Skip to main content
Erschienen in: Current Diabetes Reports 11/2021

01.11.2021 | Economics and Policy in Diabetes (AA Baig and N Laiteerapong, Section Editors)

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

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

Erschienen in: Current Diabetes Reports | Ausgabe 11/2021

Einloggen, um Zugang zu erhalten

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.

Summary

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.
Literatur
1.
Zurück zum Zitat •• American Diabetes Association. Diabetes technology: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(Suppl 1):S85–99. https://doi.org/10.2337/dc21-S007. The most current (2021) ADA Standards regarding technology use in diabetes, including CGM, and thorough consideration of evidence.CrossRef •• American Diabetes Association. Diabetes technology: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(Suppl 1):S85–99. https://​doi.​org/​10.​2337/​dc21-S007. The most current (2021) ADA Standards regarding technology use in diabetes, including CGM, and thorough consideration of evidence.CrossRef
3.
Zurück zum Zitat •• 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):107–39. https://doi.org/10.4158/CS-2019-0472. The most current (2020) AACE/ACE statement on type 2 diabetes management, including preferred use of CGM over SMBG and reasons for this preference.CrossRefPubMed •• 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):107–39. https://​doi.​org/​10.​4158/​CS-2019-0472. The most current (2020) AACE/ACE statement on type 2 diabetes management, including preferred use of CGM over SMBG and reasons for this preference.CrossRefPubMed
4.
Zurück zum Zitat • 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):365–74. https://doi.org/10.7326/M16-2855. RCT demonstrating greater HbA1c decrease in rtCGM than SMBG, with additional benefits in mean glucose, TIR, and TAR.CrossRefPubMed • 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):365–74. https://​doi.​org/​10.​7326/​M16-2855. RCT demonstrating greater HbA1c decrease in rtCGM than SMBG, with additional benefits in mean glucose, TIR, and TAR.CrossRefPubMed
5.
Zurück zum Zitat • 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. https://doi.org/10.1007/s13300-016-0223-6. RCT demonstrating substantial decreases in hypoglycemia in adults with T2D treated with IIT.CrossRefPubMed • 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. https://​doi.​org/​10.​1007/​s13300-016-0223-6. RCT demonstrating substantial decreases in hypoglycemia in adults with T2D treated with IIT.CrossRefPubMed
7.
Zurück zum Zitat • 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. https://doi.org/10.1136/bmjdrc-2019-001115. Among the first RCTs to evaluate CGM in adults with T2D who do not use insulin therapy, this demonstrated greater increase in TIR for CGM than for SMBG, with improvements later sustained for CGM but not for SMBG.CrossRefPubMedPubMedCentral • 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. https://​doi.​org/​10.​1136/​bmjdrc-2019-001115. Among the first RCTs to evaluate CGM in adults with T2D who do not use insulin therapy, this demonstrated greater increase in TIR for CGM than for SMBG, with improvements later sustained for CGM but not for SMBG.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat 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):2262–72. https://doi.org/10.1001/jama.2021.7444.CrossRefPubMed 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):2262–72. https://​doi.​org/​10.​1001/​jama.​2021.​7444.CrossRefPubMed
9.
Zurück zum Zitat 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):1178–84. https://doi.org/10.2337/dc18-0166.CrossRefPubMed 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):1178–84. https://​doi.​org/​10.​2337/​dc18-0166.CrossRefPubMed
21.
Zurück zum Zitat 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. https://doi.org/10.2196/21778.CrossRefPubMedPubMedCentral 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. https://​doi.​org/​10.​2196/​21778.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat 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.PubMed 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.PubMed
34.
Zurück zum Zitat 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. https://doi.org/10.1177/1932296820955228. 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. https://​doi.​org/​10.​1177/​1932296820955228​.
Metadaten
Titel
Personal Continuous Glucose Monitoring Use Among Adults with Type 2 Diabetes: Clinical Efficacy and Economic Impacts
verfasst von
Tamara K. Oser
Michelle L. Litchman
Nancy A. Allen
Bethany M. Kwan
Lawrence Fisher
Bonnie T. Jortberg
William H. Polonsky
Sean M. Oser
Publikationsdatum
01.11.2021
Verlag
Springer US
Erschienen in
Current Diabetes Reports / Ausgabe 11/2021
Print ISSN: 1534-4827
Elektronische ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-021-01408-1

Weitere Artikel der Ausgabe 11/2021

Current Diabetes Reports 11/2021 Zur Ausgabe

Hospital Management of Diabetes (A Wallia and J Seley, Section Editors)

Glycemic Control in Hospitalized Stroke Patients: A Review

Diabetes and Pregnancy (M-F Hivert and CE Powe, Section Editors)

Assessing Glycemic Control Using CGM for Women with Diabetes in Pregnancy

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

ADT zur Radiatio nach Prostatektomie: Wenn, dann wohl länger

24.05.2024 Prostatakarzinom Nachrichten

Welchen Nutzen es trägt, wenn die Strahlentherapie nach radikaler Prostatektomie um eine Androgendeprivation ergänzt wird, hat die RADICALS-HD-Studie untersucht. Nun liegen die Ergebnisse vor. Sie sprechen für länger dauernden Hormonentzug.

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

So sicher sind Tattoos: Neue Daten zur Risikobewertung

22.05.2024 Melanom Nachrichten

Das größte medizinische Problem bei Tattoos bleiben allergische Reaktionen. Melanome werden dadurch offensichtlich nicht gefördert, die Farbpigmente könnten aber andere Tumoren begünstigen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.