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连续血糖监测在2型糖尿病患者血糖管理中的价值，尤其是低血糖发现、血糖波动控制、患者依从性和生活质量改善
连续血糖监测（CGM）对2型糖尿病患者具有非常明确的临床价值：它能像“血糖雷达”一样全天候捕捉常规扎手指发现不了的隐匿性低血糖，有效平抑血糖的过山车式波动，并像“健康教练”一样通过直观的数据反馈帮助患者改善依从性和生活质量，最终带来糖化血红蛋白的稳步下降。
传统测血糖的方式就像“盲人摸象”，一天扎几次手指，只能看到瞬间的血糖点；而连续血糖监测则像给身体装了“全景监控”，能看清全天的血糖起伏。下面为您详细拆解它在2型糖尿病管理中的四大核心价值。
一、 低血糖的“探雷器”：精准捕捉隐匿风险
低血糖是糖尿病治疗中最让人担心的急性并发症之一，轻则心慌出冷汗，重则可能导致昏迷甚至危及生命。特别是对于老年患者，低血糖的风险甚至比轻度高血糖更可怕。
- 揪出“暗中潜伏”的低血糖：很多低血糖（特别是夜间低血糖）发生时，患者可能正在睡觉，没有任何感觉，常规的白天扎手指根本发现不了。CGM能够24小时不间断工作，哪怕是在夜间，一旦血糖跌破安全线（通常指低于70 mg/dL，即3.9 mmol/L），它就能及时发出警报，把隐匿的低血糖揪出来。
- 显著减少低血糖发生时间：综合多项临床试验的汇总分析显示，与传统的扎手指测血糖相比，使用CGM的2型糖尿病患者，血糖低于目标范围的时间（TBR，即处于低血糖状态的时间比例）平均减少了0.66%。在一项针对住院患者的研究中，对于已经发生过低血糖的患者，使用CGM指导调整胰岛素，能让低血糖的再次发生次数显著减少，且血糖低于70 mg/dL的时间占比从传统监测的5.47%大幅降至1.89%。
- 运动时的“安全护卫”：运动是2型糖尿病的重要干预手段，但运动也容易诱发低血糖，尤其是运动后的夜间低血糖。CGM可以作为一个实用的防跌倒工具，帮助患者在运动前后实时了解血糖走势，及时加餐或调整药物，防止运动相关的不良事件。
二、 血糖波动的“减震器”：把“过山车”拉回平稳轨道
血糖波动（专业上称为“血糖变异牲”）就像坐过山车，忽高忽低，这种剧烈波动比单纯的高血糖更伤血管，是导致糖尿病并发症的重要推手。
- 增加血糖达标时间（TIR）：TIR（Time in Range）是指一天中血糖保持在3.9-10.0 mmol/L（70-180 mg/dL）这个安全区间内的时间比例。TIR越高，说明血糖越平稳。研究显示，使用CGM后，2型糖尿病患者的TIR平均增加了6.36%。在一项针对仅使用基础胰岛素（基础胰岛素：每天只打一针长效胰岛素，不随餐打短效胰岛素）的2型糖尿病患者的研究中，CGM组的TIR高达59%，而传统扎手指组仅为43%，两者差距巨大。
- 削减血糖高峰（TAR）：TAR是指血糖高于10.0 mmol/L的时间比例。CGM能让患者直观看到吃了什么食物、多大运动量会让血糖飙升，从而及时调整。数据显示，CGM可使血糖高于目标范围的时间减少5.86%。在上述基础胰岛素研究中，CGM组血糖严重超标（>250 mg/dL，即13.9 mmol/L）的时间仅为11%，而传统组高达27%。
- 降低整体波动幅度：综合分析证实，CGM能有效降低2型糖尿病患者的血糖变异性（降低了1.47%）。更平稳的血糖意味着对血管内皮的冲击更小，研究表明，更高的TIR与降低白蛋白尿（肾脏损伤早期信号）、视网膜病变（眼底出血）、心血管疾病死亡及全因死亡风险都显著相关。
三、 患者依从性的“催化剂”：从被动吃药到主动管理
再好的技术，如果患者不愿意用，也是白搭。依从性就是患者能不能坚持按规矩治疗和监测。
- 用起来不难，戴着愿意坚持：有人担心贴个传感器在身上麻烦，但实际数据很乐观。在一项针对每天多次注射胰岛素的2型糖尿病患者的研究中，患者平均每周佩戴CGM的时间长达6.7天（几乎每天都戴），这说明大家对这种技术的接受度很高。
- 打消扎手指的恐惧：很多老年人或者怕疼的人，一想到一天要扎好几次手指就打退堂鼓，索性不测了，这就成了管理的盲区。CGM只需在皮下植入一个细软的探头，扫一扫或直接看手机就能看血糖，大大减轻了测糖的心理负担和皮肉之苦。
- 数据是最好的“监督员”：CGM不仅能看实时血糖，还能生成“动态葡萄糖图谱”（AGP）。这份图表清晰展示了哪一餐吃得不对、哪天运动效果好。这种“做错事立刻有反馈”的机制，比医生口头说教管用得多，能促使患者主动改变不健康的生活方式。对于不用胰岛素的2型糖尿病患者，CGM带来的行为改变（如调整饮食、增加运动）是其改善血糖的独立驱动力。
四、 生活质量的“阳光”：减轻焦虑，重获掌控感
糖尿病不仅是身体的病，长期的各种担忧（怕低血糖、怕并发症、这不敢吃那不敢吃）很容易引发“糖尿病痛苦症”，严重影响生活质量。
- 吃得更踏实，睡得更安稳：有了实时血糖和低血糖警报，患者不再需要提心吊胆地担心半夜低血糖昏迷，也不用在每次尝试新食物时忐忑不安。这种安全感的提升，是传统测血糖无法给予的。
