Endocrine Abstracts

Good metabolic control depends on the information of blood glucose concentration, routinely obtained with self-monitoring of blood glucose (SMBG). More frequent SMBG is associated with improved metabolic control. In the last decade, real-time continuous glucose monitoring (CGM) of subcutaneous glucose concentration became routinely available and is now introduced into day-to-day management helping people with diabetes make informed decisions on dosing, eating and engaging in physical activity.

Several randomised controlled trials (RCT) demonstrated a clinically meaningful reduction in glycated haemoglobin A1c with the use of CGM. A meta-analysis based on individual patients’ data demonstrated that the reduction in A1c is most pronounced in patients with poor metabolic control and when CGM is used most of the study time. The reduction of A1c was significant when CGM was used with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). In more recent RCTs, a reduction of A1c was associated with a concomitant reduction of time spent in hypoglycaemia.

CGM can be used with CSII combined in a single device. RTCs comparing sensor-augmenting insulin pumps (SAP) to MDI or CSII demonstrated a significant and clinically meaningful decrease in A1c. Moreover, a SAP can include an automated insulin delivery suspension on pre-selected low glucose threshold. This automated insulin delivery suspension feature was demonstrated in RCTs to reduce both hypoglycaemia and severe hypoglycaemia across all age groups of people with diabetes.

Finally, CGM can be used as a part of an artificial pancreas. RCTs using different algorithms for closed-loop insulin delivery based on CGM demonstrate both improvement in metabolic control and reduction in hypoglycaemia.

Currently available CGM systems still have quite a few technical limitations, related to the subcutaneous sensors, wireless connectivity, signal strength, accuracy and reliability. Further improvements are needed along with a continuous safety and quality surveillance for a sustained long term use of CGM that will empower people with diabetes for a more flexible, less burdensome and successful metabolic control.

Disclosure: Slovenian National Research Agency grants J3-2412, J3-9663 and P3-0343.