruited into 11 studies (eight randomized controlled trials [n = 5,346] and three observational studies [n = 196]). The sample size ranged 6-4,678 participants, the mean age was 51.7-60.0 years and diabetes duration was 2.1-19.2 years, with high heterogeneity between studies. Overall, the available evidence showed, compared with traditional self-monitoring of blood glucose levels, CGM promoted greater reductions in glycated hemoglobin, bodyweight and caloric intake; higher adherence rating to a personal eating plan; and increases in physical activity. High compliance to CGM wear-time and device calibration was reported (>90%). The addition of lifestyle and/or behavioral counseling to CGM appeared to further potentiate these improvements. Preliminary evidence suggests that CGM use promotes glycemic and weight control, and lifestyle behavior adherence in adults with type 2 diabetes. These benefits might be further enhanced with integration of diet, exercise, and glucose excursion education and counseling. However, specific attributes of effective interventions and the application of CGM information for promoting improved outcomes and healthier choices remain unclear.

Keywords: Glycemic control; Lifestyle; Technology.

© 2018 Commonwealth Scientific and Industrial Research Organisation. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Figures

Figure 1
Figure 1
Article selection process. CGM, continuous glucose monitoring; T1, type 1; T2, type 2.

References

    1. World Health Organisation (WHO) . Global Report on Diabetes. Geneva: World Health Organisation, 2016. Available from . Accessed June 7, 2017.
    1. Herman WH, Zimmet P. Type 2 diabetes: an epidemic requiring global attention and urgent action. Diabetes Care 2012; 35: 943–944.
    1. Nanditha A, Ma RC, Ramachandran A, et al Diabetes in Asia and the Pacific: implications for the global epidemic. Diabetes Care 2016; 39: 472–485.
    1. Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus[mdash]present and future perspectives. Nat Rev Endocrinol 2012; 8: 228–236.
    1. Ahmad NS, Islahudin F, Paraidathathu T. Factors associated with good glycemic control among patients with type 2 diabetes mellitus. J Diabetes Investig 2014; 5: 563–569.
    1. Anoop M, Lokesh K, Sumit I, et al South Asian diets and insulin resistance. Br J Nutr 2009; 101: 465–473.
    1. Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 2017; 128: 40–50.
    1. American Diabetes Association (ADA) . Standards of Medical Care in Diabetes ‐ 2017. J Clin Appl Res Educat 2017; 41(Suppl. 1): 1–156.
    1. Hu FB, Manson J, Stampfer M, et al Diet, lifestyle and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001; 345: 790–797.
    1. Franz MJ, Boucher JL, Rutten‐Ramos S, et al Lifestyle weight‐loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta‐analysis of randomized clinical trials. J Acad Nutr Diet 2015; 115: 1447–1463.
    1. Wens J, Vermeire E, Royen PV, et al GPs’ perspectives of type 2 diabetes patients’ adherence to treatment: a qualitative analysis of barriers and solutions. BMC Fam Pract 2005; 6: 20.
    1. Schnell OAH, Battelini T, Ceriello A, et al Self‐monitoring of blood glucose in type 2 diabetes: recent studies. J Diabetes Sci Technol 2013; 7: 479–488.
    1. Erbach M, Freckmann G, Hinzmann R, et al Interferences and limitations in blood glucose self‐testing: an overview of the current knowledge. J Diabetes Sci Technol 2016; 10: 1161–1168.
    1. Czupryniak L, Barkai L, Bolgarska S, et al Self‐monitoring of blood glucose in diabetes: from evidence to clinical reality in Central and Eastern Europe–recommendations from the international Central‐Eastern European expert group. Diabetes Technol Ther 2014; 16: 460–475.
    1. Allen NA, Fain JA, Braun B, et al Continuous glucose monitoring in non‐insulin‐using individuals with type 2 diabetes: acceptability, feasibility, and teaching opportunities. Diabetes Technol Ther 2009; 11: 151–158.
    1. Poolsup N, Suksomboon N, Kyaw AM. Systematic review and meta‐analysis of the effectiveness of continuous glucose monitoring (CGM) on glucose control in diabetes. Diabetol Metab Syndr 2013; 5: 39.