- 提升治疗满意度与自我效能：多项研究表明，使用CGM的2型糖尿病患者，其糖尿病相关的满意度评分显著提高。当患者看到自己通过努力让血糖曲线变平时，会获得极大的成就感，觉得自己能“掌控”这个病，而不是被病“牵着鼻子走”，这种 empowerment（赋能感）对生活质量的提升至关重要。
- 对老年群体的特殊关怀：老年2型糖尿病患者往往伴有认知下降、视力减退或手部灵活性差，传统测血糖对他们来说既困难又危险。CGM不仅避免了频繁扎手指，还能让远端的子女或护工通过手机远程查看老人的血糖，极大地减轻了老人的管理负担和照护压力，提升了晚年生活品质。
客观存在的挑战：普及路上的“绊脚石”
虽然CGM好处多多，但目前想要在2型糖尿病患者中人手一台，还有几道坎要过：
- 价格门槛高：传感器的耗材费用对很多家庭来说是不小的负担，这是目前阻碍CGM广泛应用的最大障碍。
- 皮肤不适与佩戴尴尬：部分患者对传感器的医用胶布过敏，出现红肿瘙痒；也有人觉得身上贴个硬币大小的设备不好看，怕别人异样的眼光。
- 数据过载与数字鸿沟：CGM每几分钟就产生一个数据，一天下来数据量巨大。有些老年患者看着满屏的数据发懵，不知道该怎么调整；还有些人对智能设备不熟悉，缺乏技术支持，导致设备变成了摆设。
- 特定人群仍需谨慎：对于患有慢性肾病（CKD）的糖尿病患者，他们发生低血糖的风险极高，CGM对其预防低血糖至关重要，但在透析治疗期间，CGM的准确度可能会受到影响，需要结合传统监测。
总结来说，连续血糖监测对2型糖尿病患者而言，早已不再是1型糖尿病的“专属特权”。无论您是打胰岛素，还是仅靠口服药控制，CGM都能在揪出低血糖、抚平血糖波动、督促良好习惯和提升生活幸福感上发挥巨大作用。随着未来价格的亲民化和设备的更简易化，它有望成为2型糖尿病日常管理的标配。
References
1Continuous glucose monitoring for the routine care of type 2 diabetes mellitus.PubMed
Ramzi A Ajjan, Tadej Battelino, Xavier Cos, et al.
Although continuous glucose monitoring (CGM) devices are now considered the standard of care for people with type 1 diabetes mellitus, the uptake among people with type 2 diabetes mellitus (T2DM) has been slower and is focused on those receiving intensive insulin therapy. However, increasing evidence now supports the inclusion of CGM in the routine care of people with T2DM who are on basal insulin-only regimens or are managed with other medications. Expanding CGM to these groups could minimize hypoglycaemia while allowing efficient adaptation and escalation of therapies. Increasing evidence from randomized controlled trials and observational studies indicates that CGM is of clinical value in people with T2DM on non-intensive treatment regimens. If further studies confirm this finding, CGM could soon become a part of routine care for T2DM. In this Perspective we explore the potential benefits of widening the application of CGM in T2DM, along with the challenges that must be overcome for the evidence-based benefits of this technology to be delivered for all people with T2DM.
2Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis.PubMed
Milena Jancev, Tessa A C M Vissers, Frank L J Visseren, et al.
