Personal Continuous Glucose Monitoring Use Among Adults with Type 2 Diabetes: Clinical Efficacy and Economic Impacts

Tamara K Oser, Michelle L Litchman, Nancy A Allen, Bethany M Kwan, Lawrence Fisher, Bonnie T Jortberg, William H Polonsky, Sean M Oser, Tamara K Oser, Michelle L Litchman, Nancy A Allen, Bethany M Kwan, Lawrence Fisher, Bonnie T Jortberg, William H Polonsky, Sean M Oser

Abstract

Purpose of review: This article reviews recent clinical efficacy research and economic analysis of the use of personal continuous glucose monitoring (CGM) in type 2 diabetes (T2D).

Recent findings: Studies from the past 5 years include a variety of randomized controlled trials, meta-analyses, and other studies which generally favor CGM over self-monitoring of blood glucose (SMBG) in T2D, especially among people with T2D treated with insulin. Concurrently, some studies show no significant difference, but there is no evidence of worse outcomes with CGM. CGM is frequently associated with greater reduction in HbA1c than is SMBG. HbA1c reductions tend to be greater when baseline HbA1c is higher. Reductions in hypoglycemia and hyperglycemia have also been demonstrated with CGM in people with T2D, as have comfort with, preference for, and psychosocial benefits of CGM compared to SMBG. There is a small but growing evidence base on the economics and cost-effectiveness of CGM in T2D. CGM has been clearly demonstrated to have clinical benefits in people with T2D, especially among those treated with insulin. Economic and cost-effectiveness data are more scant but are generally favorable. CGM should be an important consideration in the management of T2D, and its use is likely to increase as efficacy data accumulate further and as costs associated with CGM gradually decrease.

Keywords: CGM; Continuous glucose monitor; Diabetes technology; Economics; Type 2 diabetes.

Conflict of interest statement

The authors did not receive support from any organization for the submitted work. Financial interests: SO and TO have served on advisory boards for Cecelia Health, DiabetesWise.org, and Dexcom. LF has served as an advisor to Ascensia, Dexcom, and Eli Lilly. WP has received research funding from and served as an advisor to Abbott and Dexcom. NA and ML have received equipment grants from Dexcom to conduct unrelated studies. ML has received an investigator-initiated grant from Abbott to conduct an unrelated study.

