Benefits and limitations of continuous glucose monitoring in type 1 diabetes

ABSTRACT

Introduction: Type 1 diabetes (T1D) is a chronic condition characterized by a complete deficiency in insulin production. Optimal management requires constant knowledge of glucose levels for safe and effective insulin administration. Self-monitoring of blood glucose (SMBG) using capillary blood glucose meters is cumbersome and provides limited information to guide management. Continuous glucose monitoring (CGM) technology addresses many of these gaps, but itself has limitations which have prevented people with diabetes and their clinicians from fully embracing this technology. This review covers the benefits and limitations of CGM use, and looks toward future application of this technology in the management of T1D.

Areas covered: Impact of CGM on physical and psychosocial outcomes in people with T1D. Barriers to CGM uptake. Integration with insulin pumps and other technologies. Opportunities for future application.

Expert opinion: CGM technology will be utilized by the majority of people with T1D and increasing numbers of people with type 2 diabetes due to improved insurance coverage and easier-to-use systems. Its use as part of artificial pancreas systems will add further utility, as it will help to protect from both hypoglycemia and hyperglycemia. People with diabetes will spend more time in range and experience fewer acute and chronic complications.

KEYWORDS:

• Type 1 diabetes
• Type 2 diabetes
• continuous glucose monitoring
• CGM
• technology
• glucose management
• self-monitoring of blood glucose
• SMBG
• benefits
• barriers
• limitations

Article Highlights

• Type 1 diabetes requires knowledge of glucose levels for safe and effective insulin dosing.

• Intermittent fingerstick testing using glucose meters (SMBG) is highly burdensome to the patient and provides inadequate data for decision-making guidance.

• Continuous glucose monitoring (CGM) addresses these gaps by enabling users to access glucose information in real-time without the burden of frequent testing.

• CGM use is associated with reduced HbA1c and improvements in other measurements of glycemic control including increased time spent in euglycemia, reduced time spent in hypo- and hyperglycemia, and decreased glycemic variability.

• CGM use is also shown to improve quality of life in a number of diabetes-related assessments (decreased fear of hypoglycemia, decreased diabetes distress, increased hypoglycemia and treatment confidence, increased sense of independence).

• In spite of evidence supporting the benefits of CGM, uptake remains low, likely due to barriers associated with access and/or use.

• Barriers to CGM include physical limitations (skin problems, pain associated with insertion and wear, limited surface area for wear, particularly in multiple device users), emotional or psychosocial concerns (alarm fatigue, concerns about accuracy, body image issues, information overload), and clinical inertia (clinicians hesitance to initiate CGM use due to lack of training or other concerns).

• Addressing these barriers is critical to maximize the potential of CGM, particularly as part of integrated and ‘connected care’ systems.

Declaration of interest

JY Stone has been a clinical advisory board member for Senseonics. TS Bailey has declared research support from Abbott, Ascensia, Capillary Biomedical, Dance Biopharm, Dexcom, Diasome, Eli Lilly, Kowa, Lexicon, Medtronic, Novo Nordisk, REMD, Sanofi, Senseonics, Viacyte, vTv Therapeutics, Zealand. TS Bailey has received Consulting Honoraria from Abbott, Diasome, Eli Lilly, Lifescan, Medtronic, Novo, Sanofi. TS Bailey has received speaking Honoraria from Medtronic, Sanofi, Senseonics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was not funded.