    1. Dunkley AJ, Charles K, Gray LJ, et al Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta‐analysis. Diabetes Obes Metab 2012; 14: 616–625.
    1. Battelino T, Liabat S, Veeze HJ, et al Routine use of continuous glucose monitoring in 10 501 people with diabetes mellitus. Diab Med 2015; 32: 1568–1574.
    1. Joanna Briggs Institute (JBI) . “The Joanna Briggs Institute Reviewer’ Manual: 2015 edition / Supplement.” Available from: Accessed February 12, 2017.
    1. Olczuk D, Priefer R. A history of continuous glucose monitors (CGMs) in self‐monitoring of diabetes mellitus. Diabetes Metab Syndr: Clin Res Rev 2017.
    1. Rodbard D. Continuous glucose monitoring: a review of recent studies demonstrating improved glycemic outcomes. Diabetes Technol Ther 2017; 19: S25–S37.
    1. Hoeks L, Greven WL, de Valk HW. Real‐time continuous glucose monitoring system for treatment of diabetes: a systematic review. Diab Med 2011; 28: 386–394.
    1. Cox DJ, Taylor AG, Singh H, et al Glycemic load, exercise, and monitoring blood glucose (GEM): a paradigm shift in the treatment of type 2 diabetes mellitus. Diabetes Res Clin Pract 2016; 111: 28–35.
    1. Vigersky RA, Fonda SJ, Chellappa M, et al Short‐ and long‐term effects of real‐time continuous glucose monitoring in patients with type 2 diabetes. Diabetes Care 2012; 35: 32–38.
    1. Ehrhardt NM, Chellappa M, Walker MS, et al The effect of real‐time continuous glucose monitoring on glycemic control in patients with type 2 diabetes mellitus. J Diabetes Sci Technol 2011; 5: 668–675.
    1. Tang TS, Digby EM, Wright AM, et al Real‐time continuous glucose monitoring versus internet‐based blood glucose monitoring in adults with type 2 diabetes: a study of treatment satisfaction. Diabetes Res Clin Pract 2014; 106: 481–486.
    1. Yoo HJ, An HG, Park SY, et al Use of a real time continuous glucose monitoring system as a motivational device for poorly controlled type 2 diabetes. Diabetes Res Clin Pract 2008; 82: 73–79.
    1. Allen NA, Fain JA, Braun B, et al Continuous glucose monitoring counseling improves physical activity behaviors of individuals with type 2 diabetes: a randomized clinical trial. Diabetes Res Clin Pract 2008; 80: 371–379.
    1. Allen N, Whittemore R, Melkus G. A continuous glucose monitoring and problem‐solving intervention to change physical activity behavior in women with type 2 diabetes: a pilot study. Diabetes Technol Ther 2011; 13: 1091–1099.
    1. Beck RW, Riddlesworth TD, Ruedy K, et al Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections. Annals Intern Med 2017; 167: 365–374.
    1. Anjana RM, Kesavadev J, Neeta D, et al A multicenter real‐life study on the effect of flash glucose monitoring on glycemic control in patients with type 1 and type 2 diabetes. Diabetes Technol Ther 2017; 19: 533–540.
    1. Haak T, Hanaire H, Ajjan R, et al Flash glucose‐sensing technology as a replacement for blood glucose monitoring for the management of insulin‐treated type 2 diabetes: a multicenter, open‐label randomized controlled trial. Diabetes Ther 2017; 8: 55–73.
    1. Cox DJ, Taylor AG, Moncrief M, et al Continuous glucose monitoring in the self‐management of type 2 diabetes: a paradigm shift. Diabetes Care 2016; 39: E71–E73.
    1. Allen NA, Jacelon CS, Chipkin SR. Feasibility and acceptability of continuous glucose monitoring and accelerometer technology in exercising individuals with type 2 diabetes. J Clin Nurs 2009; 18: 373–383.
    1. Mohan V, Jain S, Kesavadev J, et al Use of retrospective continuous glucose monitoring for optimizing management of type 2 diabetes in India. J Assoc Phys India 2016; 64: 16–21.
    1. Klonoff DC, Buckingham B, Christiansen JS, et al Continuous glucose monitoring: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2011; 96: 2968–2979.
    1. Bailey TS, Grunberger G, Bode BW, et al American Association of Clinical Endocrinologists and American College of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement. Endocr Pract 2016; 22: 231–261.
