The use of real time continuous glucose monitoring or flash glucose monitoring in the management of diabetes: A consensus view of Italian diabetes experts using the Delphi method
Daniela Bruttomesso,Luigi Laviola,Angelo Avogaro,Enzo Bonora,S. Del Prato,Simona Frontoni,Emanuela Orsi,Ivana Rabbone,Giorgio Sesti,Francesco Purrello +9 more
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TLDR
A consensus amongst Italian diabetes physicians on the attributes of rtCGM and FGM technologies is delineated, and a consistent approach for their use by Italian healthcare professionals is introduced to increase the efficacy and effectiveness of continuous glucose monitoring in Italy.Abstract:
Until recently, in Italy, the use of continuous glucose monitoring (CGM) systems has been limited, but is now rapidly increasing, including the so-called real-time CGM (rtCGM) and the intermittently viewed CGM (iCGM), also called Flash Glucose Monitoring (FGM). These technologies overcome many of the limitations of self-monitoring of blood glucose (SMBG) by fingerprick and allow to go beyond HbA1c to check glucose control in diabetes. However, standardized protocols for applying and interpreting rtCGM and FGM data are lacking. In this paper, we delineate a consensus amongst Italian diabetes physicians on the attributes of rtCGM and FGM technologies, and introduce a consistent approach for their use by Italian healthcare professionals. Most experts consider rtCGM and FGM as two separate categories of interstitial subcutaneous fluid (ISF) sensing technologies, and see them as superior to SMBG. Furthermore, there is strong consensus that rtCGM and FGM reduce hypoglycemia risk, increase the amount of time in the target glucose range and augment treatment satisfaction. However, there is still no agreement on the indication of the FGM for subjects who suffer asymptomatic hypoglycemia. Consensus on the role of education in initiating and optimizing use of rtCGM/FGM and about the interpretation of glucose trends was near unanimous, whereas no consensus was reached on the statement that there are no disadvantages/risks of rtCGM/FGM. Some issues remain in rtCGM/FGM management: a) risk of excessive correction of high or low glucose; b) risk of alert fatigue leading to alert silencing or rtCGM termination; c) allergic reaction to the adhesive keeping rtCGM or FGM sensors in place. The panel almost unanimously agreed that sensor accuracy depends on multiple variables, that alarm setting should be individualized, and that global glycemic profile represent an useful tool in interpreting glucose data. More clinical studies and a wider use of these devices will increase the efficacy and effectiveness of continuous glucose monitoring in Italy.read more
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Journal ArticleDOI
Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy.
Benedetta Maria Bonora,Federico Boscari,Angelo Avogaro,Daniela Bruttomesso,Gian Paolo Fadini +4 more
TL;DR: Despite the limited possibility to exercise and the incumbent psychologic stress, glycaemic control improved in patients with T1D who stopped working during the lockdown, suggesting that slowing down routine daily activities can have beneficial effects on type 1 diabetes management, at least in the short term.
Journal ArticleDOI
Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis
Marco Castellana,Claudia Parisi,Sergio Di Molfetta,Ludovico Di Gioia,Annalisa Natalicchio,Sebastio Perrini,Angelo Cignarelli,Luigi Laviola,Francesco Giorgino +8 more
TL;DR: Evidence is provided for the use of FGM as an effective strategy for the management of diabetes and a limited number of studies, with a heterogeneous design and usually with a short-term follow-up and without specific training, were found.
Journal ArticleDOI
Cutaneous Complications With Continuous or Flash Glucose Monitoring Use: Systematic Review of Trials and Observational Studies.
TL;DR: The incidence rate of reported cutaneous complications with CGM/FGM use from the available literature is low, with one event per eight weeks of sensor wear-time, and reported complication severity was also low, leading to low rates of CGM /FGM discontinuation.
Journal ArticleDOI
Continuous glucose monitoring: A review of the evidence in type 1 and 2 diabetes mellitus
TL;DR: In this article, a literature search was conducted by combining subject headings "CGM" and "flash glucose monitoring", with key words "type 1 diabetes" and 'type 2 diabetes", limited to "1999 to current".
Journal ArticleDOI
Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes: A meta-analysis of observational studies.
Monia Garofolo,Michele Aragona,Cosimo Rodia,Pierpaolo Falcetta,Alessandra Bertolotto,Fabrizio Campi,Stefano Del Prato,Giuseppe Penno +7 more
TL;DR: In this paper, the effects of lockdown due to COVID-19 pandemic on glucose metrics, measured by glucose monitoring systems, in adult individuals with type 1 diabetes were assessed using a systematic literature search for English language articles from MEDLINE, Scopus and Web of Science up to February 28, 2021.
References
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Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial.
Roy W. Beck,Tonya D Riddlesworth,Katrina J. Ruedy,Andrew J. Ahmann,Richard M. Bergenstal,Stacie Haller,Craig Kollman,Davida F. Kruger,Janet B. McGill,William H. Polonsky,Elena Toschi,Howard Wolpert,David Price +12 more
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TL;DR: Novel flash glucose testing reduced the time adults with well controlled type 1 diabetes spent in hypoglycaemia in the intervention group, and future studies are needed to assess the effectiveness of this technology in patients with less well controlled diabetes and in younger age groups.
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The Performance and Usability of a Factory-Calibrated Flash Glucose Monitoring System.
TL;DR: Interstitial glucose measurements with the FreeStyle Libre system were found to be accurate compared with capillary BG reference values, with accuracy remaining stable over 14 days of wear and unaffected by patient characteristics.
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