New Consensus Recommendations on Use of Continuous Glucose Monitoring

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Real-time CGM and intermittently viewed CGM address many of the limitations inherent in HbA1c testing and self-monitoring of blood glucose.
Real-time CGM and intermittently viewed CGM address many of the limitations inherent in HbA1c testing and self-monitoring of blood glucose.

In a consensus statement published in Diabetes Care, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress provided evidence-based suggestions for continuous glucose monitoring (CGM) use as it relates to establishing long-term glucose control, aiding clinical trials, and improving risk assessment for diabetes-related complications.

The consensus statement emphasized the importance of patient education and training for interpretation of CGM data in an effort to improve the chances for greater long-term diabetes control. Panelists also provided recommendations on hypoglycemia, which represents an important barrier to appropriate glucose control.

The ATTD Congress suggests that the definition of hypoglycemia in people with diabetes should include the nadir level of blood glucose measured, the compartment of measurement (arterial, venous, and capillary blood or interstitial), and the duration of the event and related symptoms.

For assessment of hypoglycemia in patient care, the ATTD Congress also suggests that the following factors be taken into consideration: weight gain, reduced awareness of subsequent hypoglycemia, associated confusion or cardiac arrhythmia, and fear of hypoglycemia. In addition to the overall clinical representation of glycemic control, glycemic variability data from CGM should be considered carefully, as this variability may be an important predictor of future diabetes complications.

Assessment of hemoglobin (Hb)A1c levels was also discussed by the ATTD Congress. Based on the literature findings, the panelists determined that HbA1c levels should be measured using a National Glycohemoglobin Standardization Program-certified device or a device certified by the International Federation of Clinical Chemistry and Laboratory Medicine.

Additionally, glycated albumin, fructosamine, self-monitoring of blood glucose, and CGM should be used simultaneously with HbA1c measurements when there are discrepancies between actual HbA1c and the estimated A1C during glucose measurement.

As demonstrated by the overall recommendations from this consensus statement, the assessment of continuous glucose data may, “complement HbA1c for a wide range of patients with diabetes and should be considered for use to help them improve glycemic control, provided that appropriate educational and technical support is available.”

Reference

Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017;40:1631-1640. 

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