How use of continuous glucose monitoring can address therapeutic inertia in primary care

ABSTRACT

A significant proportion of individuals with diabetes have suboptimal glycemic management. Studies have shown that persistent hyperglycemia significantly increases the risks for both acute and long-term microvascular and macrovascular complications of diabetes. A key contributor to suboptimal glycemic management is therapeutic inertia in which clinicians delay intensifying therapy when patients are not meeting their glycemic goals. During the past five years, an increasing number of individuals with type 1 diabetes (T1D) and insulin-treated type 2 diabetes (T2D) have adopted the use of continuous glucose monitoring (CGM) for daily measurement of glucose levels. As demonstrated in numerous clinical trials and real-world observational studies, use of CGM improves glycated hemoglobin (HbA1c) and reduces the occurrence and severity of hypoglycemia. However, for primary care clinicians who are unfamiliar with using CGM, integrating this technology into clinical practice can be daunting. In this article, we discuss the benefits and rationale for using CGM compared with traditional blood glucose monitoring (BGM), review the evidence supporting the clinical value of CGM in patients with T1D and T2D, and describe how use of CGM in primary care can facilitate appropriate and more timely therapy adjustments.

KEYWORDS:

• Continuous glucose monitoring
• CGM
• Ambulatory glucose profile
• AGP
• Type 1 diabetes
• Type 2 diabetes

Disclosure of financial/other conflicts of interest

Thomas Martens has received research support and/or consulting fees from Abbott Diabetes Care, Dexcom, Medtronic, Insulet, Novo Nordisk, and Lilly. His employer, non-profit International Diabetes Center/HealthPartners Institute/Park Nicollet, contracts for his services and he receives no personal income from these activities.

Christopher Parkin has received consulting fees from Abbott Diabetes Care, CeQur SA, Dexcom, Inc., Mannkind, Onduo, Provention and Roche Diabetes Care. The authors have no other relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics statement

All patients have given written informed consent for this information to be published as a part of this research and all ethical standards have been adhered to following the Declaration of Helsinki 2013.

Additional information

Funding

Dexcom, Inc., provided funding for manuscript development. The funders had no role in manuscript content or preparation of the manuscript.