Make room for continuous glucose monitoring in type 2 diabetes management
Here’s how the various devices can be used to reach an individualized target of glycemic control and what reimbursement to expect from insurers.
PRACTICE RECOMMENDATIONS
› Initiate continuous glucose monitoring early in the disease process, based on a patient’s needs or preferences. C
› Interpret a continuous glucose monitor (CGM) report with the understanding that time within target range is the most important factor to evaluate. Minimizing or eliminating time below range is of paramount importance. B
› Advise patients who use a CGM to continue to have access to a glucometer and instruct them on appropriate times when such confirmation might be necessary. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
The MOBILE trial demonstrated that use of an rtCGM reduced baseline A1C from 9.1% to 8.0% in the CGM group, compared to 9.0% to 8.4% in the non-CGM group.27
Practical utilization of CGMs
Patient education
Detailed patient education resources—for initial setup, sensor application, methods to ensure appropriate sensor adhesion, and app and platform assistance—are available on each manufacturer’s website.
Clinical targets
In 2019, the Advanced Technologies & Treatments for Diabetes Congress determined that what is known as the time in range metric yields the most practical data to help clinicians manage glycemic control.28 The time in range metric comprises:
- time in the target glucose range (TIR)
- time below the target glucose range (TBR)
- time above the target glucose range (TAR).
TIR glucose ranges are modifiable and based on the A1C goal. For example, if the A1C goal is < 7.0%, the TIR glucose range is 70-180 mg/dL. If a patient maintains TIR > 70% for 3 months, the measured A1C will correlate well with the goal. Each 10% fluctuation in TIR from the goal of 70% corresponds to a difference of approximately 0.5% in A1C. Therefore, TIR of approximately 50% predicts an A1C of 8.0%.28
A retrospective review of 1440 patients with CGM data demonstrated that progression of retinopathy and development of microalbuminuria increased 64% and 40%, respectively, over 10 years for each 10% reduction in TIR—highlighting the importance of TIR and consistent glycemic control.29 Importantly, the CGM sensor must be active ≥ 70% of the wearable time to provide adequate TIR data.30
Continue to: Concerns about accuracy
