Abstract
Numerous randomized controlled trials (RCTs) have demonstrated the glycemic benefits of continuous glucose monitoring (CGM) in management of type 1 diabetes (T1D) and type 2 diabetes. Although RCTs remain the gold standard clinical study design, findings from these trials do not necessarily reflect the effectiveness of CGM or reveal the feasibility and wider applications for use in broader real-life settings. This review evaluates recent real-world evidence (RWE) demonstrating the value of CGM to improve clinical outcomes, such as avoidance of severe hypoglycemic and hyperglycemic crises, and improved measures of psychological health and quality of life. Additionally, this review considers recent RWE for the role of CGM to enhance health care resource utilization, including prediction of T1D and applications in gestational diabetes, chronic kidney disease, and monitoring during surgery.
Highlights
Well-designed, randomized controlled trials (RCTs) have traditionally been considered the highest level of trial evidence
This retrospective real-world analysis of a cohort of 2463 type 2 diabetes (T2D) adults treated with short- or rapid-acting insulin noted significant reductions in adverse events (ADEs) and allcause hospitalizations (ACHs) during the 6 months after acquiring their flash continuous glucose monitoring (CGM) device compared with the 6-month period before acquisition
Findings of decreased rates of ADEs and ACHs have been reported in a cohort of 10,282 adult T2D patients treated with nonintensive or noninsulin therapy.[25]
Summary
Well-designed, randomized controlled trials (RCTs) have traditionally been considered the highest level of trial evidence. A retrospective chart review of 363 T2D adults from three European countries assessed the effectiveness of flash CGM use in conjunction with basal–bolus therapy.[21] After >90 days following initiation of flash CGM, A1C levels were significantly lower: -0.9% (Austria), -0.8% (France), and -0.9% (Germany), all P < 0.0001 The impact of this magnitude of A1C reductions after acquiring a flash CGM device is reflected in findings from an analysis of IBM MarketScan Commercial Claims and Medicare Supplemental databases.[27] This retrospective real-world analysis of a cohort of 2463 T2D adults treated with short- or rapid-acting insulin noted significant reductions in ADEs (from 0.180 to 0.072 events/ patient-year, P < 0.001) and ACHs (from 0.420 to 0.283 events/patient-year, P < 0.001) during the 6 months after acquiring their flash CGM device compared with the 6-month period before acquisition. A U.S chart review study of 100 T2D adults treated with basal
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