Monitoreo continuo de glucosa: indicaciones, interpretación de datos y toma de decisiones terapéuticas
DOI:
https://doi.org/10.47196/diab.v54i3.455Palabras clave:
diabetes, monitoreo continuo de glucosa, control glucémico, insulinoterapia intensificadaResumen
Las herramientas para evaluar el grado de control glucémico se modificaron últimamente. La hemoglobina glicosilada (HbA1c), parámetro de referencia (gold standard), refleja el control glucémico de los últimos tres meses de manera retrospectiva, sin expresar la variabilidad glucémica. El automonitoreo glucémico capilar (AGC) brinda información inmediata y prospectiva, pero dispone de pocos datos glucémicos para generar promedios y desviaciones estándares representativas. No detecta tendencias y tiene limitaciones para obtener datos nocturnos o durante la actividad física. Es invasivo y muchas veces rechazado. Contrariamente, el monitoreo continuo de glucosa (MCG) mide la glucosa instantáneamente, y muestra sus tendencias y su variabilidad en forma continua, incorporando nuevas métricas de control.
Citas
I. American Diabetes Association. Glycemic Targets: Standards of medical care in diabetes-2020. Diabetes Care 2020 Jan; 43(Supplement 1):S66-S76.
II. Litwak LE, Mileo VR, Álvarez A, Gutman RA. Autocontrol de la glucemia capilar: evaluación del resultado a largo plazo (3 a 7 años). Medicina (Buenos Aires) 1999; 59:71-78.
III. Commendatore VF, Linari MA, Dieuzeide G, Ferraro M, Lapertosa S, Puchulu F, et al. Automonitoreo y monitoreo de glucosa y cetonas en la persona con diabetes. Rev Soc Arg Diab 2007; 41:95-104.
IV. American Diabetes Association. Diabetes Technology: Standards of Medical Care in Diabetes 2020. Diabetes Care 2020; S77-S88.
V. Advani A. Positioning time in range in diabetes management. Diabetologia 2020; 63:242-252.
VI. U.S. Food and Drug Administration. FreeStyle Libre Flash Glucose Monitoring System: summary of safety and effectiveness data (SSED). Disponible en:. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P160030. Acceso: 06/07/ 2017.
VII. Bailey TS, Grunberger G, Bode BW, Handelsman Y, Hirsch IB, Jovanovič L, et al. American Association of Clinical Endocrinologists and American College of Endocrinology. 2016 Outpatient glucose monitoring consensus statement. Endocr Pract 2016; 22:231-261.
VIII. Sherr J, Tauschmann M, Battelino T, Bock M, Forlenza G, Roman R, Hood K, Maahs D. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes Technologies. Pediatric Diabetes 2018; 19 (Suppl.27):302-325.
IX. American Diabetes Association. Diabetes Technology: Standars of medical care in diabetes-2019. Diabetes Care 2019; 42(Suppl. 1):S71-80.
X. Laffel L, Aleppo G, Buckingham G, Forlenza G, Rasbach L, Tsalikian E, et al. A practical approach to using trend arrows on the Dexcom G5 CGM system to manage children and adolescents with diabetes. J Endocr Soc 2017 Dec; 1(12):1461-1476.
XI. Murphy HR, Rayman G, Duffield K, et al. Changes in the glycemic profiles of women with type 1 and type 2 diabetes during pregnancy. Diabetes Care 2007 Nov; 30(11):2785-2791.
XII. Kröger J, Fasching P, Hanaire H, et al. Three European retrospective real-world chart review studies to determine the effectiveness of flash glucose monitoring on HbA1c in adults with type 2 diabetes. Diabetes Ther 2020 Jan;11(1):279-291.
XIII. Evans M, Welsh Z, Ells S, et al. The impact of flash glucose monitoring on glycaemic control as measured by HbA1c: a meta-analysis of Clinical Trials and Real-World Observational Studies. Diabetes Ther 2020 Jan; 11(1):83-95.
XIV. Battelino T, Danne T, Bergenstal RM, 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.
XV. Bergenstal RM, Ahmann AJ, Bailey T, et al. Recommendations for standardizing glucose reporting and analysis to optimize clinical decision making in diabetes: the ambulatory glucose profile (AGP). Diabetes Technol Ther 2013; 15:198-211.
XVI. Xing D, Kollman C, Beck RW, et al.; Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Optimal sampling intervals to assess long-term glycemic control using continuous glucose monitoring. Diabetes Technol Ther 2011; 13:351-358.
XVII. Riddlesworth TD, Beck RW, Gal RL, et al. Optimal sampling duration for continuous glucose monitoring to determine long-term glycemic control. Diabetes Technol Ther 2018; 20:314-316.
