Clinical and economic benefits of continuous blood glucose monitoring devices
Keywords:Glycemic control, DM, CGM, Management
The main intervention to reduce the macro-and microvascular complications of diabetes mellitus (DM) remains to achieve better long-term glycemic control. We have discussed the clinical and economic advantages of using continuous glucose monitoring (CGM) devices for type 1 DM and type 2 DM (T1DM and T2DM) based on data from relevant studies in the literature. Our findings show that using these modalities is associated with remarkable outcomes, including reduced HbA1c levels and enhanced glycemic control among patients with T1DM and T2DM. This can enhance the quality of care and life for diabetic patients and intervene against the development of serious complications and hypoglycemia-related adverse events. The cost of routinely using these devices might seem relatively high. However, the estimated cost benefits are usually higher as they can significantly reduce hospitalization rates due to hypoglycemia and the frequency of diabetic therapy malpractices, which are frequently encountered. However, not many studies have reported these outcomes, indicating the need to conduct future relevant studies.
Gregg EW, Gu Q, Cheng YJ, Narayan KM, Cowie CC. Mortality trends in men and women with diabetes, 1971 to 2000. Ann Internal Med. 2007;147(3):149-55.
Gregg EW, Sattar N, Ali MK. The changing face of diabetes complications. Lancet Diabetes Endocrinol. 2016;4(6):537-47.
Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes/Metabol Res Rev. 1999;15(3):205-18.
Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control and Complications (DCCT) Research Group. Kidney Int. 1995;47(6):1703-20.
Adler AI, Stratton IM, Neil HA. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000;321(7258):412-9.
Nathan DM, Cleary PA, Backlund JY. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Eng J Med. 2005;353(25):2643-53.
Ajjan RA. How Can We Realize the Clinical Benefits of Continuous Glucose Monitoring? Diabetes Technol Therapeutics. 2017;19(S2):S27-36.
Tamborlane WV, Beck RW, Bode BW. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Eng J Med. 2008;359(14):1464-76.
Beck RW, Buckingham B, Miller K. Factors predictive of use and of benefit from continuous glucose monitoring in type 1 diabetes. Diabetes Care. 2009;32(11):1947-53.
Beck RW, Riddlesworth T, Ruedy K. Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial. JAMA. 2017;317(4):371-8.
Little SA, Leelarathna L, Walkinshaw E. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: a multicenter 2×2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring (HypoCOMPaSS). Diabetes Care. 2014;37(8):2114-22.
Van Beers CA, DeVries JH, Kleijer SJ, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial. Lancet Diabetes Endocrinol. 2016;4(11):893-902.
Heinemann L, Freckmann G, Ehrmann D. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet (London, England). 2018;391(10128):1367-77.
Bergenstal RM, Bailey TS, Rodbard D. Comparison of Insulin Glargine 300 Units/mL and 100 Units/mL in Adults With Type 1 Diabetes: Continuous Glucose Monitoring Profiles and Variability Using Morning or Evening Injections. Diabetes Care. 2017;40(4):554-60.
Argento NB, Nakamura K. Glycemic effects of SGLT-2 inhibitor canagliflozin in type 1 diabetes patients using the dexcom G4 platinum CGM. Endocrine Practice. 2016;22(3):315-22.
Patton SR, Clements MA. Psychological Reactions Associated With Continuous Glucose Monitoring in Youth. J Diabetes Sci Technol. 2016;10(3):656-61.
Beck RW, Lawrence JM, Laffel L. Quality-of-life measures in children and adults with type 1 diabetes: Juvenile Diabetes Research Foundation Continuous Glucose Monitoring randomized trial. Diabetes Care. 2010;33(10):2175-7.
Lind M, Polonsky W, Hirsch IB. Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in Adults With Type 1 Diabetes Treated With Multiple Daily Insulin Injections: The GOLD Randomized Clinical Trial. JAMA. 2017;317(4):379-87.
Charleer S, Mathieu C, Nobels F. Effect of Continuous Glucose Monitoring on Glycemic Control, Acute Admissions, and Quality of Life: A Real-World Study. J Clin Endocrinol Metabol. 2018;103(3):1224-32.
Vigersky RA, Fonda SJ, Chellappa M, Walker MS, Ehrhardt NM. Short- and long-term effects of real-time continuous glucose monitoring in patients with type 2 diabetes. Diabetes Care. 2012;35(1):32-8.
Beck RW, Riddlesworth TD, Ruedy K. Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial. Ann Internal Med. 2017;167(6):365-74.
Ehrhardt NM, Chellappa M, Walker MS, Fonda SJ, Vigersky RA. The effect of real-time continuous glucose monitoring on glycemic control in patients with type 2 diabetes mellitus. J Diabetes Sci Technol. 2011;5(3):668-75.
Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C. Continuous Glucose Monitoring in Older Adults With Type 1 and Type 2 Diabetes Using Multiple Daily Injections of Insulin: Results From the DIAMOND Trial. J Diabetes Sci Technol. 2017;11(6):1138-46.
Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline JP, Rayman G. Flash Glucose-Sensing Technology as a Replacement for Blood Glucose Monitoring for the Management of Insulin-Treated Type 2 Diabetes: a Multicenter, Open-Label Randomized Controlled Trial. Diabetes Therapy. 2017;8(1):55-73.
Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet (London, England). 2016;388(10057):2254-63.
Anjana RM, Kesavadev J, Neeta D. A Multicenter Real-Life Study on the Effect of Flash Glucose Monitoring on Glycemic Control in Patients with Type 1 and Type 2 Diabetes. Diabetes Technol Therapeutics. 2017;19(9):533-40.
Dunn TC, Xu Y, Hayter G, Ajjan RA. Real-world flash glucose monitoring patterns and associations between self-monitoring frequency and glycaemic measures: A European analysis of over 60 million glucose tests. Diabetes Res Clin Pract. 2018;137:37-46.
Reddy M, Jugnee N, Anantharaja S, Oliver N. Switching from Flash Glucose Monitoring to Continuous Glucose Monitoring on Hypoglycemia in Adults with Type 1 Diabetes at High Hypoglycemia Risk: The Extension Phase of the I HART CGM Study. Diabetes Technol Therapeutics. 2018;20(11):751-7.
Robertson SL, Shaughnessy AF, Slawson DC. Continuous Glucose Monitoring in Type 2 Diabetes Is Not Ready for Widespread Adoption. Am Family Physician. 2020;101(11):646.
Wan W, Skandari MR, Minc A. Cost-effectiveness of Continuous Glucose Monitoring for Adults With Type 1 Diabetes Compared With Self-Monitoring of Blood Glucose: The DIAMOND Randomized Trial. Diabetes Care. 2018;41(6):1227-34.
Chaugule S, Oliver N, Klinkenbijl B, Graham C. An Economic Evaluation of Continuous Glucose Monitoring for People with Type 1 Diabetes and Impaired Awareness of Hypoglycaemia within North West London Clinical Commissioning Groups in England. European Endocrinol. 2017;13(2):81-5.
Blissett DB, Attvall S, Hellmund RA. Analysis Estimating the Potential Cost Impact of Utilizing Flash Glucose Monitoring with Optional Alarms in Swedish Adults with Diabetes with Impaired Awareness of Hypoglycaemia, Using Intensive Insulin. Diabetes Therapy. 2021;12(8):2179-93.
Ajjan R, Slattery D, Wright E. Continuous Glucose Monitoring: A Brief Review for Primary Care Practitioners. Adv Therapy. 2019;36(3):579-96.