AIMS/HYPOTHESIS: Continuous glucose monitoring (CGM) is increasingly used in the treatment of type 2 diabetes, but the effects on glycaemic control are unclear. The aim of this systematic review and meta-analysis is to provide a comprehensive overview of the effect of CGM on glycaemic control in adults with type 2 diabetes. METHODS: We performed a systematic review using Embase, MEDLINE, Web of Science, Scopus and ClinicalTrials.gov from inception until 2 May 2023. We included RCTs investigating real-time CGM (rtCGM) or intermittently scanned CGM (isCGM) compared with self-monitoring of blood glucose (SMBG) in adults with type 2 diabetes. Studies with an intervention duration <6 weeks or investigating professional CGM, a combination of CGM and additional glucose-lowering treatment strategies or GlucoWatch were not eligible. Change in HbA and the CGM metrics time in range (TIR), time below range (TBR), time above range (TAR) and glycaemic variability were extracted. We evaluated the risk of bias using the Cochrane risk-of-bias tool version 2. Data were synthesised by performing a meta-analysis. We also explored the effects of CGM on severe hypoglycaemia and micro- and macrovascular complications. RESULTS: We found 12 RCTs comprising 1248 participants, with eight investigating rtCGM and four isCGM. Compared with SMBG, CGM use (rtCGM or isCGM) led to a mean difference (MD) in HbA of -3.43 mmol/mol (-0.31%; 95% CI -4.75, -2.11, p<0.00001, I=15%; moderate certainty). This effect was comparable in studies that included individuals using insulin with or without oral agents (MD -3.27 mmol/mol [-0.30%]; 95% CI -6.22, -0.31, p=0.03, I=55%), and individuals using oral agents only (MD -3.22 mmol/mol [-0.29%]; 95% CI -5.39, -1.05, p=0.004, I=0%). Use of rtCGM showed a trend towards a larger effect (MD -3.95 mmol/mol [-0.36%]; 95% CI -5.46 to -2.44, p<0.00001, I=0%) than use of isCGM (MD -1.79 mmol/mol [-0.16%]; 95% CI -5.28, 1.69, p=0.31, I=64%). CGM was also associated with an increase in TIR (+6.36%; 95% CI +2.48, +10.24, p=0.001, I=9%) and a decrease in TBR (-0.66%; 95% CI -1.21, -0.12, p=0.02, I=45%), TAR (-5.86%; 95% CI -10.88, -0.84, p=0.02, I=37%) and glycaemic variability (-1.47%; 95% CI -2.94, -0.01, p=0.05, I=0%). Three studies reported one or more events of severe hypoglycaemia and macrovascular complications. In comparison with SMBG, CGM use led to a non-statistically significant difference in the incidence of severe hypoglycaemia (RR 0.66, 95% CI 0.15, 3.00, p=0.57, I=0%) and macrovascular complications (RR 1.54, 95% CI 0.42, 5.72, p=0.52, I=29%). No trials reported data on microvascular complications. CONCLUSIONS/INTERPRETATION: CGM use compared with SMBG is associated with improvements in glycaemic control in adults with type 2 diabetes. However, all studies were open label. In addition, outcome data on incident severe hypoglycaemia and incident microvascular and macrovascular complications were scarce. REGISTRATION: This systematic review was registered on PROSPERO (ID CRD42023418005).
3Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin: A Randomized Clinical Trial.PubMed
Thomas Martens, Roy W Beck, Ryan Bailey, et al.
IMPORTANCE: Continuous glucose monitoring (CGM) has been shown to be beneficial for adults with type 2 diabetes using intensive insulin therapy, but its use in type 2 diabetes treated with basal insulin without prandial insulin has not been well studied. OBJECTIVE: To determine the effectiveness of CGM in adults with type 2 diabetes treated with basal insulin without prandial insulin in primary care practices. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted at 15 centers in the US (enrollment from July 30, 2018, to October 30, 2019; follow-up completed July 7, 2020) and included adults with type 2 diabetes receiving their diabetes care from a primary care clinician and treated with 1 or 2 daily injections of long- or intermediate-acting basal insulin without prandial insulin, with or without noninsulin glucose-lowering medications. INTERVENTIONS: Random assignment 2:1 to CGM (n = 116) or traditional blood glucose meter (BGM) monitoring (n = 59). MAIN OUTCOMES AND MEASURES: The primary outcome was hemoglobin A1c (HbA1c) level at 8 months. Key secondary outcomes were CGM-measured time in target glucose range of 70 to 180 mg/dL, time with glucose level at greater than 250 mg/dL, and mean glucose level at 8 months. RESULTS: Among 175 randomized participants (mean [SD] age, 57 [9] years; 88 women [50%]; 92 racial/ethnic minority individuals [53%]; mean [SD] baseline HbA1c level, 9.1% [0.9%]), 165 (94%) completed the trial. Mean HbA1c level decreased from 9.1% at baseline to 8.0% at 8 months in the CGM group and from 9.0% to 8.4% in the BGM group (adjusted difference, -0.4% [95% CI, -0.8% to -0.1%]; P = .02). In the CGM group, compared with the BGM group, the mean percentage of CGM-measured time in the target glucose range of 70 to 180 mg/dL was 59% vs 43% (adjusted difference, 15% [95% CI, 8% to 23%]; P < .001), the mean percentage of time at greater than 250 mg/dL was 11% vs 27% (adjusted difference, -16% [95% CI, -21% to -11%]; P < .001), and the means of the mean glucose values were 179 mg/dL vs 206 mg/dL (adjusted difference, -26 mg/dL [95% CI, -41 to -12]; P < .001). Severe hypoglycemic events occurred in 1 participant (1%) in the CGM group and in 1 (2%) in the BGM group. CONCLUSIONS AND RELEVANCE: Among adults with poorly controlled type 2 diabetes treated with basal insulin without prandial insulin, continuous glucose monitoring, as compared with blood glucose meter monitoring, resulted in significantly lower HbA1c levels at 8 months. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03566693.
