Wood Anna, O'Neal David, Furler John, Ekinci Elif I
Department of Endocrinology, Austin Health, Repatriation Campus Heidelberg West, Melbourne, Victoria, Australia.
Department of Medicine, St Vincent's Hospital and The University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2018 May;48(5):499-508. doi: 10.1111/imj.13770.
The advent of devices that can track interstitial glucose levels, which are closely related to blood glucose levels, on a near continuous basis, has facilitated better insights into patterns of glycaemia. Continuous glucose monitoring (CGM) therefore allows for more intensive monitoring of blood glucose levels and potentially improved glycaemic control. In the context of the announcement on 1 April 2017 that the Australian Government will fund CGM monitoring for people with type 1 diabetes under the age of 21 years, this paper provides a review of the evidence for CGM and some of the ongoing challenges. There is evidence that real-time CGM in type 1 diabetes improves HbA1c and hypoglycaemia, while in type 2 diabetes, the evidence is less robust. Initial barriers to widespread implementation of CGM included issues with accuracy and user friendliness; however, as the technology has evolved, these issues have largely improved. Ongoing barriers include cost, and weaker evidence for their benefit in certain populations such as those with type 2 diabetes and less glycaemic variability. CGM has the potential to reduce healthcare costs, although real-world studies, including cost-effectiveness analyses, are needed in this area.
能够近乎持续地追踪与血糖水平密切相关的组织间液葡萄糖水平的设备的出现，有助于更深入地了解血糖模式。因此，连续血糖监测（CGM）能够对血糖水平进行更密集的监测，并有可能改善血糖控制。鉴于2017年4月1日宣布澳大利亚政府将为21岁以下的1型糖尿病患者提供CGM监测资金，本文对CGM的证据以及一些当前面临的挑战进行了综述。有证据表明，1型糖尿病患者进行实时CGM可改善糖化血红蛋白（HbA1c）水平并减少低血糖发生，而在2型糖尿病患者中，相关证据则不那么确凿。CGM广泛应用的最初障碍包括准确性和用户友好性问题；然而，随着技术的发展，这些问题已在很大程度上得到改善。当前的障碍包括成本，以及在某些人群（如2型糖尿病患者和血糖变异性较小的人群）中其益处的证据较弱。CGM有降低医疗成本的潜力，不过在这一领域需要开展包括成本效益分析在内的实际研究。
