Moving Beyond Glycated Hemoglobin to Glucose Patterns: Newer Indications for Continuous Glucose Monitor Use

Abstract

Glucose homeostasis is a constant process involving several physiological mechanisms. Estimation of glucose via continuous glucose monitor (CGM) sensors provides a 24-hour comprehensive evaluation of glycemic excursions, enabling a closer understanding of the underlying defective mechanisms beyond current biomarkers of glycemia, focusing on the impact of glucose exposure, and not on the constant changes. CGM use in type 2 diabetes has shown to have a beneficial effect in improving glycated hemoglobin and time spent in range of 70-180 mg/dL. Some studies have also shown a legacy effect of CGM use after its discontinuation. Use of CGM in various other conditions such as end stage kidney disease, obstructive sleep apnea, gastroparesis, postbariatric hypoglycemia, and insulinoma has been shown to fill the diagnostic and therapeutic void. The advent of new glycemic metrics with the coming of CGM also improves our pathophysiological understanding of such diseases in the context of more readily available glycemic data. As future studies continue to emerge demonstrating the benefits of CGM in conditions other than diabetes; a frameshift focus on the value of constant glucose assessment and not on point-in-time metrics is necessary. Understanding and changing our approach to glycemic excursion will be pivotal for use of CGM beyond traditional indications and improve patient outcomes and quality of life metrics.