Role of continuous glucose monitoring for type 2 in diabetes management and research.
The advent of continuous glucose monitoring (CGM) is a significant stride forward in our ability to better understand the glycemic status of our patients. Current clinical practice employs two forms of CGM: professional (retrospective or "masked") and personal (real-time) to evaluate and/or monitor glycemic control. Most studies using professional and personal CGM have been done in those with type 1 diabetes (T1D). However, this technology is agnostic to the type of diabetes and can also be used in those with type 2 diabetes (T2D). The value of professional CGM in T2D for physicians, patients, and researchers is derived from its ability to: (1) to discover previously unknown hyper- and hypoglycemia (silent and symptomatic); (2) measure glycemic control directly rather than through the surrogate metric of hemoglobin A1C (HbA1C) permitting the observation of a wide variety of metrics that include glycemic variability, the percent of time within, below and above target glucose levels, the severity of hypo- and hyperglycemia throughout the day and night; (3) provide actionable information for healthcare providers derived by the CGM report; (4) better manage patients on hemodialysis; and (5) effectively and efficiently analyze glycemic effects of new interventions whether they be pharmaceuticals (duration of action, pharmacodynamics, safety, and efficacy), devices, or psycho-educational. Personal CGM has also been successfully used in a small number of studies as a behavior modification tool in those with T2D. This comprehensive review describes the differences between professional and personal CGM and the evidence for the use of each form of CGM in T2D. Finally, the opinions of key professional societies on the use of CGM in T2D are presented.
950 F St., NW, Suite 500, Washington, DC 20004, U.S.A.. Electronic address: robert.a.vigersky@medtronic.com.
Robert
R
Vigersky
Medtronic Plc, Non-Intensive Diabetes Therapies, 3033 Campus Drive, Minneapolis, MN 55441. Electronic address: maneesh@ieee.org.
Maneesh
M
Shrivastav
D000203:Activities of Daily Living; D001786:Blood Glucose / Q000032:analysis*; D003131:Combined Modality Therapy / Q000009:adverse effects; D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000628:therapy; D019317:Evidence-Based Medicine; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control; D007003:Hypoglycemia / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control; D018670:Monitoring, Ambulatory; D000073278:Self-Management; D012720:Severity of Illness Index
D001786:Blood Glucose
Continuous glucose monitoring; Diabetes management; Glycemic control; Hypoglycemia; Type 2 diabetes mellitus