For those at risk for hypoglycemia such as patients using sulfonylureas, basal insulin, mealtime insulin, or insulin pumps, CGM systems that have alarms such as the Dexcom G6, Medtronic Guardian Connect, Eversense, or FreeStyle Libre 2 would be preferred because they all offer real-time glucose alerts. Ideal candidates for personal CGM use would be individuals who need or want more engagement with their diabetes management. For patients using the system’s app on a mobile device, data are automatically uploaded to the Cloud, allowing HCPs to view data at any time by logging into an HCP portal. For patients using a dedicated reader that comes with their device, data can be downloaded in the clinic or at home by patients using a cable that connects the reader to a computer. This type of system is sometimes referred to as “flash CGM.” All the systems shown in Table 1 provide software that allows results to be accessed by HCPs and patients, which can be useful for both educational and treatment purposes. In addition, the FreeStyle Libre system requires the user to “swipe,” or scan, the receiver or a smartphone over the sensor to obtain a reading. Differences among the available systems include varying need for calibration with fingerstick BGM, differing software and phone applications (apps) for data showing and interpretation, and differing sensor warm-up periods and wear times. Because of the observational study design, findings may have been susceptible to selection bias.Several options exist for both professional and personal CGM ( Table 1). In this retrospective cohort study, insulin-treated patients with diabetes selected by physicians for real-time continuous glucose monitoring compared with noninitiators had significant improvements in hemoglobin A1c and reductions in emergency department visits and hospitalizations for hypoglycemia, but no significant change in emergency department visits or hospitalizations for hyperglycemia or for any reason. Initiation of real-time CGM was not associated with statistically significant changes in rates of hyperglycemia, emergency department visits for any reason, or hospitalizations for any reason. 001) and telephone visits (adjusted difference-in-differences estimate, 1.1 95% CI, 0.8 to 1.4 P <. 001) and in the number of outpatient visits (adjusted difference-in-differences estimate, -0.4 95% CI, -0.6 to -0.2 P <. 001), and higher than 9% (adjusted difference-in-differences estimate, -7.1% 95% CI, -9.5% to -4.6% P <. There were also statistically significant differences in the adjusted net changes in the proportion of patients with HbA1c lower than 7% (adjusted difference-in-differences estimate, 9.6% 95% CI, 7.1% to 12.2% P <. Hypoglycemia rates declined among real-time CGM initiators from 5.1% to 3.0% and increased among noninitiators from 1.9% to 2.3% (difference-in-differences estimate, -2.7% 95% CI, -4.4% to -1.1% P =. Mean HbA1c declined among real-time CGM initiators from 8.17% to 7.76% and from 8.28% to 8.19% among noninitiators (adjusted difference-in-differences estimate, -0.40% 95% CI, -0.48% to -0.32% P <. The prebaseline mean HbA1c was lower among real-time CGM initiators than among noninitiators, but real-time CGM initiators had higher prebaseline rates of hypoglycemia and hyperglycemia. The real-time CGM initiators included 3806 patients (mean age, 42.4 years 51% female 91% type 1, 9% type 2) the noninitiators included 37 947 patients (mean age, 63.4 years 49% female 6% type 1, 94% type 2). Ten end points measured during the 12 months before and 12 months after baseline: hemoglobin A1c (HbA1c) hypoglycemia (emergency department or hospital utilization) hyperglycemia (emergency department or hospital utilization) HbA1c levels lower than 7%, lower than 8%, and higher than 9% 1 emergency department encounter or more for any reason 1 hospitalization or more for any reason and number of outpatient visits and telephone visits. Initiation vs noninitiation of real-time CGM (reference group). A total of 41 753 participants with insulin-treated diabetes (5673 type 1 36 080 type 2) receiving care from a Northern California integrated health care delivery system (2014-2019), being treated with insulin, self-monitoring their blood glucose levels, and having no prior CGM use were included. To estimate clinical outcomes of real-time CGM initiation.Įxploratory retrospective cohort study of changes in outcomes associated with real-time CGM initiation, estimated using a difference-in-differences analysis. Continuous glucose monitoring (CGM) is recommended for patients with type 1 diabetes observational evidence for CGM in patients with insulin-treated type 2 diabetes is lacking.
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