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

References

    1. American Diabetes Association Diabetes technology: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(Suppl 1):S85–S99. doi: 10.2337/dc21-S007.
    1. American Diabetes Association Diabetes technology: standards of medical care in diabetes—2020. Diabetes Care. 2020;43(Suppl 1):S77–S88. doi: 10.2337/dc20-S007.
    1. Garber AJ, Handelsman Y, Grunberger G, Einhorn D, Abramson MJ, Barzillay JI, Blonde L, Bush MA, DeFronzo RA, Garber JR, Garvey WT, Hirsch IB, Jellinger JS, McGill JB, Mechanick JI, Perreault L, Rosenblit PD, Samson S, Umpierrez GE. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2020 executive summary. Endocr Pract. 2020;26(1):107–139. doi: 10.4158/CS-2019-0472.
    1. Beck RW, Riddlesworth TD, Ruedy K, Ahmann A, Haller S, Kruger D, McGill JB, Polonsky W, Price D, Aronoff S, Aronson R. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Ann Intern Med. 2017;167(6):365–374. doi: 10.7326/M16-2855.
    1. Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline JP, Rayman G. 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(1):55–73. doi: 10.1007/s13300-016-0223-6.
    1. Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C. Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial. J Diabetes Sci Technol. 2017;11(6):1138–1146. doi: 10.1177/1932296817704445.
    1. Wada E, Onoue T, Kobayashi T, Handa T, Hayase A, Ito M, Furukawa M, Okuji T, Okada N, Iwama S, Sugiyama M. Flash glucose monitoring helps achieve better glycemic control than conventional self-monitoring of blood glucose in non-insulin-treated type 2 diabetes: a randomized controlled trial. BMJ Open Diabetes Res Care. 2020;8(1):e001115. doi: 10.1136/bmjdrc-2019-001115.
    1. Martens T, Beck RW, Bailey R, Ruedy KJ, Calhoun P, Peters AL, Pop-Busui R, Philis-Tsimikas A, Bao S, Umpierrez G, Davis G, Kruger D, Bhargava A, Young L, McGill JB, Aleppo G, Nguyen QT, Orozco I, Biggs W, Lucas KJ, Polonsky WH, Buse JB, Price D, Begenstal RM. Effects of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin: a randomized controlled trial. JAMA. 2021;325(22):2262–2272. doi: 10.1001/jama.2021.7444.
    1. Yaron M, Roitman E, Aharon-Hananel G, Landau Z, Ganz T, Yanuv I, Rozenberg A, Karp M, Ish-Shalom M, Singer J, Wainstein J, Raz I. Effect of flash glucose monitoring technology on glycemic control and treatment satisfaction in patients with type 2 diabetes. Diabetes Care. 2019;42(7):1178–1184. doi: 10.2337/dc18-0166.
    1. Davis TM, Dwyer P, England M, Fegan PG, Davis WA. Efficacy of intermittently scanned continuous glucose monitoring in the prevention of recurrent severe hypoglycemia. Diabetes Technol Ther. 2020;22(5):367–373. doi: 10.1089/dia.2019.0331.
    1. Cox DJ, Banton T, Moncrief M, Conaway M, Diamond A, McCall AL. Minimizing glucose excursions (GEM) with continuous glucose monitoring in type 2 diabetes: a randomized clinical trial. J Endocr Soc. 2020;4(11):bvaa118. doi: 10.1210/jendso/bvaa118.
    1. Park C, Le QA. The effectiveness of continuous glucose monitoring in patients with type 2 diabetes: a systematic review of literature and meta-analysis. Diabetes Technol Ther. 2018;20(9):613–621. doi: 10.1089/dia.2018.0177.
    1. Ida S, Kaneko R, Murata K. Utility of real-time and retrospective continuous glucose monitoring in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. J Diabetes Res. 2019;2019:4684815. doi: 10.1155/2019/4684815.
    1. Janapala RN, Jayaraj JS, Fathima N, Kashif T, Usman N, Dasari A, Jahan N, Sachmechi I. Continuous glucose monitoring versus self-monitoring of blood glucose in type 2 diabetes mellitus: a systematic review with meta-analysis. Cureus. 2019;11(9):e5634. doi: 10.7759/cureus.5634.
    1. Evans M, Welsh Z, Ells S, Seibold A. The impact of flash glucose monitoring on glycaemic control as measured by HbA1c: a meta-analysis of clinical trials and real-world observational studies. Diabetes Ther. 2020;11(1):83–95. doi: 10.1007/s13300-019-00720-0.
    1. Ish-Shalom M, Wainstein J, Raz I, Mosenzon O. Improvement in glucose control in difficult-to-control patients with diabetes using a novel flash glucose monitoring device. J Diabetes Sci Technol. 2016;10(6):1412–1413. doi: 10.1177/1932296816653412.
    1. Cox DJ, Taylor AG, Moncrief M, Diamond A, Yancy WS, Hegde S, McCall AL. Continuous glucose monitoring in the self-management of type 2 diabetes: a paradigm shift. Diabetes Care. 2016;39(5):e71–e73. doi: 10.2337/dc15-2836.
