Guidelines Address Continuous Glucose Monitoring

Laurie Barclay, MD

October 12, 2011

October 12, 2011 — Continuous glucose monitoring (CGM) assists people with diabetes in maintaining target blood glucose levels, according to an Endocrine Society clinical practice guideline published in the October issue of the Journal of Clinical Endocrinology and Metabolism.

"There are some caveats to consider before accepting continuous monitoring of glucose as a routine measure to improve glycemic control in diabetes," guidelines task force chair David C. Klonoff, MD, from Mills-Peninsula Health Services in San Mateo, California, said in a news release. "There are still concerns about the high costs of CGM and the accuracy of the various systems available. However, the new [clinical practice guideline] shows that CGM can be a beneficial tool to help maintain target levels of glycemia and limit the risk of hypoglycemia."

CGM, using various devices, measures glucose in the interstitial fluid; the intended use is for patients with type 1 or type 2 diabetes to make decisions about food, medicines, and exercise. A task force of experts, a methodologist, and a medical writer set out to develop evidence-based practice guidelines for identifying clinical scenarios in which CGM would be most beneficial to patients with diabetes. The goals of CGM are to maintain target levels of glycemia and to limit the risk for hypoglycemia in 3 potential settings: real-time (RT) CGM in hospitalized adults, RT-CGM in children and adolescent outpatients, and RT-CGM in adult outpatients.

The strength of the recommendations and the quality of the evidence were described using the Grading of Recommendations, Assessment, Development, and Evaluation system. Consensus was established in a group meeting, conference calls, and emails. The Diabetes Technology Society and the European Society of Endocrinology also reviewed and commented on preliminary drafts of these guidelines.

Specific recommendations for CGM are as follows:

  • While awaiting further evidence, RT-CGM alone should not be used for glucose management of adults in the intensive care unit or operating room.

  • Children and adolescent outpatients with type 1 diabetes mellitus (T1DM) and glycosylated hemoglobin (HbA1c) levels less than 7.0% should use RT-CGM with currently approved devices.

  • Pediatric, adolescent, and adult outpatients with T1DM and HbA1c levels of 7.0% or more should use RT-CGM if they are able to use these devices on a nearly daily basis.

  • The guidelines do not recommend for or against the use of RT-CGM by children younger than 8 years with T1DM.

  • Patients should be given treatment guidelines so that they can safely and effectively use the information obtained from RT-CGM.

  • Intermittent use of CGM systems capable of short-term retrospective analysis is recommended in children and adults with diabetes and possible nocturnal hypoglycemia, dawn phenomenon, and postprandial hyperglycemia; in patients with hypoglycemic unawareness; and in patients undergoing significant changes to their diabetes regimen.

  • Adults with T1DM and HbA1c levels less than 7.0% should use RT-CGM devices if they can use them on a nearly daily basis.

"CGM can be beneficial in maintaining target levels of glycemia and limiting the risk of hypoglycemia," the guidelines authors write.

All Endocrine Society clinical practice guidelines are supported entirely by society funds. Some members report various financial relationships with Bayer, C8 MediSensors, Insuline, LifeScan, Medtronic Diabetes, Roche, Diabetes Technology Society, MedTronic MiniMed, LifeScan, NovoNordisk, JDRF, UnoMedical, European Society of Endocrinology. KER Unit (Mayo Clinic), Abbott Diabetes, Eli Lilly, Macrogenics, Dexcom, the Endocrine Society, and/or Insulet.

J Clin Endocrinol Metabol. 2011;96:2968-2979. Abstract

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