Department of Pharmaceutical Care, University of Iowa Hospitals & Clinics, Iowa City (Dr. Schleich); Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City (Drs. Schleich and Ray) kevin-schleich@uiowa.edu
The authors reported no potential conflict of interest relevant to this article.
Chart review.Data extracted from chart reviews in Austria, France, and Germany demonstrated a mean improvement in A1C of 0.9% among patients when using a CGM after using SMBG previously.22
A retrospective reviewof patients with T2D who were not taking bolus insulin and who used a CGM had a reduction in A1C from 10.1% to 8.6% over 60 to 300 days.23
Evidence for rtCGMs
The DIAMOND study included a subset of patients with T2D who used an rtCGM and were compared to a subset who received usual care. The primary outcome was the change in A1C. A 0.3% greater reduction was observed in the CGM group at 24 weeks. There was no difference in hypoglycemic events between the 2 groups; there were few events in either group.24
An RCT demonstrated a similar reduction in A1C in rtCGM users and in nonusers over 1 year.25 However, patients who used the rtCGM by protocol demonstrated the greatest reduction in A1C. The CGM utilized in this trial required regular fingerstick calibration, which likely led to poorer adherence to protocol than would have been the case had the trial utilized a CGM that did not require calibration.
A prospective trialdemonstrated that utilization of an rtCGM only 3 days per month for 3 consecutive months was associated with (1) significant improvement in A1C (a decrease of 1.1% in the CGM group, compared to a decrease of 0.4% in the SMBG group) and (2) numerous lifestyle modifications, including reduction in total caloric intake, weight loss, decreased body mass index, and an increase in total weekly exercise.26 This trial demonstrated that CGMs might be beneficial earlier in the course of disease by reinforcing lifestyle changes.