Ajjan R A, Seidu S, Riveline J P
Leeds Institute for Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK.
St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, LS9 7TF, UK.
Diabetes Ther. 2024 Aug;15(8):1657-1672. doi: 10.1007/s13300-024-01607-5. Epub 2024 Jun 22.
Continuous glucose monitoring (CGM) is now advocated for the clinical management of individuals with type 1 diabetes (T1D). However, this glucose monitoring strategy is not routinely used in type 2 diabetes (T2D), given the large population, significant cost implications and relatively limited supporting evidence. T2D is a more heterogenous condition compared with T1D with various glucose lowering therapies that do not necessarily require CGM to ensure within target glucose levels. While all individuals with T2D may benefit from CGM at certain time points, the whole T2D population does not necessarily require this technology continuously, which should be prioritized based on patient benefit and cost effectiveness. In this pragmatic opinion piece, we describe the rationale and evidence for CGM use in different subgroups of individuals with T2d, divided according to the stage of the condition, glycemic therapies, presence of diabetes complications, or associated co-morbidities. We discuss a total of 16 T2D subgroups and provide a clinical view on CGM use in each, based on current evidence while also highlighting areas of knowledge gaps. This work provides health care professionals with a simple guide to CGM use in different T2D groups and gives suggestion for future studies to justify expansion of this technology.
目前,连续血糖监测(CGM)被推荐用于1型糖尿病(T1D)患者的临床管理。然而,鉴于2型糖尿病(T2D)患者数量众多、成本影响巨大且支持证据相对有限,这种血糖监测策略在T2D中并未得到常规应用。与T1D相比,T2D是一种更为异质性的疾病,有多种降糖疗法,不一定需要CGM来确保血糖水平达标。虽然所有T2D患者在某些时间点可能从CGM中获益,但并非整个T2D人群都需要持续使用这项技术,应根据患者获益和成本效益来确定优先次序。在这篇务实的观点文章中,我们描述了在不同T2D亚组中使用CGM的基本原理和证据,这些亚组根据病情阶段、血糖治疗方法、糖尿病并发症的存在情况或相关合并症进行划分。我们共讨论了16个T2D亚组,并根据当前证据对每个亚组中CGM的使用提供临床观点,同时也突出了知识空白领域。这项工作为医疗保健专业人员提供了一份在不同T2D组中使用CGM的简易指南,并为未来研究提出建议,以证明扩大这项技术应用的合理性。