Continuous glucose monitoring: evidence and consensus statement for clinical use

Abstract

Continuous glucose monitoring (CGM) is an essential tool for modern diabetes therapy. Randomized controlled studies have provided evidence that hemoglobin A1c (HbA1c) results can be improved in patients with type 1 diabetes with elevated baseline HbA1c when using CGM frequently enough and that the frequency and duration of hypoglycemic events can be reduced in patients with satisfactory baseline HbA1c. The CGM group within the Working Group Diabetes Technology (AGDT) of the German Diabetes Association (DDG) has defined evidence-based indications for the practical use of CGM in this consensus statement related to hypoglycemia (frequent, severe, or nocturnal) or hypoglycemia unawareness, insufficient metabolic control despite use of all possible therapeutic options and patient compliance, pregnancy associated with inadequate blood glucose results, and the need for more than 10 blood glucose measurements per day. Contraindications and defined preconditions for the successful use of CGM should be considered.

Figure 1

General differences in the use of CGM systems.

Figure 2

Changes in metabolic control (reduction in HbA1c compared with the baseline value) and in the hypoglycemic frequency in randomized, controlled studies (marked with appropriate colors) with usage of CGM systems, in some cases also with SaP therapy.^,– The data relate to the change in hypoglycemic frequency, not direct values. (Details of studies: duration in months, year of publication, number of patients with preexisting insulin pump therapy, number of patients with sensor-augmented insulin pump therapy [adjustment to this option in the study])