Continuous Glucose Monitoring Beyond Intensive Insulin Therapy in Type 2 Diabetes: Evidence, Over-the-Counter...

Area of Science:

• Endocrinology and Metabolism
• Diabetes Technology
• Clinical Practice Guidelines

Background:

• Continuous glucose monitoring (CGM) is expanding beyond intensive insulin therapy for type 2 diabetes management.
• Its utility in routine care hinges on pattern recognition for improved management, not just data volume.

Purpose of the Study:

• To review evidence, device types, over-the-counter (OTC) systems, equity, and implementation of CGM for adults with type 2 diabetes not on intensive insulin therapy.
• Focus on non-insulin-treated and basal insulin-treated (without prandial) adults.

Main Methods:

• Structured narrative review of existing evidence.
• Analysis of device categories, including OTC systems.
• Examination of practical implementation frameworks and equity considerations.

Main Results:

• In non-insulin-treated adults, CGM can identify hyperglycemia and support lifestyle discussions, though evidence for long-term outcomes is less robust than for glycemic metrics.
• For basal insulin-treated adults, CGM supports glycemic assessment and safer treatment reviews.
• OTC systems and consumer biosensors may broaden access but require careful distinction from diabetes-specific clinical evidence.

Conclusions:

• CGM serves as structured decision support for type 2 diabetes management, particularly for non-intensive insulin users.
• Implementation requires patient selection, education, data interpretation, and integration into shared decision-making.
• Considerations include coverage, digital access, language support, and safety to ensure effective and equitable use.