Endocrine Abstracts

In people with diabetes, optimizing glucose control is critical to reduce the risk of both acute and chronic complications. Technologies measuring interstitial glucose concentrations provide professional teams and patients with glucose data and interpretation tools which can improve metabolic control and optimize therapy management. There is strong evidence supporting both rtCGM and FGM use in people with type 1 diabetes (T1DM), with benefits of reduced HbA1c and hypoglycaemia, and increased time in range. Similar benefits have been demonstrated in insulin-treated type 2 diabetic patients (T2DM). By contrast, evidence in non-insulin treated T2DM is less robust, with scarce RCTs and some observational studies showing limited or no impact on HbA1c and hypoglycemia. Notably, in most trials comparing CGM with SMBG in T2DM, the control arm was not on structured SMBG, which has been shown per se to significantly reduce HbA1c. Thus, the overall cost-benefit evaluation does not support continuous glucose monitoring in most T2DM. Thus, it seems reasonable to follow a personalized, patient-centered approach in taking advantage of the available CGM devices: T1DM and T2DM on MDI should be offered the opportunity to wear glucose sensors to improve metabolic control and glucose metrics. On the other hand, most DMT2 should be encouraged to exploit the benefits of adequately structured SMBG. Retrospective or intermittent CGM may be proposed in these patients, aiming at optimizing therapy and lifestyle management and increasing awareness of glucose patterns. As technology provides more and more accurate and reliable tools, more clinical research projects and a wider use of these devices will increase the expertise of diabetes teams and ultimately improve everyday life in people with diabetes.