Continuous glucose monitoring (CGM) shows great promise in vulnerable populations, according to the speakers at Saturday morning’s ADA Diabetes Care Symposium—Using Continuous Glucose Monitoring and Smart Devices to Control Glucose when It Matters Most. The speakers also agreed that more research and randomized clinical trials are needed.
Helen R. Murphy, MD, FRACP, Professor at the University of East Anglia and at Norwich/Kings College London, United Kingdom, said she strongly supports CGM use for most pregnant women with diabetes because the technology has been associated with improved neonatal outcomes.
Data from the Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial (CONCEPTT), which enrolled patients at 31 international centers, indicated that improved glucose monitoring led to a modest change in maternal hyperglycemia. At 34 weeks in the study, mothers using CGM spent an extra 100 minutes a day in the glucose target range of 3.5-7.8mmol/L and 72 minutes less a day above the target range.
Those improvements also translated to newborn health outcomes, Dr. Murphy said. Newborns from mothers with improved glucose monitoring spent less time in the NICU and were released from the hospital a day earlier on average, which may prove cost-effective when weighed against the cost of CGM, Dr. Murphy noted.
Guillermo E. Umpierrez, MD, CDE, FACP, FACE, Professor of Medicine and Director of Clinical Research at the Diabetes & Metabolism Center at Emory University School of Medicine, said that in-hospital glycemic control remains sub-optimal, but the technology continues to evolve quickly.
Lack of knowledge is one of the barriers to increased CGM use and better outcomes in hospitals, he said, so education and training programs are needed. But even with that caveat, he said he’s optimistic about CGM use in the non-ICU setting for high-risk patients.
“Overall, this is a very good technique. We just need more studies to learn more about this,” Dr. Umpierrez said.
For patients using insulin pumps, he noted that consensus among diabetologists allows for patients to continue self-management. But this is another area lacking randomized clinical trials, he noted, adding that institutions must establish policies and procedures concerning pump use.
Jennifer Sherr, MD, PhD, Associate Professor of Pediatrics at Yale University, said improvements in hybrid closed-loop (HCL) systems could help more children benefit from the technology.
Many families worry about hypoglycemia overnight and during school hours, Dr. Sherr said. An HCL basal insulin delivery system may improve time in target, in turn helping families and secondary caregivers feel more comfortable. Improved sleep for children and parents is another benefit.
“Integration of HCL systems holds the promise to improve glycemic control while reducing the burden of this chronic medical condition,” Dr. Sherr said. “Ultimately, this will allow our pediatric patients with type 1 diabetes to just be kids.”