Recommendations: Glucose Monitoring (3)
Recommendations for glucose monitoring1 are summarized on three slides Slide 3 of 3 Continuous glucose monitoring (CGM) with intensive insulin regimens can be a useful tool to lower A1C in selected adults (age ≥25 years) with type 1 diabetes (A) Evidence for A1C-lowering less strong in children, teens, and younger adults; however, CGM may be helpful; success correlates with adherence to ongoing use of the device (C) CGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes (E) Real-time CGM through the measurement of interstitial glucose (which correlates well with plasma glucose) is available; these sensors require calibration with SMBG; the latter are still recommended for making acute treatment decision and CGM devices have alarms for hypo- and hyperglycemic excursions A 26-week randomized trial of 322 type 1 patients showed that adults age 25 years and older using intensive insulin therapy and CGM experienced a 0.5% reduction in A1C (from ~7.6–7.1%) compared with usual intensive insulin therapy with SMBG2 Overall, meta-analyses suggests that compared with SMBG, CGM lowers A1C by ~0.2636References American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013;36(suppl 1):S17-S18. Tamborlane WV, Beck RW, Bode BW, et al for the 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. Yeh HC, Brown TT, Maruthur N, et al. Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Ann Intern Med 2012;157:336–347.