New Guidelines for Continuous Glucose Monitoring (CGM) in Type 1’s

Both pediatric and adult patients with type 1 diabetes should use CGM to measure blood glucose levels, according to new guidelines

David Klonoff, MD, of Mills-Peninsula Health Services in San Mateo, Calif., and colleagues reported in a clinical practice guideline from the Endocrine Society that, there’s high-quality evidence from studies showing that CGM can reduce the risk of hypoglycemia and help maintain good glycated hemoglobin (HbA1c) control in both populations.

”There are still concerns about the high costs of CGM and the accuracy of the various systems available,” Klonoff said in a statement. ”However, the new guideline shows that CGM can be a beneficial tool to help maintain target levels of glycemia and limit the risk of hypoglycemia.”

Standard blood glucose monitoring with finger sticks can provide only intermittent snapshots of glucose levels, the researchers said, and often miss sustained hyperglycemic and hypoglycemic excursions.

On the other hand, CGM allows for more complete blood glucose profiles, though there have been concerns over the accuracy of interstitial tissue sampling compared with actual blood levels. However, newer devices have shown improved accuracy, Klonoff and colleagues reported.

In their review of the literature for creating the guidelines, they found sufficient high-quality evidence to recommend the use of real-time CGM in children and adolescents with type 1 diabetes who are at least 8 years old. There was also high-quality evidence to recommend CGM in adult type 1 diabetes patients, they wrote.

The guidelines also suggested intermittent use of CGM in both children and adults who can’t use real-time CGM, in order to analyze nocturnal hypoglycemia, the ”dawn phenomenon,” and postprandial hyperglycemia. Intermittent use also can help manage hypoglycemic unawareness, as well as assist patients when significant changes are made to their diabetes regimens.

They noted, however, that this suggestion was made on the basis of low-quality evidence.

The guidelines also recommend against the use of CGM in the intensive care unit or in the operating room ”until further studies provide sufficient evidence for its accuracy and safety in those settings.”
Practice Pearls:

* Explain that both pediatric and adult patients with type 1 diabetes should use continuous glucose monitoring (CGM) to measure blood glucose levels, according to new guidelines.
* Point out that the guidelines also recommend against the use of CGM in the intensive care unit or in the operating room until further studies are completed.

From www.diabetesincontrol.com

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Abstracts

Continuous Glucose Monitoring: An Endocrine Society Clinical Practice Guideline

1. David C. Klonoff,
2. Bruce Buckingham,
3. Jens S. Christiansen,
4. Victor M. Montori,
5. William V. Tamborlane,
6. Robert A. Vigersky and
7. Howard Wolpert

– Author Affiliations

1.
Mills-Peninsula Health Services (D.C.K.), San Mateo, California 94401; Stanford University School of Medicine (B.B.), Stanford, California 94305; Aarhus University Hospital (J.S.C.), 8000 Aarhus C, Denmark; Mayo Clinic (V.M.M.), Rochester, Minnesota 55905; Yale University School of Medicine (W.V.T.), New Haven, Connecticut 06510; Walter Reed National Military Medical Center (R.A.V.), Bethesda, Maryland 20889; and Joslin Diabetes Center (H.W.), Boston, Massachusetts 02215

1. Address all correspondence and requests for reprints to: The Endocrine Society, 8401 Connecticut Avenue, Suite 900, Chevy Chase, Maryland 20815. E-mail: govt-prof@endo-society.org, Telephone: 301-941-0200. Address all commercial reprint requests for orders 101 and more to: Walchli Tauber Group Inc., E-mail: Karen.burkhardt@wt-group.com. Address all reprint requests for orders for 100 or fewer to Society Services, Telephone: 301-941-0210, E-mail: societyservices@endo-society.org, or Fax: 301-941-0257.

Abstract

Objective: The aim was to formulate practice guidelines for determining settings where patients are most likely to benefit from the use of continuous glucose monitoring (CGM).

Participants: The Endocrine Society appointed a Task Force of experts, a methodologist, and a medical writer.

Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.

Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society, the Diabetes Technology Society, and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines.

Conclusions: The Task Force evaluated three potential uses of CGM: 1) real-time CGM in adult hospital settings; 2) real-time CGM in children and adolescent outpatients; and 3) real-time CGM in adult outpatients. The Task Force used the best available data to develop evidence-based recommendations about where CGM can be beneficial in maintaining target levels of glycemia and limiting the risk of hypoglycemia. Both strength of recommendations and quality of evidence were accounted for in the guidelines.
Footnotes

*

Abbreviations:

CGM
Continuous glucose monitoring
CIT
conventional insulin therapy
HbA1c
glycosylated hemoglobin
ICU
intensive care unit
IIT
intensive insulin therapy
ISF
interstitial fluid
MDI
multiple daily injections
MICU
medical ICU
POC
point-of-care
RT-CGM
real-time CGM
SMBG
self-monitoring of blood glucose
T1DM
type 1 diabetes mellitus.

Nyhetsinfo
www red DiabetologNytt

Publicerad: |2011-10-22|