4Continuous glucose monitoring: A review of the evidence in type 1 and 2 diabetes mellitus.PubMed
Rose Lin, Fran Brown, Steven James, et al.
CONTEXT AND AIM: Continuous glucose monitoring (CGM) is becoming widely accepted as an adjunct to diabetes management. Compared to standard care, CGM can provide detailed information about glycaemic variability in an internationally standardised ambulatory glucose profile, enabling more informed user and clinician decision making. We aimed to review the evidence, user experience and cost-effectiveness of CGM. METHODS: A literature search was conducted by combining subject headings 'CGM' and 'flash glucose monitoring', with key words 'type 1 diabetes' and 'type 2 diabetes', limited to '1999 to current'. Further evidence was obtained from relevant references of retrieved articles. RESULTS: There is a strong evidence for CGM use in people with type 1 diabetes, with benefits of reduced glycated haemoglobin and hypoglycaemia, and increased time in range. While the evidence for CGM use in type 2 diabetes is less robust, similar benefits have been demonstrated. CGM can improve diabetes-related satisfaction in people with diabetes (PWD) and parents of children with diabetes, as well as the clinician experience. However, CGM does have limitations including cost, accuracy and perceived inconvenience. Cost-effectiveness analyses have indicated that CGM is a cost-effective adjunct to type 1 diabetes management that is associated with reduced diabetes-related complications and hospitalisation. CONCLUSIONS: Continuous glucose monitoring is revolutionising diabetes management. It is a cost-effective adjunct to diabetes management that has the potential to improve glycaemic outcomes and quality of life in PWD, especially type 1 diabetes.
5Continuous Glucose Monitoring and Physical Activity.PubMed
Oliver Schubert-Olesen, Jens Kröger, Thorsten Siegmund, et al.
Continuous glucose monitoring (CGM) use has several potential positive effects on diabetes management. These benefits are, e.g., increased time in range (TIR), optimized therapy, and developed documentation. Physical activity is a recommended intervention tool in diabetes management, especially for people with type 2 diabetes (T2D). The benefits of physical activity for people with diabetes can be seen as an improvement of glycemic control, glycemic variability, and the reduction of insulin resistance. In relation to the physical activity of people with T2D, the benefits of CGM use can even be increased, and CGM can be a helpful tool to prevent adverse events due to physical activity of people with diabetes, such as hypoglycemic events and nocturnal hypoglycemia after sports. This narrative review aims to provide solid recommendations for the use of CGM in everyday life physical activities based on the noted benefits and to give a general overview of the guidelines on physical activity and CGM use for people with diabetes.
6Continuous Glucose Monitoring-Guided Insulin Administration in Hospitalized Patients With Diabetes: A Randomized Clinical Trial.PubMed
Elias K Spanakis, Agustina Urrutia, Rodolfo J Galindo, et al.
OBJECTIVE: The efficacy and safety of continuous glucose monitoring (CGM) in adjusting inpatient insulin therapy have not been evaluated. RESEARCH DESIGN AND METHODS: This randomized trial included 185 general medicine and surgery patients with type 1 and type 2 diabetes treated with a basal-bolus insulin regimen. All subjects underwent point-of-care (POC) capillary glucose testing before meals and bedtime. Patients in the standard of care (POC group) wore a blinded Dexcom G6 CGM with insulin dose adjusted based on POC results, while in the CGM group, insulin adjustment was based on daily CGM profile. Primary end points were differences in time in range (TIR; 70-180 mg/dL) and hypoglycemia (<70 mg/dL and <54 mg/dL). RESULTS: There were no significant differences in TIR (54.51% ± 27.72 vs. 48.64% ± 24.25; P = 0.14), mean daily glucose (183.2 ± 40 vs. 186.8 ± 39 mg/dL; P = 0.36), or percent of patients with CGM values <70 mg/dL (36% vs. 39%; P = 0.68) or <54 mg/dL (14 vs. 24%; P = 0.12) between the CGM-guided and POC groups. Among patients with one or more hypoglycemic events, compared with POC, the CGM group experienced a significant reduction in hypoglycemia reoccurrence (1.80 ± 1.54 vs. 2.94 ± 2.76 events/patient; P = 0.03), lower percentage of time below range <70 mg/dL (1.89% ± 3.27 vs. 5.47% ± 8.49; P = 0.02), and lower incidence rate ratio <70 mg/dL (0.53 [95% CI 0.31-0.92]) and <54 mg/dL (0.37 [95% CI 0.17-0.83]). CONCLUSIONS: The inpatient use of real-time Dexcom G6 CGM is safe and effective in guiding insulin therapy, resulting in a similar improvement in glycemic control and a significant reduction of recurrent hypoglycemic events compared with POC-guided insulin adjustment.
7Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial.PubMed
Roy W Beck, Tonya D Riddlesworth, Katrina Ruedy, et al.
BACKGROUND: Continuous glucose monitoring (CGM), which studies have shown is beneficial for adults with type 1 diabetes, has not been well-evaluated in those with type 2 diabetes receiving insulin. OBJECTIVE: To determine the effectiveness of CGM in adults with type 2 diabetes receiving multiple daily injections of insulin. DESIGN: Randomized clinical trial. (The protocol also included a type 1 diabetes cohort in a parallel trial and subsequent second trial.) (ClinicalTrials.gov: NCT02282397). SETTING: 25 endocrinology practices in North America. PATIENTS: 158 adults who had had type 2 diabetes for a median of 17 years (interquartile range, 11 to 23 years). Participants were aged 35 to 79 years (mean, 60 years [SD, 10]), were receiving multiple daily injections of insulin, and had hemoglobin A1c (HbA1c) levels of 7.5% to 9.9% (mean, 8.5%). INTERVENTION: Random assignment to CGM (n = 79) or usual care (control group, n = 79). MEASUREMENTS: The primary outcome was HbA1c reduction at 24 weeks. RESULTS: Mean HbA1c levels decreased to 7.7% in the CGM group and 8.0% in the control group at 24 weeks (adjusted difference in mean change, -0.3% [95% CI, -0.5% to 0.0%]; P = 0.022). The groups did not differ meaningfully in CGM-measured hypoglycemia or quality-of-life outcomes. The CGM group averaged 6.7 days (SD, 0.9) of CGM use per week. LIMITATION: 6-month follow-up. CONCLUSION: A high percentage of adults who received multiple daily insulin injections for type 2 diabetes used CGM on a daily or near-daily basis for 24 weeks and had improved glycemic control. Because few insulin-treated patients with type 2 diabetes currently use CGM, these results support an additional management method that may benefit these patients. PRIMARY FUNDING SOURCE: Dexcom.
8Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes.PubMed
David Rodbard
Continuous Glucose Monitoring (CGM) has been demonstrated to be clinically valuable, reducing risks of hypoglycemia and hyperglycemia, glycemic variability (GV), and improving patient quality of life for a wide range of patient populations and clinical indications. Use of CGM can help reduce HbA1c and mean glucose. One CGM device, with accuracy (%MARD) of approximately 10%, has recently been approved for self-adjustment of insulin dosages (nonadjuvant use) and approved for reimbursement for therapeutic use in the United States. CGM had previously been used off-label for that purpose. CGM has been demonstrated to be clinically useful in both type 1 and type 2 diabetes for patients receiving a wide variety of treatment regimens. CGM is beneficial for people using either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). CGM is used both in retrospective (professional, masked) and real-time (personal, unmasked) modes: both approaches can be beneficial. When CGM is used to suspend insulin infusion when hypoglycemia is detected until glucose returns to a safe level (low-glucose suspend), there are benefits beyond sensor-augmented pump (SAP), with greater reduction in the risk of hypoglycemia. Predictive low-glucose suspend provides greater benefits in this regard. Closed-loop control with insulin provides further improvement in quality of glycemic control. A hybrid closed-loop system has recently been approved by the U.S. FDA. Closed-loop control using both insulin and glucagon can reduce risk of hypoglycemia even more. CGM facilitates rigorous evaluation of new forms of therapy, characterizing pharmacodynamics, assessing frequency and severity of hypo- and hyperglycemia, and characterizing several aspects of GV.
9Complications of Diabetes and Metrics of Glycemic Management Derived From Continuous Glucose Monitoring.PubMed
Michael Yapanis, Steven James, Maria E Craig, et al.
CONTEXT: Although glycated hemoglobin A1c is currently the best parameter used clinically to assess risk for the development of diabetes complications, it does not provide insight into short-term fluctuations in glucose levels. This review summarizes the relationship between continuous glucose monitoring (CGM)-derived metrics of glycemic variability and diabetes-related complications. EVIDENCE ACQUISITION: PubMed and Embase databases were searched from January 1, 2010 to August 22, 2020, using the terms type 1 diabetes, type 2 diabetes, diabetes-related microvascular and macrovascular complications, and measures of glycaemic variability. Exclusion criteria were studies that did not use CGM and studies involving participants who were not diabetic, acutely unwell (post stroke, post surgery), pregnant, or using insulin pumps. EVIDENCE SYNTHESIS: A total of 1636 records were identified, and 1602 were excluded, leaving 34 publications in the final review. Of the 20 852 total participants, 663 had type 1 diabetes (T1D) and 19 909 had type 2 diabetes (T2D). Glycemic variability and low time in range (TIR) showed associations with all studied microvascular and macrovascular complications of diabetes. Notably, higher TIR was associated with reduced risk of albuminuria, retinopathy, cardiovascular disease mortality, all-cause mortality, and abnormal carotid intima-media thickness. Peripheral neuropathy was predominantly associated with standard deviation of blood glucose levels (SD) and mean amplitude of glycemic excursions (MAGE). CONCLUSION: The evidence supports the association between diabetes complications and CGM-derived measures of intraday glycemic variability. TIR emerged as the most consistent measure, supporting its emerging role in clinical practice. More longitudinal studies and trials are required to confirm these associations, particularly for T1D, for which there are limited data.
