Comité de Innovación. Indicaciones para el uso del monitoreo continuo de la glucosa
Palabras clave:
bomba de insulina, dosificación automática de insulina, monitorización continúa de la glucosa, infusión subcutánea continúa de insulina, hipoglucemia, sensores de glucosaResumen
La adopción de la monitorización continua de glucosa (MCG), que incluye MCG en tiempo real (MCGtr) y MCG intermitente (MCGi), ha aumentado en los últimos años. A diferencia del automonitoreo de glucosa capilar (self-monitoring of the blood glucosa, SMBG), que proporciona información estática de mediciones de glucosa, los actuales dispositivos MCG muestran datos en formatos numéricos y gráficos, informando el nivel de glucosa con flechas de tendencia, que indican la dirección y velocidad de los cambios en los niveles de glucosa en sangre. Estos datos permiten a las personas con diabetes mellitus (DM) responder de manera más oportuna para mitigar o prevenir eventos glucémicos agudos, y tomar decisiones sobre su autogestión. Varios estudios demostraron beneficios clínicos significativos del uso del MCG en personas con DM, independientemente del método de administración de la insulina. En este artículo se resumen las recomendaciones y aspectos relevantes de la utilización del MCG en las personas con DM.
Citas
I. Grunberger G, Sherr J, Allende M, Blevins T, Bode B, Handelsman Y, et al. American Association of Clinical Endocrinology Clinical Practice Guideline: the use of advanced technology in the management of persons with diabetes mellitus. Endocr Pract 2021;27(6):505:537.
II. Litwak LE, Querzoli I, Musso C, Dain A, Houssay S, Proietti A, et al. Continuous glucose monitoring. Utility and indications. Med 2019;79(1).
III. Danne T, Nimri R, Battelino T, Bergenstal RM, Close KL, DeVries JH, et al. International consensus on use of continuous glucose monitoring. Diabetes Care 2017;40(12):1631-1640.
IV. Tamborlane WV, Beck RW, Bode BW, et al.; Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med 2008;359:14641476.
V. Tumminia A, Crimi S, Sciacca L, et al. Efficacy of real-time continuous glucose monitoring on glycaemic control and glucose variability in type 1 diabetic patients treated with either insulin pumps or multiple insulin injection therapy: a randomized controlled crossover trial. Diabetes Metab Res Rev 2015;31:61-68.
VI. Beck RW, Riddlesworth T, Ruedy K, et al.; DIAMOND Study Group. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. JAMA 2017;317:371-378.
VII. Lind M, Polonsky W, Hirsch IB, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. JAMA 2017;317:379-387
VIII. Battelino T, Conget I, Olsen B, et al.; SWITCH Study Group. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia 2012;55:3155-3162.
IX. Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care 2011;34:795-800.
X. Beck RW, Riddlesworth TD, Ruedy K, et al.; DIAMOND Study Group. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Ann Intern Med 2017;167:365-374.
XI. Ehrhardt NM, Chellappa M, Walker MS, Fonda SJ, Vigersky RA. The effect of real-time continuous glucose monitoring on glycemic control in patients with type 2 diabetes mellitus. J Diabetes Sci Technol 2011;5:668-675.
XII. Martens T, Beck RW, Bailey R, et al.; MOBILE Study Group. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin: a randomized clinical trial. JAMA 2021;325:2262-2272.
XIII. Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline JP, Rayman G. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulintreated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther 2017;8:55-73.
XIV. Yaron M, Roitman E, Aharon-Hananel G, et al. Effect of flash glucose monitoring technology on glycemic control and treatment satisfaction in patients with type 2 diabetes. Diabetes Care 2019;42:1178-1184.
XV. Leelarathna L, Evans ML, Neupane S; FLASH-UK Trial Study Group. Intermittently scanned continuous glucose monitoring for type 1 diabetes. N Engl J Med 2022;387:1477-1487.
XVI. Lind M, Polonsky W, Hirsch IB, Heise T, Bolinder J, Dahlqvist S, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections the gold randomized clinical trial. JAMA 2017;317(4):379-87.
XVII. Riddlesworth T, Price D, Cohen N, Beck RW. Hypoglycemic event frequency and the effect of continuous glucose monitoring in adults with type 1 diabetes using multiple daily insulin injections. Diabetes Ther 2017;8(4):947:951.
XVIII. Beck RW, Riddlesworth T, Ruedy K, Ahmann A, Bergenstal R, Haller S, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections the diamond randomized clinical trial. JAMA 2017;317(4):371:378.
XIX. Hásková A, Radovnická L, Petruželková L, et al. Real-time CGM is superior to flash glucose monitoring for glucose control in type 1 diabetes: the CORRIDA randomized controlled trial. Diabetes Care 2020;43:2744-2750 93.
XX. Visser MM, Charleer S, Fieuws S, et al. Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): a 6-month, prospective, multicentre, randomised controlled trial. Lancet 2021;397:2275-2283.
XXI. Miller KM, Kanapka LG, Rickels MR, et al. Benefit of continuous glucose monitoring in reducing hypoglycemia is sustained through 12 months of use among older adults with type 1 diabetes. Diabetes Technol Ther 2022;24:424-434.
XXII. Van Beers CAJ, DeVries JH, Kleijer SJ, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial. Lancet Diabetes Endocrinol 2016;4:893-902.
XXIII. Heinemann L, Freckmann G, Ehrmann D, et al. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. Lancet 2018;391:1367-1377.
XXIV. Reddy M, Jugnee N, El Laboudi A, Spanudakis E, Anantharaja S, Oliver N. A randomized controlled pilot study of continuous glucose monitoring and flash glucose monitoring in people with type 1 diabetes and impaired awareness of hypoglycaemia. Diabet Med 2018;35:483-490.
XXV. Davis TME, Dwyer P, England M, Fegan PG, Davis WA. Efficacy of intermittently scanned continuous glucose monitoring in the prevention of recurrent severe hypoglycemia. Diabetes Technol Ther 2020;22:367-373.
XXVI. Feig DS, Donovan LE, Corcoy R, et al.; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet 2017;390:2347-2359.
XXVII. Kristensen K, Ögge LE, Sengpiel V, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies. Diabetologia. 2019; 62:1143-1153.
XXVIII. Tauschman M, Forlenza G, Hood K, Cardona-Hernández R, Giani E, Hendrieckx C, De Salvo DJ, Laffel LM, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: glucose monitoring. Pediatr Diabetes 2022;23:1390-1405.
XXIX. Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, et al. Clinical targets for continuous glucose monitoring data interpretation: Recommendations from the international consensus on time in range. Diabetes Care 2019;42(8):1593:1603.
XXX. Litwak L, Carreño N, Carnero R, Dain A, Grosembacher L, Musso C, et al. Monitoreo continuo de glucosa: indicaciones, interpretación de datos y toma de decisiones terapéuticas. Rev Soc Arg Diab 2020;54(3):140-154.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2024 a nombre de los autores. Derechos de reproducción: Sociedad Argentina de Diabetes
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Dirección Nacional de Derecho de Autor, Exp. N° 5.333.129. Instituto Nacional de la Propiedad Industrial, Marca «Revista de la Sociedad Argentina de Diabetes - Asociación Civil» N° de concesión 2.605.405 y N° de disposición 1.404/13.
La Revista de la SAD está licenciada bajo Licencia Creative Commons Atribución – No Comercial – Sin Obra Derivada 4.0 Internacional.
Por otra parte, la Revista SAD permite que los autores mantengan los derechos de autor sin restricciones.
