Experts recommend use of CGM technology immediately after diagnosis in people with type 2 diabetes

An international panel of expert diabetologists and endocrinologists have recommended the use of glucose sensing technology with real-time readings in all individuals with type 2 diabetes as soon as possible after their diagnosis. 

The report also argues that continuous glucose monitoring (CGM) technology should be used in all people with type 2 diabetes throughout their natural history of living with the condition.

A CGM is seen by the medical community as standard of care for people on intensive insulin therapy but a group of European diabetes experts believe it’s also an essential tool right after diagnosis of type 2 diabetes.

It helps the doctor to establish the glucose profile of their patient, decide on initial treatment plan and evaluate after 14 days. It also provides education on the response of glucose levels to diet and exercise.

Early intensive glucose control as soon as possible after diagnosis of type 2 diabetes is proven to significantly reduce the risk of developing microvascular complications of diabetes, including retinopathy, chronic kidney disease or neuropathy. Just as important, early glucose control for people with type 2 diabetes results in sustained reductions in risk of myocardial infarction and death from any cause.

It is estimated that a one-year delay in treatment intensification for people newly diagnosed with type 2 diabetes and HbA1c >7.5 per cent (58 mmol/mol) is associated with a 67 per cent increased risk of myocardial infarction, a 51 per cent increase in risk of stroke and a 64 per cent increased risk of heart failure, compared to those who receive timely treatment intensification. Early glycaemic control is therefore critical for long-term prevention of life-changing health-related complications for people with type 2 diabetes, and to reduce the associated costs of hospital admissions.

A key attribute of using the FreeStyle Libre 2 system in type 2 diabetes is that users are able to get immediate biofeedback, such as visible minute-by-minute glucose readings and trend arrows that indicate what their glucose levels are and how rapidly they are changing.

This feedback helps people with type 2 diabetes to adapt their diet and physical activities to improve their daily glucose profiles, in a way that is not possible with infrequent finger prick testing.

Making such decisions assisted by CGM technology has been shown to be effective for people with type 2 diabetes on basal-insulin therapy and data indicates this is similarly motivational in those with newly diagnosed type 2 diabetes.

Sam Seidu, Professor in Primary Care Diabetes and Cardio-metabolic Medicine at the University of Leicester, is an author of the study. He said: “Glucose sensing technology has been around for many years now and we’ve seen direct correlation between access to regular glucose insights and better outcomes for people living with type 1 diabetes.

“There has been so much progress in innovation and better access to this technology which eases the daily challenges of living with type 1 diabetes, which is amazing. But for people with type 2 diabetes, which represents a majority, access to this technology in the UK is still very limited and our findings today highlight a real opportunity for us to focus our attention on tackling the causes of diabetes complications, rather than simply treating the symptoms.

“Knowing how your glucose levels individually respond to food and exercise choices for example, right from diagnosis, sets a clearer pathway to better management across the lifespan, and in most cases could significantly limit further issues.”

Neil Harris, General Manager for Abbott’s diabetes care business in the UK and Ireland, said: “Recent reports indicate that up to one million people could be living with type 2 diabetes in the UK without knowing, so we hope the findings of this research will help health leaders rethink how we manage one of Britain’s biggest health threats.

“We have seen the impact access to real-time glucose data can have on driving better outcomes over the past decade, through actionable insights and behavioural change.”

He added: “It’s clear we have so much further to go in the drive for broadened access to sensing technology for the millions of people with diabetes who could benefit from it.

“This report expands our knowledge of the application of CGM technology and shows that we’re only scratching the surface when it comes to understanding its true potential.”

NICE updated its guidelines to recommend sensor-based glucose monitoring systems for people with type 2 diabetes who are administering multiple daily injections and meet certain criteria in 2022.

Before this update, people, such as Ken Tait from Bromley, who has lived with type 2 diabetes since 1999 and has been on multiple daily injections since 2003, solely relied on finger pricking to test their sugar levels.

In 2021, Ken decided to self-fund the use of Abbott’s FreeStyle Libre 2 system which, at the time, was only available via the NHS to some people with type 1 diabetes.

Ken has now become a known advocate for widening access to CGM technology within the diabetes community.

Speaking about the new report, Ken, said: “For many years, managing my diabetes was pure guesswork.

“I’d get a result from finger pricking but I didn’t know if the reading meant my glucose levels were going up or down or staying the same.

“When I started using the FreeStyle Libre 2 system, it was a complete revelation to me. For the first time in my life with diabetes, I could see what was happening in my body.

“How the food I ate and exercise I did would affect my glucose levels, and various other information that was now available to help me manage my diabetes 24/7, 365 days a year.

“To now see reports coming out recommending the use of CGM technology in all people with type 2 diabetes feels like a huge step forward and one I completely support. It has been invaluable to me, and I know it would be for many others living with type 2 diabetes, no matter what stage they are at.”

The consensus report is now available in Nature Reviews Endocrinology.