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This site is intended for managed care professionals in the U.S.

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Continuous Glucose Monitoring

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American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

Source:

The American Association of Clinical Endocrinology (AACE) with a task force of medical experts developed evidence-based guideline recommendations regarding the use of advanced diabetes technology in clinical settings. The guidelines reveal that ensuring universal access to advanced diabetes technologies is anticipated to result in improved glycemia and allowing more persons with diabetes to achieve glycemic targets, improve quality of life, and potentially reduce burden of care. Furthermore, diabetes technology can improve the efficiency and effectiveness of clinical decision-making.

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Who would benefit from routine use of CGM?
  • CGM is strongly recommended for all persons with diabetes treated with intensive insulin therapy, defined as 3 or more injections of insulin per day or an insulin pump1
  • CGM is recommended for:
    • All individuals with problematic hypoglycemia (frequent/severe hypoglycemia, nocturnal hypoglycemia, hypoglycemia unawareness).2
    • Children/adolescents with T1D.2
    • Pregnant women with T1D and T2D treated with intensive insulin therapy.2
    • Women with gestational diabetes mellitus (GDM) on insulin therapy.3
  • CGM may be recommended for:
    • Women with GDM who are not on insulin therapy.3
    • Individuals with T2D who are treated with less intensive insulin therapy.4
When is one method of CGM (real-time CGM vs. intermittently scanned monitoring) preferred over the other?
Real-time CGM should be recommended over intermittently scanned CGM for: isCGM should be considered for:
  • persons with diabetes with problematic hypoglycemia (frequent/severe hypoglycemia, nocturnal hypoglycemia, hypoglycemia unawareness) who require predictive alarms/alerts; however the lifestyle of persons with diabetes and other factors should also be considered5
  • persons with diabetes who meet 1 or more of the following criteria6
    • Newly diagnosed with T2D
    • Treated with nonhypoglycemic therapies
    • Motivated to scan device several times per day
    • At low risk for hypoglycemia, but desire more data than SMBG provides

1Grade A; High Strength of Evidence; BEL 1; 2Grade A; Intermediate-High Strength of Evidence; BEL 1; 3Grade A; Intermediate Strength of Evidence; BEL 1; 4Grade B; Intermediate Strength of Evidence, BEL 1; 5Grade B; Low-Intermediate Strength of evidence; BEL; 6Grade D; Low Strength of Evidence/Expert Opinion of Task Force; BEL 4


NICE Recommends CGM for Diabetes in Pregnancy

Source: National Institute for Health and Care Excellence (NICE) Guideline – Diabetes in Pregnancy: Management from Preconception to the Postnatal Period (2020)

Key Takeaway: In December 2020, NICE reviewed the evidence and changed the recommendations on intermittently scanned CGM (isCGM, also commonly referred to as flash) and continuous glucose monitoring during pregnancy for women with type 1 diabetes.

Recommendations for Managing Diabetes During Pregnancy-
Intermittently scanned CGM and continuous glucose monitoring

1.3.17

Offer continuous glucose monitoring (CGM) to all pregnant women with type 1 diabetes to help them meet their pregnancy blood glucose targets and improve neonatal outcomes. 

1.3.18

Offer intermittently scanned CGM (isCGM, commonly referred to as flash) to pregnant women with type 1 diabetes who are unable to use continuous glucose monitoring or express a clear preference for it. 

1.3.19

Consider continuous glucose monitoring for pregnant women who are on insulin therapy but do not have type 1 diabetes, if:

    • they have problematic severe hypoglycaemia (with or without impaired awareness of hypoglycaemia) or
    • they have unstable blood glucose levels that are causing concern despite efforts to optimise glycaemic control.
1.3.20

For pregnant women who are using isCGM or continuous glucose monitoring, a member of the joint diabetes and antenatal care team with expertise in these systems should provide education and support (including advising women about sources of out-of-hours support).

For a short explanation of why the committee made the 2020 recommendations and how they might affect practice, see the rationale and impact section on flash and continuous glucose monitoring on pages 35-36 in the Guideline. Full details of the evidence and the committee’s discussion are in evidence review A: continuous glucose monitoring.


National Institute for Health and Care Excellence (NICE) Medtech Innovation Briefing for Dexcom G6 Real-Time CGM – November 2020

Source:

Key Takeaway: The intended place in therapy is as an alternative to routine blood glucose monitoring in people (over 2 years old), including pregnant women, with type 1 or type 2 diabetes, who use multiple daily insulin injections or use insulin pumps and are self-managing their diabetes.  Dexcom G6 could reduce costs and would benefit the healthcare system by improving long-term outcomes, reducing the need for intensive treatment and, in the short term, reducing severe hypoglycaemic events leading to hospital admissions. Remote care may reduce the need for hospital visits.


Diabetes Technology: Standards of Medical Care in Diabetes – 2021

Source: Diabetes Care

Key Takeaway: The ADA Standards of Medical Care in Diabetes provides the most authoritative and current guidelines for diabetes care. The recommendations are intended to provide clinicians, patients, researchers and payers with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Following are ADA recommendations regarding CGM:

American Diabetes Association

rtCGM should be used continuously for maximal benefit. 

isCGM should be scanned frequently throughout the day (minimum of once every 8 hours)

7.9: When used properly, real-time CGM’s in conjunction with multiple daily injections and continuous subcutaneous insulin infusion (A) and other forms of insulin therapy (C) are a useful tool to lower and/or maintain A1c levels and/or reduce hypoglycemia in adults and youth with diabetes.

7.10: When used properly, intermittently scanned CGM’s in conjunction with multiple daily injections and continuous subcutaneous insulin infusion (B) and other forms of insulin therapy (C) can be useful and may lower A1c levels and/or reduce hypoglycemia in adults and youth with diabetes to replace self-monitoring of blood glucose.

Level of Clinical Evidence: A = Clear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered; B = Supportive evidence from well-conducted cohort studies; C = Supportive evidence from poorly controlled or uncontrolled studies


Continuous Glucose Monitoring: A Consensus Conference of the American Association of Clinical Endocrinologists and American College of Endocrinology

Source: American Association of Clinical Endocrinologists

Conclusion: CGM improves glycemic control, reduces hypoglycemia, and may reduce overall costs of diabetes management. Expanding CGM coverage and utilization is likely to improve the health outcomes of people with diabetes.