Continuous glucose monitoring (CGM) is well established in the management of type 1 diabetes (T1D), with studies showing improved glycemic control with the use of CGM in both children and adults with T1D.1 A growing body of research is investigating the potential benefits of CGM for type 2 diabetes (T2D), and findings thus far have shown promise for its use in adults.
In a randomized controlled trial reported in 2012 in Diabetes Care, adult patients with T2D (n=100) who were not on prandial insulin were assigned to either intermittent real-time CGM or self-monitoring of blood glucose (SMBG) for a 12-week period.2
They were subsequently followed for 40 weeks. Diabetes care was delivered by each patient’s regular provider, with no involvement by the researchers.
The results revealed significant and sustained improvement in the mean unadjusted hemoglobin A1c (HbA1c) levels of the CGM group vs the SMBG group. At 12, 24, 38, and 52 weeks, levels had decreased by 1.0%, 1.2%, 0.8%, and 0.8%, respectively, in the CGM group, compared with 0.5%, 0.5%, 0.5%, and 0.2%, respectively, in the SMBG group (P =.04).
The researchers stated that CGM “provides important feedback about glycemic trends in response to meals, exercise, and insulin in [people with] type 1 [diabetes] and type 2 [diabetes] on prandial insulin with resultant improvement in overall glycemic control.” Various other studies have demonstrated HbA1c reductions ranging from 0.5% to 2.7% with the use of CGM.3
Based on such findings, professional organizations now encourage the use of CGM for people with T2D to guide clinicians in medication adjustment and as a research tool.4,5 Although evidence supporting the benefits of CGM in adult patients with T2D continues to increase, data are scarce pertaining to the use of CGM in childhood-onset T2D, according to a review published in Current Diabetes Reports.3This is an important gap, considering the increasing prevalence of childhood-onset T2D.
T2D is linked with numerous cardiovascular and metabolic complications in the pediatric population, along with higher rates of monotherapy failure and faster disease progression compared with adults.6,7 These associations are “in no small part because those affected are predominantly from disadvantaged backgrounds with limited resources and socioeconomic challenges affecting their ability to manage their disease effectively,” wrote the review authors. “Furthermore, much remains unknown about the pathophysiology and natural history of youth-onset T2D. Ongoing studies are needed to determine which management strategies are optimal for preventing disease progression and complications.”
Studies using CGM in this group thus far have focused on CGM as a research tool — for example, to identify links between glucose patterns and diabetes risk — rather than for personal use by adolescents. The authors note that although this population may be likely to have low adherence rates to personal use of CGM, the professional use of CGM could offer providers a more comprehensive understanding of a patient’s glycemic patterns.
In a cohort study of 98 obese children and adolescents with or without prediabetes, even patients with normal HbA1c, fasting plasma glucose, and 2-hour oral glucose tolerance test were found to have higher levels of free-living glucose on CGM than previously observed in non-obese children and adolescents.8 The findings further showed that HbA1c and oral glucose tolerance test were associated with differing glycemic patterns.
“Given the greater burden of disease in youth with T2D, further studies are required to identify whether or not intermittent use of CGM directed…