10Continuous Glucose Monitoring Use in Older Adults for Optimal Diabetes Management.PubMed
Medha N Munshi
More than one third of U.S. adults age ≥65 years have diabetes. According to early studies, 61% of all diabetes-related costs in the United States were for individuals age ≥65 years, and more than half of these costs attributable to treating diabetes-related complications. Numerous studies have shown that use of continuous glucose monitoring (CGM) has been shown to improve glycemic control and reduce the incidence and severity of hypoglycemia in younger adults with type 1 diabetes and insulin-treated type 2 diabetes (T2D), and there is growing evidence demonstrating the same benefits in older T2D populations. However, because older adults with diabetes are a heterogeneous group with variable clinical, functional, and psychosocial milieu, clinicians must consider whether each patient can use CGM and, if so, the type of CGM device best addresses each patient's needs and capabilities. This article reviews the evidence supporting CGM in the older population, discusses the barriers and benefits of CGM use in older adults with diabetes, and provides recommendations for how different types of CGM systems can be used strategically to improve glycemic control, reduce hypoglycemia, decrease the burden of diabetes, and improve quality of life.
11Effectiveness of Continuous Glucose Monitoring on Metrics of Glycemic Control in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials.PubMed
Stacey Uhl, Anuja Choure, Benjamin Rouse, et al.
PURPOSE: To provide a systematic review and meta-analysis synthesizing the findings of randomized controlled trials (RCTs) of continuous glucose monitors (CGMs) in the management of adults with type 2 diabetes mellitus (T2DM) on glucose control and clinical outcomes. METHODS: MEDLINE, Embase, and Cochrane were searched for RCTs that assessed the effectiveness of real-time CGM (rt-CGM) or flash CGM (FGM) in adults (≥18 years) with T2DM that reported on at least 1 of the following outcomes: hemoglobin A1c (HbA1c), time in range, time in hyperglycemia, or time in hypoglycemia. The GRADE approach was used to assess certainty of evidence for primary outcomes. RESULTS: Fourteen RCTs assessing CGM were included, with 825 patients in 9 RCTs using rt-CGM and 822 in 5 RCTs using FGM. Moderate certainty of evidence indicated that use of CGM had a modest but statistically significant reduction in HbA1c levels of about 0.32%. Our analyses of each device type separately showed similar reductions in HbA1c (0.34% and 0.33%, respectively, for rt-CGM and FGM), with trends for improvement in other glucose metrics favoring rt-CGM over self-monitored blood glucose. CONCLUSION: Both rt-CGM and flash CGM led to modest but statistically significant declines in HbA1c among individuals with T2DM, with little heterogeneity in the results. However, the duration of the included RCTs was relatively short and few studies reported on important clinical outcomes, such as adverse events, emergency department use, or hospitalization. Longer term studies are needed to determine if the short-term improvements in glucose control leads to improvements in clinically important outcomes.
12Continuous glucose monitoring in type 2 diabetes: a systematic review of barriers and opportunities for care improvement.PubMed
Maria Assunta Barchiesi, Armando Calabrese, Roberta Costa, et al.
BACKGROUND: Diabetes mellitus, particularly type 2 diabetes (T2DM), is a chronic disease associated with serious complications, such as heart disease, kidney failure, and blindness. Continuous glucose monitoring (CGM) systems have emerged as a more effective alternative to traditional fingerstick testing, offering patients greater control over their condition. Despite their potential benefits, several barriers to CGM sensor use persist, limiting their widespread adoption among patients with T2DM. This review explores the barriers to CGM sensor use, particularly from the patient's perspective. METHODS: A systematic literature review is conducted following PRISMA guidelines. The search focuses on studies published between January 2018 and June 2024 and is performed in two primary databases, PubMed and Scopus, selected for their relevance to T2DM research. Studies are included if they explore challenges and barriers to CGM adoption, report patient perspectives, or provide insights into the usability and accessibility of technology. The data are analyzed using deductive content analysis, applying Wilson et al.'s thematic categories as a predefined framework to systematically classify and interpret barriers to CGM adoption. This approach ensures methodological consistency and alignment with existing research on eHealth adoption challenges. RESULTS: The review identifies several key barriers to CGM sensor use despite the benefits, such as improved glucose control and reduced hypoglycemic events. Major challenges include the high cost of sensors, wearability issues, discomfort from adhesive materials, and concerns about the visibility of the sensors. Additionally, patients report difficulties in interpreting the large volumes of data generated by CGM systems, as well as discomfort or fear related to sensor insertion. Lack of technological support, low health literacy, and insufficient social support are also identified as factors contributing to non-adoption. CONCLUSIONS: Policymakers and healthcare providers are encouraged to address these barriers by developing patient-centered strategies that support the adoption of CGM sensors. Successfully overcoming these challenges can further support integrating CGM sensors with the Chronic Care Model and Automated Insulin Delivery systems. As an implication, this integration has the potential to enhance glycemic control and improve patient quality of life in the management of T2DM. Furthermore, addressing these barriers may drive advancements in sensor design, improve accessibility, and minimize the environmental impact of CGM sensor use.
