Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes

Abstract

Continuous Glucose Monitoring (CGM) has been demonstrated to be clinically valuable, reducing risks of hypoglycemia and hyperglycemia, glycemic variability (GV), and improving patient quality of life for a wide range of patient populations and clinical indications. Use of CGM can help reduce HbA1c and mean glucose. One CGM device, with accuracy (%MARD) of approximately 10%, has recently been approved for self-adjustment of insulin dosages (nonadjuvant use) and approved for reimbursement for therapeutic use in the United States. CGM had previously been used off-label for that purpose. CGM has been demonstrated to be clinically useful in both type 1 and type 2 diabetes for patients receiving a wide variety of treatment regimens. CGM is beneficial for people using either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). CGM is used both in retrospective (professional, masked) and real-time (personal, unmasked) modes: both approaches can be beneficial. When CGM is used to suspend insulin infusion when hypoglycemia is detected until glucose returns to a safe level (low-glucose suspend), there are benefits beyond sensor-augmented pump (SAP), with greater reduction in the risk of hypoglycemia. Predictive low-glucose suspend provides greater benefits in this regard. Closed-loop control with insulin provides further improvement in quality of glycemic control. A hybrid closed-loop system has recently been approved by the U.S. FDA. Closed-loop control using both insulin and glucagon can reduce risk of hypoglycemia even more. CGM facilitates rigorous evaluation of new forms of therapy, characterizing pharmacodynamics, assessing frequency and severity of hypo- and hyperglycemia, and characterizing several aspects of GV.

Keywords: Ambulatory glucose profile (AGP); Artificial pancreas (AP); Automated insulin delivery (AID); Closed-loop control (CLC); Continuous glucose monitoring (CGM); Continuous subcutaneous insulin infusion (CSII); Flash glucose monitoring; Glycemic variability (GV); Hyperglycemia; Hypoglycemia; Multiple daily injections (MDI); Sensor-augmented pump (SAP); Time in range (TIR); Type 1 diabetes (T1DM); Type 2 diabetes (T2DM)..

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.

Flowchart of current and potential future options for management of patients receiving basal–bolus therapy. The first clinical decision is whether to add CGM, to add CSII, or introduce both CGM and CSII. CGM, continuous glucose monitoring; CSII, continuous subcutaneous insulin infusion.