![]() One can analyze the average or typical glucose patterns by time of day for any specified day or for various periods of time for one subject and for groups of subjects. One can also evaluate glycemic variability (GV) within and between days or between days of the week. In addition to quantifying the changes in mean glucose, and risks of hypo- and hyperglycemia, CGM enables the patient and physician to visualize the typical patterns of glucose throughout the day, including changes following meals, exercise, medications, and in response to changes in treatment regimen. (4) For individuals experiencing a high risk of hypoglycemia, real-time CGM usually resulted in significant clinically meaningful reductions in risk of hypoglycemia by 33% to 50%.) 6, 7 The JDRF study made several critically important observations based on a large number of subjects and 6-month follow-up: The JDRF cooperative studies 6, 7 reported in 20 represented a breakthrough in terms of size, rigor, use of three different CGM systems, multiple patient populations (children, adolescents, adults), and evaluation of factors such as the extent of usage. 9 With the benefit of time and the large number of studies that have followed, we can now be much more assertive regarding the clinical benefits of CGM. Price and coworkers have pointed out a number of pitfalls in meta-analyses. “Randomized controlled studies have provided evidence that hemoglobin HbA1c (HbA1c) results can be improved in patients with type 1 diabetes with elevated baselineHbA1c when using CGM frequently enough and that the frequency and duration of hypoglycemic events can be reduced in patients with satisfactory baselineHbA1c.” 8 8 focusing on eight major studies (also including the JDRF-CGM studies) reached somewhat stronger, but still guarded, conclusions: There are indications that higher compliance of wearing the CGM device improves glycosylated hemoglobin HbA1c level (HbA1c) to a larger extent.” 5Īn independent review by Liebl et al. The risk of severe hypoglycemia or ketoacidosis was not significantly increased for CGM users, but as these events occurred infrequent these results have to be interpreted cautiously. The largest improvements in glycemic control were seen for sensor-augmented insulin pump therapy in patients with poorly controlled diabetes who had not used an insulin pump before. “There is limited evidence for the effectiveness of real-time CGM use in children, adults and patients with poorly controlled diabetes. After 10 years of clinical experience, an evaluation by the Cochrane collaboration, 5 based on 22 randomized controlled trials (through 2011, including the JDRF-CGM studies 6, 7), was extremely cautious 5: However, early CGM sensors had limited accuracy, limited duration of use, and limited usability. 1–4 CGM was widely heralded as a great advance. 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.Ĭlinical application of modern-era continuous glucose sensing began in 2000. Closed-loop control using both insulin and glucagon can reduce risk of hypoglycemia even more. A hybrid closed-loop system has recently been approved by the U.S. Closed-loop control with insulin provides further improvement in quality of glycemic control. Predictive low-glucose suspend provides greater benefits in this regard. 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. ![]() CGM is used both in retrospective (professional, masked) and real-time (personal, unmasked) modes: both approaches can be beneficial. CGM is beneficial for people using either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). 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 had previously been used off-label for that purpose. 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. Use of CGM can help reduce HbA1c and mean glucose. ![]() 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. ![]()
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