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Editorials |19 September 2017

Continuous Glucose Monitoring in Patients With Type 2 Diabetes Receiving Insulin Injections: Does This Mean Continuous Glucose Monitoring for Everyone?

Vanessa Arguello, MD; Matthew Freeby, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 22 August 2017.
  • From David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.

    Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2121.

    Requests for Single Reprints: Vanessa Arguello, MD, David Geffen School of Medicine at UCLA, 1245 16th Street, Suite 307, Santa Monica, CA 90404; e-mail, varguello@mednet.ucla.edu.

    Current Author Addresses: Dr. Arguello: David Geffen School of Medicine at UCLA, 1245 16th Street, Suite 307, Santa Monica, CA 90404.

    Dr. Freeby: David Geffen School of Medicine at UCLA, 200 Medical Plaza Driveway, Suite 530, Los Angeles, CA 90095.

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Despite advances in care over the past 2 decades, nearly half of persons living with type 2 diabetes mellitus (T2DM) have uncontrolled disease and are at high risk for complications (1). New technologies aimed at treatment, including advancements in glucose monitoring, may affect control and reduce hypoglycemia risk. Almost 3 decades has passed since the U.S. Food and Drug Administration approved the first continuous glucose monitoring (CGM) system. These devices, introduced in 1999, were uncomfortable, inaccurate, and difficult to use. Now, compact devices can provide consistent and timely data by measuring interstitial fluid every 5 minutes, correlating well with plasma glucose levels; they transmit current and predicted glucose values to cell phones and other devices, providing real-time user feedback. As a result, real-time CGM (RT-CGM) enables both patients and physicians to visualize daily glucose patterns, including variations after meals, exercise, and illness and in response to changes in treatment regimens. Furthermore, device alerts notify users and their support systems of impending hypoglycemia and hyperglycemia.
Because of these advances, randomized controlled trials (RCTs) in patients with type 1 diabetes mellitus (T1DM) have consistently had positive outcomes. The Juvenile Diabetes Research Foundation (2), SWITCH (3), and GOLD (4) studies showed greater reductions in hemoglobin A1c (HbA1c) levels in adults with RT-CGM than with intermittent self-monitoring of blood glucose (SMBG); mean differences were 0.53%, 0.41%, and 0.43%, respectively. In parallel to the trial reported in this issue (5), Beck and...
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Arguello V, Freeby M. Continuous Glucose Monitoring in Patients With Type 2 Diabetes Receiving Insulin Injections: Does This Mean Continuous Glucose Monitoring for Everyone?. Ann Intern Med. 2017;167:436–437. [Epub ahead of print 22 August 2017]. doi: https://doi.org/10.7326/M17-2121

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Published: Ann Intern Med. 2017;167(6):436-437.

DOI: 10.7326/M17-2121

Published at www.annals.org on 22 August 2017

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2017 American College of Physicians
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