XVIII. Beck RW, Connor CG, Mullen DM, Wesley DM, Bergenstal RM. The fallacy of average: how using HbA1c al one to assess glycemic control can be misleading. Diabetes Care 2017; 40:994-999.
XIX. Bergenstal RM, Beck RW, Close KL, et al. Glucose management indicator (GMI): a new term for estimating A1C from continuous glucose monitoring. Diabetes Care 2018; 41:2275-2280.
XX. American Diabetes Association. Diabetes Technology: Standards of medical care in diabetes-2019. Diabetes Care 2019; 43(suppl 1):S1-S212.
XXI. 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.
XXII. Lu J, Ma X, Zhou J, et al. Association of time in range, as assessed by continuous glucose monitoring, with diabetic retinopathy in type 2 diabetes. Diabetes Care 2018; 41:2370-2376.
XXIII. Beck RW, Bergenstal RM, Riddlesworth TD, et al. Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care 2019; 42:400-405.
XXIV. Beck RW, Bergenstal RM, Cheng P, et al. The relationships between time in range, hyperglycemia metrics, and HbA1c. J Diabetes Sci Technol 2019 Jan (Epub ahead of print). Doi:10.1177/1932296818822496.
XXV. Vigersky RA, Mc Mahon C. The relationship of hemoglobin A1C to time-in-range in patients with diabetes. Diabetes Technol Ther 2019; 21:81-85.
XXVI. Rodbard D. Glucose variability: a review of clinical applications and research developments. Diabetes Technol Ther 2018; 20(suppl 2):S25-S215.
XXVII. Monnier L, Colette C, Wojtusciszyn A, Dejager S, Renard E, Molinari N, et al. Toward defining the threshold between low and high glucose variability in diabetes. Diabetes Care 2017 Jul; 40:832-838.
XXVIII. Rodbard D. Hypo and hyperglycemia in relation to the mean, standard deviation, coefficient of variation, and nature of the glucose distribution. Diabetes Technol Ther 2012; 14:868-876.
XXIX. Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care 2017; 40:1631-1640.
XXX. Litwak L, Querxoli I, Musso C, Dain A, Houssay S, Costa Gil JE. Monitoreo continuo de glucosa, utilidad e indicaciones. Medicina (Buenos Aires) 2019; 79:44-52.
XXXI. Ziegler R, von Sengbusch S, Kröger J, Schubert O, Werkmeister P, Deiss D, Siegmund T. Therapy adjustments based on trend arrows using continuous glucose monitoring systems. J Diabetes Sci Technol 2019; 1-11.
XXXII. Borot S, Benhamou P, Atlan C, Bismuth E, Bonnemaison E, Catargi B, et al. Practical implementation, education and interpretation guidelines for continuous glucose monitoring: A French position statement. Diabetes Metab 2018; 44:61-72.
XXXIII. Aleppo G, Laffel L, Ahmann A, Hirsch I, Kruger D, Peters A, et al. Un enfoque práctico para usar las flechas de tendencia en el sistema Dexcom G5 CGM para el manejo de adultos con diabetes. Journal of the Endocrine Society 2017 Dec; 1(12):1445-1460.
XXXIV. Yaron M, Roitman E, Aharon-Hananel G, Landau Z, Ganz T, Yanuv I, et al. Effect of flash glucose monitoring technology on glycemic control and treatment satisfaction in patients with type 2 diabetes. Diabetes Care 2019 Jul; 42(7):1178-1184.
XXXV. 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 insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther 2017;8:55-73.
XXXVI. Website plataformas digitales de FreeStyle Libre. Disponible en: www.freestylelibre.com.ar, www.libreview.com
XXXVII. Hirsch I, Battelino T, Peters AL, Chamberlain JJ, Aleppo G, Bergenstal R. Role of continuous glucose monitoring in diabetes treatment. Arlington (VA): American Diabetes Association; 2018 Aug.
XXXVIII. Ajjan RA, Cummings MH, Jennings P, Leelarathna L, Rayman G, Wilmot EG. Optimising use of rate-of-change trend arrows for insulin dosing decisions using the FreeStyle Libre flash glucose monitoring system. Diab Vasc Dis Res 2019 Jan; 16(1):3-12.
XXXIX. Chico A, Aguilera E, Ampudia-Blasco FJ, Bellido V, Cardona-Hernández R, Escalada FJ, et al. Clinical approach to flash glucose monitoring: an expert recommendation. J Diabetes Sci Technol 2020 Jan;14(1):155-164.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
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.
