Doctors recommend continuous glucose monitoring for patients with type 1 diabetes

BMJ 2016; 354 doi: (Published 27 September 2016) Cite this as: BMJ 2016;354:i5247
  1. Michael McCarthy
  1. Seattle

Adult patients with type 1 diabetes should use continuous glucose monitoring (CGM) devices to manage their blood glucose levels, the Endocrine Society has recommended in new guidelines.1

The recommendations, which were published in the society’s Journal of Clinical Endocrinology and Metabolism, were supported by the European Society of Endocrinology.

CGM devices, which use subcutaneous sensors to monitor blood glucose concentration, let patients track their blood glucose levels in near real time and adjust their insulin doses accordingly. The devices usually have alarms that warn patients when their blood glucose falls too low or rises too high.

The task force chair, Anne L Peters, of the University of Southern California’s Keck School of Medicine, said that the scientific evidence supported the use of CGM devices in both those with type 1 diabetes whose blood sugar was well controlled, as well as those whose blood sugar levels ran above their therapeutic targets.

“Studies have found that people with type 1 diabetes who used CGMs were able to maintain better control of their blood sugar without increasing episodes of hypoglycemia, compared with those who self-monitored blood glucose with periodic fingersticks,” Peters said.

The task force also recommended insulin pump therapy with devices that provided continuous subcutaneous insulin infusion (CSII) for patients with type 1 diabetes who had not achieved their hemoglobin A1c targets, or those who had achieved their targets but were experiencing severe hypoglycemia or high glucose variability.

Insulin pump therapy was also recommended for patients with type 2 diabetes who had poor glycemic control despite intensive therapy with oral medications, insulin, other injectable agents, and lifestyle modifications. In addition, the task force recommended the short term use of CGM devices for adults with type 2 diabetes who were not on prandial insulin who had hemoglobin A1c levels of 7% or higher.

The task force noted that this recommendation was based on limited data from randomized controlled trials that involved patients on diet and exercise alone, and in combination with antihyperglycemic medications including basal, but not prandial, insulin. “The ongoing Daily Injections and Continuous Glucose Monitoring in Diabetes study2 should provide conclusive data regarding the potential benefits of this technology for this population,” the task force said.

CSII pumps, CGM monitors, and their supplies can cost thousands of dollars a year. As a result, some insurers do not cover the devices and Medicare, the federal insurance plan for the elderly and disabled, does not provide coverage for the devices for adults aged 65 and older. The society has called on Medicare to extend its coverage, which it said would improve outcomes and reduce hypoglycemic events in older patients.

The authors disclosed multiple potential competing interests, which the society said had been reviewed, resolved, or managed. The society said that it alone funded the guideline’s preparation and that the task force received no funding from any commercial or other entities.


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