rtCGM has also been shown to improve quality of life and hypoglycemia distress in adults with type 1 diabetes ( 11–13).įor people living with type 2 diabetes using basal-bolus injection therapy, a randomized controlled trial of 158 subjects demonstrated that the use of rtCGM reduced A1C to a greater extent than usual care, with more time spent in the target range and less time spent above range at 24 weeks ( 14). not necessarily symptomatic) hypoglycemia, rtCGM has been shown to reduce episodes of severe hypoglycemia in adults with a history of severe hypoglycemia or impaired awareness of hypoglycemia using multiple daily injections (MDI) ( 11). These glycemic benefits of rtCGM have been demonstrated in trials recruiting adults and children with A1C at target (<7.5%) ( 6) or above target ( 4–6, 9) and in trials which included adults at or above target ( 8). Real-Time Continuous Glucose Monitoring (rtCGM)įor people living with type 1 diabetes who use basal-bolus injection therapy or continuous subcutaneous insulin infusion (CSII), rtCGM has been shown to reduce A1C ( 4–9) and increase glucose time in range (TIR) ( 5, 7, 8, 10), while simultaneously reducing duration and incidence of hypoglycemia ( 5, 7–11) in adults and children. Measurement of interstitial fluid glucose via a sensing device that stores the data to be retrieved at a later time Professional continuous glucose monitoring Masked continuous glucose monitoring (mCGM) ∗ Measurement of interstitial fluid glucose via a sensing device that is continuously transmitting the data to a device with real-time display for viewing at any time Real-time continuous glucose monitoring (rtCGM) Measurement of interstitial fluid glucose via intermittent scanning of sensing device Intermittently scanned continuous glucose monitoring (isCGM) ∗mCGM is a diagnostic tool for use by diabetes care providers, not for diabetes self-management.ĭetermination of glucose in the capillary blood using finger sticks Terminology for different glucose monitoring modalities To address this expanding field, the terminology used to describe the different modalities needs to adapt to allow for future growth and has been updated in Table 1. To measure glucose levels in real time, different modalities exist currently and new technologies are being studied. However, A1C is a measure of chronic glycemic levels over months and does not provide information that can inform immediate/short-term decisions. Testing of glycated hemoglobin (A1C) continues to be the primary modality to ensure that glycemic goals are being met and the recommended frequency of testing remains unchanged. It allows people living with diabetes and their health-care providers to assess glycemic status and adverse effects, and to determine the effectiveness of glucose lowering therapies. Glucose monitoring remains a cornerstone of diabetes management. The finalized recommendations were unanimously approved by the CPG Steering Committee. The grading of recommendations was reviewed independently by the Independent Methods Review Co-Chair (D.R.). For this update, the CPG Steering Committee reviewed the cited evidence independently and suggested revisions to the draft recommendations and the text. The expert working group reviewed the citations, graded the evidence, drafted the revised recommendations and created the initial draft of the preamble document to accompany the revised recommendations. Diabetes Canada has a formal policy to manage conflict of interest for the CPG Steering Committee. Members of the expert working group were selected by the CPG Steering Committee with the goal of ensuring representation of diverse perspectives (across disciplines, and academic and community settings), appropriate content and methodologic expertise, while limiting the potential of financial conflict, as much as possible. The full-text citations and critical appraisal reports were provided to the expert working group. All MERST staff (librarians and methodologists) were without financial or intellectual conflict. Relevant citations were abstracted and critically reviewed by a methodologist from MERST. The MERST team reviewed all relevant citations at title, abstract and full-text levels. A systematic search of the literature for relevant articles published from Novemto Octowas performed by the health science librarians at the McMaster Evidence Review and Synthesis Team (MERST). A consolidated search strategy (for adults, children and pregnant women) was developed by modifying and updating PICO (population, intervention, comparison and outcome) questions used for the 2018 CPG (chapters 9, 34, 35, 36).
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