Continuous Glucose Monitoring–Derived Data Report—Simply a Better Management Tool

Abstract

The introduction of A1C into routine diabetes care some 30 years ago provided the first reliable marker of glycemic control, clearly related to devastating chronic complications of diabetes. A1C became the standard metric to judge the quality of diabetes care and the primary outcome for all diabetes intervention trials investigating novel medications and new technologies. This dependence on A1C as our sole glycemic management guide and primary outcome measure was questioned by some investigators (1); however, the A1C was familiar and convenient and became the key diabetes pay-for-performance quality metric in the U.S. After decades of the “A1C era” in diabetes care, it is now evident that the management of diabetes guided by A1C has not yielded our desired results, and despite novel medicines and diabetes technology the mean A1C has actually deteriorated in the last decade (2–5). As national A1C levels were slipping, an impactful article entitled “Resurgence in Diabetes-Related Complications” was published (6), pointing out that while health care access, delivery, and preventive services are far from ideal, we also need to focus on innovative strategies to safely achieve glycemic targets. It seems fair to ask, what went wrong? Wasn’t the introduction of continuous glucose monitoring (CGM) going to transform diabetes management (7)? While it often takes 17 years to get approved therapies or technology innovations adopted and implemented in clinical practice (8), we believe that in the case of CGM, effective implementation will also involve a refinement of our management philosophy. Our current training on use of the CGM glucose profile and data report is to always address any noted patterns of hypoglycemia first. This is a sound principle, and using CGM we have been extremely successful in minimizing hypoglycemia as demonstrated in randomized clinical trials …