    1. Weiss J, Cohen N, Zajac JD, Ekinci EI. Flash glucose monitoring—using technology to improve outcomes for patients with diabetes. Aust J Rural Health. 2018;26(6):453–454. doi: 10.1111/ajr.12440.
    1. Hirsch IB, Welsh JB, Calhoun P, Puhr S, Walker TC, Price DA. Associations between HbA1c and continuous glucose monitoring-derived glycaemic variables. Diabet Med. 2019;36(12):1637–1642. doi: 10.1111/dme.14065.
    1. Kröger J, Fasching P, Hanaire H. Three European retrospective real-world chart review studies to determine the effectiveness of flash glucose monitoring on HbA1c in adults with type 2 diabetes. Diabetes Ther. 2020;11(1):279–291. doi: 10.1007/s13300-019-00741-9.
    1. Majithia AR, Kusiak CM, Lee AA, Colangelo FR, Romanelli RJ, Robertson S, Miller DP, Erani DM, Layne JE, Dixon RF, Zisser H. Glycemic outcomes in adults with type 2 diabetes participating in a continuous glucose monitor–driven virtual diabetes clinic: prospective trial. J Med Internet Res. 2020;22(8):e21778. doi: 10.2196/21778.
    1. Bergenstal RM, Layne JE, Zisser H, Gabbay RA, Barleen NA, Lee AA, Majithia AR, Parkin CG, Dixon RF. Remote application and use of real-time continuous glucose monitoring by adults with type 2 diabetes in a virtual diabetes clinic. Diabetes Technol Ther. 2021;23(2):128–132. doi: 10.1089/dia.2020.0396.
    1. Gilbert TR, Noar A, Blalock O, Polonsky WH. Change in hemoglobin A1c and quality of life with real-time continuous glucose monitoring use by people with insulin-treated diabetes in the landmark study. Diabetes Technol Ther. 2021;23(S1):S35–S39. doi: 10.1089/dia.2020.0666.
    1. Karter AJ, Parker MM, Moffet HH, Gilliam LK, Dlott R. Association of real-time continuous glucose monitoring with glycemic control and acute metabolic events among patients with insulin-treated diabetes. JAMA. 2021;325(22):2273–2284. doi: 10.1001/jama.2021.6530.
    1. Gehlaut RR, Dogbey GY, Schwartz FL, Marling CR, Shubrook JH. Hypoglycemia in type 2 diabetes – more common than you think: a continuous glucose monitoring study. J Diabetes Sci Technol. 2015;9(5):999–1005. doi: 10.1177/1932296815581052.
    1. Reddy M, Oliver N. Self-monitoring of blood glucose requirements with the use of intermittently scanned continuous glucose monitoring: a follow-up analysis using real-life data. Diabetes Technol Ther. 2020.10.1089/dia.2020.0477.
    1. Abdelhamid YA, Bernjak A, Phillips LK, Summers MJ, Weinel LM, Lange K, Chow E, Kar P, Horowitz M, Heller S, Deane AM. Nocturnal hypoglycemia in patients with diabetes discharged from ICUs: a prospective two-center cohort study. Crit Care Med. 2021;49(4):636–649. doi: 10.1097/CCM.0000000000004810.
    1. Robertson SL, Shaughnessy AF, Slawson DC. Continuous glucose monitoring in type 2 diabetes is not ready for widespread adoption. Am Fam Physician. 2020;101(11):646.
    1. Anderson JE, Gavin JR, Kruger DF. Current eligibility requirements for CGM coverage are harmful, costly, and unjustified. Diabetes Technol Ther. 2020;22(3):169–173. doi: 10.1089/dia.2019.0303.
    1. Danne T, Nimri R, Battelino T, Bergenstal RM, Close KL, DeVries JH, Garg S, Heinemann L, Hirsch I, Amiel SA, Beck R. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017;40(12):1631–1640. doi: 10.2337/dc17-1600.
    1. Fonda SJ, Graham C, Munakata J, Powers JM, Price D, Vigersky RA. The cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) in type 2 diabetes. J Diabetes Sci Technol. 2016;10(4):898–904. doi: 10.1177/1932296816628547.
    1. Sierra JA, Shah M, Gill MS, Flores Z, Chawla H, Kaufman FR, Vigersky R. Clinical and economic benefits of professional CGM among people with type 2 diabetes in the United States: analysis of claims and lab data. J Med Econ. 2018;21(3):225–230. doi: 10.1080/13696998.2017.1390474.
    1. National Committee on Quality Assurance. In: Health Insurance Exchange 2021 Quality Rating System Measure Technical Specifications. 2020. . Accessed 20 Mar 2021.
    1. Isaacson B, Kaufusi S, Sorensen J, Joy E, Jones C, Ingram V, Mark N, Phillips M, Briesacher M. Demonstrating the clinical impact of continuous glucose monitoring within an integrated healthcare delivery system. J Diabetes Sci Technol. 2020:1932296820955228. 10.1177/1932296820955228.
    1. American Diabetes Association Economic costs of diabetes in the US in 2017. Diabetes Care. 2018;41(5):917–928. doi: 10.2337/dci18-0007.
    1. Oser SM, Oser TK. Diabetes technologies: we are all in this together. Clin Diabetes. 2020;38(2):188–189. doi: 10.2337/cd19-0046.

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