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Effectiveness of Continuous Glucose Monitoring  

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How CGMs can improve glycemic control and overall quality of life.

From the Personal Continuous Glucose Monitoring Implementation Playbook from ADCES and AphA. Contributors include: Patricia L. Scalzo, MSN, NP, RN, CDCES, Kelly A. Brock, PharmD, RPh and Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES. This effort was supported by Dexcom & Abbott.

Multiple research studies confirm the effectiveness of continuous glucose monitoring. Randomized controlled trials have demonstrated: 
  • Decreased HbA1C  
  • Decreased glycemic variability  
  • Increased time in range  
  • Decreased time in hypoglycemia  
  • Reduction in hypoglycemic events  

Results from the three-year follow-up to the COMISAIR Study, which were published in Diabetes Care in January 2020, demonstrated that CGM is superior to self-monitoring of fingerstick glucose in reduction of HbA1c, hypoglycemia and other end points in people with type 1 diabetes regardless of their insulin delivery method. They went on to say that CGM plus multiple daily insulin injections can be considered an equivalent but lower-cost alternative to sensor-augmented insulin pump therapy and superior to treatment with self-monitoring of fingerstick glucose plus multiple daily insulin injections or self-monitoring of fingerstick glucose plus continuous subcutaneous insulin infusion therapy.

Published in Diabetes Technology & Therapeutics in 2019, Mulinacci et al7 investigated the efficacy and safety of CGM initiation within one year of type 1 diabetes diagnosis among all age groups. They concluded that “Irrespective of insulin delivery system, early initiation of CGM within one year from T1D diagnosis was associated with better glucose control and fewer diabetes-related emergency visits.”  

Many studies have been performed with multiple populations and different device types: people with type 1 and type 2 diabetes, adults and children, personal and professional CGM. Dr. Anne Peters, Endocrinologist at the Keck School of Medicine at University of Southern California, provided a detailed review of CGM studies and outcomes in the Role of Continuous Glucose Monitoring in Diabetes Treatment supplement published by the American Diabetes Association (Chart used by permission, American Diabetes Association, 2018).

References: 

6. Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet 2016;388:2254–2263

7. Hermanns N, Schumann B, Kulzer B, Haak T. The impact of continuous glucose monitoring on low interstitial glucose values and low blood glucose values assessed by point-of-care blood glucose meters: results of a crossover trial. J Diabetes Sci Technol 2014;8:516–522

8. van Beers CA, DeVries JH, Smits MM, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial. Lancet Diabetes Endocrinol 2016;4:893–902

9. Battelino T, Conget I, Olsen B, et al.; SWITCH Study Group. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia 2012;55:3155– 3162

10. Deiss D, Bolinder J, Riveline JP, et al. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care 2006;29:2730–2732

11. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med 2008:359;1464–1476

12. O’Connell MA, Donath S, O’Neal DN, et al. Glycemic impact of patient-led use of sensor-guided pump therapy in type 1 diabetes: a randomized controlled trial. Diabetologia 2009;52:1250–1257

13. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. The effect of continuous glucose monitoring in well-controlled type 1 diabetes. Diabetes Care 2009;32:1378–1383 14. Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care 2011;34:795–800

15. Heinemann L, Freckmann G, Ehrmann D, et al. Realtime continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness of severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet 2018; 391:1367–1377

16. Ludvigsson J, Hanas R. Continuous subcutaneous glucose monitoring improved metabolic control in pediatric patients with type 1 diabetes: a controlled crossover study. Pediatrics 2003;111:933–938

17. Chase HP, Beck R, Tamborlane W, et al. A randomized multicenter trial comparing the GlucoWatch Biographer with standard glucose monitoring in children with type 1 diabetes. Diabetes Care 2005;28:1101–1106

18. Beck RW, Riddlesworth TD, Ruedy K, et al.; DIAMOND Study Group. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Ann Intern Med 2017;167:365–374

19. Ehrhardt NM, Chellappa M, Walker MS, Fonda SJ, Vigersky RA. 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

20. 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;8:55–73

21. 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

22. Garg S, Zisser H, Schwartz S, et al. Improvements in glycemic excursions with a transcutaneous, real-time continuous glucose sensor: a randomized controlled trial. Diabetes Care 2006;29:44–50

23. New JP, Aijan R, Pfeiffer AF, Freckmann G. Continuous glucose monitoring in people with diabetes: the randomized controlled Glucose Level Awareness in Diabetes Study (GLADIS). Diabet Med 2015;32:609– 617

24. Cooke D, Hurel SJ, Casbard A, et al. Randomized controlled trial to assess the impact of continuous glucose monitoring on HbA(1c) in insulin-treated diabetes (MITRE Study). Diabet Med 2009;26:540–547

25. Feig DS, Donovan LE, Corcoy R, et al.; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multi-centre international randomised controlled trial. Lancet 2017:390:2347–2359

26. Secher AL, Ringholm L, Andersen HU, Damm P, Mathiesen ER. The effect of real-time continuous glucose monitoring in pregnant women with diabetes: a randomized controlled trial. Diabetes Care 2013;36:1877– 1883

27. Wei Q, Sun Z, Yang Y, Yu H, Ding H, Wang S. Effect of a CGMS and SMBG on maternal and neonatal outcomes in gestational diabetes mellitus: a randomized controlled trial. Sci Rep 2016;6:19920

 


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