Guidelines recommend continuous monitoring for patients with type 1 diabetes

Continuous glucose monitoring is recommended for adults and children with type 1 diabetes in the outpatient setting, but not in the hospital, according to new guidelines from The Endocrine Society.

A task force of experts from the society reviewed existing research to develop a clinical practice guideline on the use of continuous glucose monitoring. The guidelines, which were also reviewed by the Diabetes Technology Society and the European Society of Endocrinology, were published in the October Journal of Clinical Endocrinology and Metabolism.

In a strong recommendation based on high-quality evidence, the experts concluded that real-time continuous glucose monitoring (CGM) is appropriate for adults with type 1 diabetes as long as the patients have demonstrated that they can use the devices on a nearly daily basis. Additionally, CGM could be used short-term in any adult with diabetes to assist in management of hypoglycemia unawareness, to monitor the results of significant changes to a therapy regimen, or to detect nocturnal hypoglycemia, the dawn phenomenon, or postprandial hyperglycemia. The recommendations on short-term use were only a suggestion, because they are based on very low-quality evidence.

Similar recommendations were made for children over age 8. High-quality evidence supports the use of CGM if they have type 1 diabetes and an A1c below 7.0%. For those with higher A1c values, CGM is recommended if they are able to use it almost daily (based on moderate-quality evidence). No recommendations were made regarding children under age 8 due to a shortage of evidence.

The guideline writers also looked at inpatient use of CGM and concluded that it should not be used alone for glucose management in the intensive care unit or operating room, due to insufficient evidence of its accuracy and safety in those settings. The authors noted that ICU patients are less likely to be able to provide feedback about hypoglycemic symptoms and they expressed “concerns regarding potential danger in [CGM] use in guiding insulin administration in an acute-care setting, which outweighs the possible convenience and trend awareness that the technology provides.” In conclusion, the guideline authors also noted that the proper use of CGM will depend on future findings regarding the costs and benefits of the technology.