13Novel approaches to hypoglycemia and burnt-out diabetes in chronic kidney disease.PubMed
Connie M Rhee, Kamyar Kalantar-Zadeh, Katherine R Tuttle
PURPOSE OF REVIEW: Diabetes mellitus is a leading cause of chronic kidney disease (CKD) that confers faster kidney disease progression, higher mortality, and various metabolic derangements including hypoglycemia. RECENT FINDINGS: Even in the absence of diabetes mellitus, growing research demonstrates that CKD patients are at heightened risk for hypoglycemia via multiple pathways. In CKD patients transitioning to end-stage renal disease (ESRD), spontaneous resolution of hyperglycemia and frequent hypoglycemia resulting in reduction and/or cessation of glucose-lowering medications are frequently observed in a phenomenon described as 'burnt-out diabetes'. In non-CKD patients, it is well established that hypoglycemia is causally associated with mortality, with pathways including arrhythmias, sudden cardiac death, stroke, and seizures. Increasing evidence shows that, in CKD and ESRD patients with and without diabetes mellitus, hypoglycemia is associated with cardiovascular complications and mortality risk. SUMMARY: Given the high prevalence of hypoglycemia in CKD patients and the morbidity and mortality associated with this metabolic complication, a multimodal strategy is needed to prevent dysglycemia, including individualization of glycemic targets, selection of glucose-lowering medications less likely to induce hypoglycemia, medical nutrition therapy administered by trained dietitians, and accurate and precise hypoglycemia detection methods, such as self-monitored blood glucose or continuous glucose monitoring including during dialysis treatment.
14The effect on glycaemic control of low-volume high-intensity interval training versus endurance training in individuals with type 2 diabetes.PubMed
Kamilla M Winding, Gregers W Munch, Ulrik W Iepsen, et al.
AIM: To evaluate whether high-intensity interval training (HIIT) with a lower time commitment can be as effective as endurance training (END) on glycaemic control, physical fitness and body composition in individuals with type 2 diabetes. MATERIALS AND METHODS: A total of 29 individuals with type 2 diabetes were allocated to control (CON; no training), END or HIIT groups. Training groups received 3 training sessions per week consisting of either 40 minutes of cycling at 50% of peak workload (END) or 10 1-minute intervals at 95% of peak workload interspersed with 1 minute of active recovery (HIIT). Glycaemic control (HbA1c, oral glucose tolerance test, 3-hour mixed meal tolerance test with double tracer technique and continuous glucose monitoring [CGM]), lipolysis, VO peak and body composition were evaluated before and after 11 weeks of intervention. RESULTS: Exercise training increased VO peak more in the HIIT group (20% ± 20%) compared with the END group (8% ± 9%) despite lower total energy expenditure and time usage during the training sessions. HIIT decreased whole body and android fat mass compared with the CON group. In addition, visceral fat mass, HbA1c, fasting glucose, postprandial glucose, glycaemic variability and HOMA-IR decreased after HIIT. The reduced postprandial glucose in the HIIT group was driven primarily by a lower rate of exogenous glucose appearance. In the CON group, postprandial lipolysis was augmented over the 11-week control period. CONCLUSIONS: Despite a ~45% lower training volume, HIIT resulted in similar or even better improvements in physical fitness, body composition and glycemic control compared to END. HIIT therefore appears to be an important time-efficient treatment for individuals with type 2 diabetes.
15Utility of Continuous Glucose Monitoring in Type 1 and Type 2 Diabetes.PubMed
Elena Toschi, Howard Wolpert
A consensus conference of the American Association of Clinical Endocrinologists and American College of Endocrinology held in February 2016 advocated expanding the use of continuous glucose monitoring (CGM) in the management of diabetes. Based on the data described in this paper, CGM use is shown to improve glucose control and reduce hypoglycemic events, and therefore has the potential to reduce the risk of acute and chronic complications of diabetes. Likely, all of the above would not only improve the quality of life and life expectancy of people with diabetes, but would also have a positive impact on health-related cost.
16Advantages of Continuous and Non-Invasive Glucose Monitoring in the Geriatric Population: A Systematic Review.PubMed
Eric Oliviu Coșovanu, Andrei Szilagyi, Alexandra Szilagyi, et al.