    1. Carlson AL, Mullen DM, Bergenstal RM. Clinical use of continuous glucose monitoring in adults with type 2 diabetes. Diabetes Technol Ther 2017; 19: S4–S11.
    1. Qiu S, Cai X, Schumann U, et al Impact of walking on glycemic control and other cardiovascular risk factors in type 2 diabetes: a meta‐analysis. PLoS One 2014; 9: e109767.
    1. Figueira FR, Umpierre D, Casali KR, et al Aerobic and combined exercise sessions reduce glucose variability in type 2 diabetes: crossover randomized trial. PLoS One 2013; 8: e57733.
    1. The Juvenile Diabetes Research Foundation CGM monitoring Study Group . Continuous glucose monitoring and intenstive treatment of type 1 diabetes. N Engl J Med 2008; 359: 1464–1476.
    1. Terranova CO, Brakenridge CL, Lawler SP, et al Effectivenss of lifestyle‐based weight loss interventions for adults with type 2 diabetes: a systematic review and meta‐analysis. Diabetes Obes Metab 2015; 17: 371–378.
    1. Stratton IMA, Neil HA, Matthews DR, et al Association of glycaemia with macrovascular and mictrovasular complications of type 2 diabetes (UKPD 35): prospective observational study. BMJ 2000; 321: 405–412.
    1. Lorenzo C, Okoloise M, Williams K, et al The metabolic syndrome as predictor of type 2 diabetes ‐ The San Antonio Heart Study. Diabetes Care 2003; 26: 3153–3159.
    1. Wander PL, Boyko EJ, Leonetti DL, et al Change in visceral adiposity independently predicts a greater risk of developing type 2 diabetes over 10 years in Japanese Americans. Diabetes Care 2013; 36: 289–293.
    1. Gomez‐Ambrosi J, Silva C, Galofre JC, et al Body adiposity and type 2 diabetes: increased risk with a high body fat percentage even having a normal BMI. Obesity (Silver Spring) 2011; 19: 1439–1444.
    1. Ross SA, Dzida G, Vora J, et al Impact of weight gain on outcomes in type 2 diabetes. Curr Med Res Opin 2011; 27: 1431–1438.
    1. DeFronzo RA. Insulin resistance, lipotoxicity, type 2 diabetes and atherosclerosis: the missing links. The Claude Bernard Lecture 2009. Diabetologia 2010; 53: 1270–1287.
    1. Wing RR, Look Ahead Research Group . Long‐term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four‐year results of the Look AHEAD trial. Arch Intern Med 2010; 170: 1566–1575.
    1. Wing RR, Lang W, Wadden TA, et al The Look AHEAD research group benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 2011; 34: 181.
    1. Ardisson Korat AV, Willett WC, Hu FB. Diet, lifestyle, and genetic risk factors for type 2 diabetes: a review from the Nurses’ Health Study, Nurses’ Health Study 2, and Health Professionals’ Follow‐up Study. Curr Nutr Rep 2014; 3: 345–354.
    1. Karstoft K, Winding K, Knudsen SH, et al The effects of free‐living interval‐walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 2013; 36: 228–236.
    1. Baker RC, Kirshenbaum DS. Self‐monitoring may be necessary for successful weight control. Behav Ther 1993; 24: 377–394.
    1. Bailey KJ, Little JP, Jung ME. Self‐monitoring using continuous glucose monitors with real‐time feedback improves exercise adherence in individuals with impaired blood glucose: a pilot study. Diabetes Technol Ther 2016; 18: 185–193.
    1. Rodbard D. Continuous glucose monitoring: a review of successes, challenges, and opportunities. Diabetes Technol Ther 2016; 18(Suppl 2): S3–S13.
    1. Borges U Jr, Kubiak T. Continuous glucose monitoring in type 1 diabetes. J Diabetes Sci Technol 2016; 10: 633–639.
    1. Joubert M, Reznik Y. Personal continuous glucose monitoring (CGM) in diabetes management: review of the literature and implementation for practical use. Diabetes Res Clin Pract 2012; 96: 294–305.
    1. Blumer I. The contemporary role of masked continuous glucose monitoring in a real‐time world. J Diabetes Sci Technol 2016; 10: 790–792.
    1. Wagner J, Tennen H, Wolpert H. Continuous glucose monitoring: a review for behavioral researchers. Psychosom Med 2012; 74: 356–365.
    1. Rodbard D. Clinical interpretation of indices of quality of glycemic control and glycemic variability. Postgrad Med 2011; 123: 107–118.

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