Optimizing the Use of Continuous Glucose Monitoring in People with Type 2 Diabetes on Noninsulin-based Regimens: A Case Series with Narrative Review and Expert Opinion

The use of continuous glucose monitoring (CGM) results in better glycemic control compared with self-monitoring of blood glucose in people with type 2 diabetes (T2D) on noninsulin regimens. However, real-world evidence is limited because CGM is often not reimbursed in this population in Asia Pacific. The aim of the current review was to develop practical recommendations on the use of CGM in noninsulin-treated T2D population using a case-based approach. We identified four profiles of T2D individuals on noninsulin regimens who may benefit from CGM: (1) individuals without comorbidities but with suboptimal glycemic control for whom CGM can provide structured feedback; (2) overweight/obese patients for whom CGM provides experiential learning and motivation and aids in personalizing lifestyle modifications to optimize glycemic indices, calorie intake and weight management; (3) patients with cardiovascular risk factors for whom CGM can provide information about the risk of atherosclerosis and potentially help slow disease progression whilst minimizing hypoglycemia; and (4) elderly individuals for whom CGM can help to improve glucose control while reducing hypoglycemia risk. Real-world cases for each profile are described and supplemented by a review of current literature to illustrate how to implement CGM into workflows and interpret ambulatory glucose profile to aid in appropriate treatment and lifestyle modifications. As an adjunct to conventional glucose monitoring in motivated noninsulin-treated T2D individuals, CGM provides comprehensive feedback on the impact of adherence to lifestyle and medication, and on glycemic status and associated cardiovascular risks, and empowers patients in self-management.