The global aging population faces an increasing prevalence of type 2 diabetes mellitus (T2DM), often complicated by frailty, cognitive decline, and impaired manual dexterity. These factors make glucose self-monitoring particularly challenging. Minimally invasive glucose monitoring methods, particularly continuous glucose monitoring (CGM) as well as emerging non-invasive glucose monitoring technologies offer potential solutions, but remain insufficiently evaluated in older adults. To systematically review and synthesize available evidence on the advantages of continuous glucose monitoring (CGM) and non-invasive glucose monitoring methods in older adults aged ≥65 years, focusing on clinical efficacy, usability, adherence, and existing knowledge gaps. A systematic literature search was conducted across PubMed, Scopus, and Web of Science, including studies from 2020 to 2025. Eligible studies included participants aged ≥65 years and evaluated the clinical performance of CGM or other minimally invasive or non-invasive glucose monitoring technologies. The PRISMA framework guided screening and selection. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Due to substantial heterogeneity among study designs and reported outcomes, a narrative synthesis approach was adopted. : A total of 426 records were identified, of which 13 met the predefined eligibility criteria after full-text screening. After risk of bias assessment, one study was excluded, resulting in 12 studies included in the final synthesis. No eligible studies evaluating completely non-invasive glucose monitoring technologies were identified, highlighting a significant research gap in this area specifically for older adults. CGM was associated with improved glycemic control, reduced hypoglycemia, and increased time in range among older adults. Usability was generally high, particularly with newer, user-friendly devices. CGM is associated with improved glycemic outcomes and favorable usability in adults aged ≥65 years. However, a significant gap exists in research on non-invasive glucose monitoring technologies in this population. Future studies should address the accuracy, feasibility, and usability of non-invasive glucose monitoring devices, while accounting for the physiological and behavioral complexities associated with aging.
17Diabetes Technology in People with Type 2 Diabetes: Novel Indications.PubMed
Shubham Agarwal, Rodolfo J Galindo, Amy V Shah, et al.
PURPOSE OF REVIEW: Diabetes technology has been continuously evolving. Current versions of continuous glucose monitors (CGM) use minimally invasive designs, monitor glucose values with high accuracy, and can be used to guide insulin dosing. Extensive evidence supports the use of diabetes technology for monitoring and insulin administration in people with type 1 diabetes. However, there is emerging evidence for people with type 2 diabetes. In this review, we present the different technological devices used to monitor glucose and deliver insulin and the evidence supporting their use in people with type 2 diabetes. RECENT FINDINGS: The use of CGMs in people with type 2 diabetes treated with insulin or non-insulin therapies has been associated with improvements in glycemic control and time spent in hypoglycemia. Smart insulin pens and smart connected devices are options to track compliance and guide insulin delivery in people who do not require insulin pump therapy. Mechanical patch pumps can be used to reduce the burden of multiple daily insulin injections. Automated insulin delivery algorithms improve glycemic control without an increase in hypoglycemia. The use of technology in the management of type 2 diabetes generates glycemic data previously inaccessible, reduces barriers for insulin initiation, improves glycemic control, tracks adherence to therapy, and improves user satisfaction.
18Management of Hyperglycemia in Older Adults with Type 2 Diabetes.PubMed
Gunjan Y Gandhi, Arshag D Mooradian
The increasing incidence of type 2 diabetes in the general population as well as enhanced life expectancy has resulted in a rapid rise in the prevalence of diabetes in the older population. Diabetes causes significant morbidity and impairs quality of life. Managing diabetes in older adults is a daunting task due to unique health and psychosocial challenges. Medical management is complicated by polypharmacy, cognitive impairment, urinary incontinence, injurious falls, and persistent pain. Health care providers now have several traditional and contemporary pharmacologic agents to manage diabetes. Avoidance of hypoglycemia is critical; however, evidence-based guidelines are lacking due to the paucity of clinical trials in older adults. For many in this population, maintaining independence is more important than adherence to published guidelines to prevent diabetes complications. The goal of diabetes care in older adults is to enhance the quality of life without subjecting these patients to intrusive and complicated interventions. Recent technological advancements such as continuous glucose monitoring systems can have crucial supplementary benefits in the geriatric population.
19Continuous glucose monitoring in persons with type 2 diabetes not using insulin.PubMed
Kevin Cowart, Wendy H Updike, Rachel Franks
INTRODUCTION: CGM is an evidence-based intervention to improve glycemic control in persons with T1D and T2D using insulin. Use of CGM in persons with T2D not using insulin is not well studied. AREAS COVERED: Existing clinical evidence for the use of CGM in persons with T2D is reviewed with a focus on persons with T2D not using insulin. Additional perspective and consideration are provided on the role and rationale for using CGM in persons with T2D not using insulin. EXPERT OPINION: On the basis of available evidence, persons with T2D not using insulin benefit clinically through reduction in HbA1c, and improvement in time in range. Additional benefits include improvement in behavior modification, satisfaction, quality of life, empowerment, and diabetes distress. Drivers of these benefits are independent of insulin use in persons with T2D and may include an improved understanding of how diet, lifestyle, and exercise impact diabetes through CGM use. Clinical benefits from CGM independent of medication use include ability to modify health behavior and subsequently improve self-management.