Expanded use of CGM for type 2 diabetes, hospitals may improve outcomes

American Association of Clinical Endocrinologists 19th Annual Meeting

BOSTON — Continuous glucose monitors, commonly used for monitoring blood glucose levels in patients with type 1 diabetes, may be helpful in managing patients with type 2 diabetes or any patient in the hospital setting, Robert M. Cuddihy, MD, said at the American Association of Clinical Endocrinologists 19th Annual Meeting and Clinical Congress.

Cuddihy discussed the currently accepted use of CGM in patients with type 1 diabetes, who utilize the device for real-time data, glucose trending, alarms for hyperglycemia and hypoglycemia, and other feedback that can be used to modify diet, physical activity and therapies.

“I see the role of CGM expanding. This is really a tool that is now established and is here to stay,” Cuddihy, medical director of the International Diabetes Center at Park Nicollet, Minneapolis, said at a press conference.

His discussion focused on the emerging use of CGM for type 2 diabetes therapy. Although it will not replace finger-prick tests, putting a patient on CGM for as few as two weeks will provide clinicians with a better picture of what is truly happening with the patients’ blood glucose levels.

“The physician will then be able to chart out the best possible treatment plan for their patient,” Cuddihy, also adjunct associated professor at the University of Minnesota Medical School, said in a press release.

Cuddihy said his center uses CGM in a “sporadic, periodic basis as a diagnostic biopsy tool…to give us a very intensive picture of the current glycemic patterns that will enable us to more rapidly titrate therapies, pick the most appropriate therapy for the underlying physiology deficit and get people to goal safely,” as an adjunct to targeted self-monitoring of blood glucose.

Another emerging use is in the hospital setting. Recent studies, such as NICE-SUGAR, have raised questions concerning the merits of tight glycemic control in the hospital setting. Emerging CGM devices will allow clinicians to review minute-by-minute trends, thereby minimizing glycemic excursions and “tipping the scales” in favor of glycemic control, Cuddihy said in a press release.

“Good glycemic control [in the hospital] is still relevant if CGMs are constantly checked,” he said in the release.

There are currently three commercial entities providing available devices in the United States: DexCom Seven PLUS; Medtronic Guardian RT (and the I-Pro); and Abbott Freestyle Navigator. Many companies are working on other devices. – by Katie Kalvaitis

My appreciation of the value and wisdom of CGM in type 2 diabetes is evident in the blog on this topic I posted recently. In our practice we cannot keep up with the demand. Once a patient with poorly controlled diabetes sees the difference between good and chaotic control, their immediate response is 'that's me' - always selecting the chaos. It is the best incentive I can offer them to do a better job of managing their own diabetes. Besides generally feeling better as their blood glucose stops oscillating so widely, almost without exception, the patient begins to loss weight as they no longer have to fight (over) insulin-induced hypoglycemia.

With the AACE/American College of Endocrinology guidelines for reimbursement codes for CGM published in the current issue of Endocrine Practice, more clinicians will follow the recommendations of Cuddihy. For now, insurance companies in our area are only allowing reimbursement for CGM every six months. As more information is gathered and published about the short- and long-term benefits derived from CGM this will hopefully change. The use of CGM for inpatient tight glycemic control is sorely needed. But these are early days and several companies are developing and testing systems for in-line (venous, not tissue or capillary) CGM with real-time results continuously displayed on the screen, as currently happens with ECG, pulse, blood pressure. The mild controversy about the value or otherwise of tight glycemic control in the ICU will be resolved - most likely in favor of tight control.

– Michael Kleerekoper, MD
Endocrine Today Editorial Board member

For more information:

• Cuddihy RM. Continuous glucose monitoring in 2010: Where do we stand?. Presented at: American Association of Clinical Endocrinologists 19th Annual Meeting and Clinical Congress; April 21-25, 2010; Boston.

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