Relevancia del monitoreo continuo de glucosa en la práctica clínica: revisión de la evidencia

  • Ana María Gómez Pontificia Universidad Javeriana
  • Diana Cristina Henao Carrillo Pontificia Universidad Javeriana
  • Lucía Tapoada Pontificia Universidad Javeriana
  • Martín Rebolledo del Toro Pontificia Universidad Javeriana

Resumen

El monitoreo continuo de glucosa (MCG) es una herramienta que permite evaluar el control glucémico, la variabilidad glucémica y la detección de episodios de hipoglucemia asintomática y nocturna. Actualmente disponemos de dispositivos de última generación que son más precisos y sensibles para la detección de hipoglucemia, lo cual ha permitido el desarrollo de algoritmos predictores con el fin de prevenir dichos eventos, ya sea utilizando alarmas para que el paciente intervenga o suspendiendo la infusión de insulina. Esta tecnología se encuentra disponible en Colombia y ha demostrado ser una alternativa segura y efectiva en el tratamiento de pacientes diabéticos con alto riesgo de hipoglucemia severa y otras poblaciones especiales como niños y mujeres embarazadas. El objetivo de esta revisión es resumir la evidencia clínica relevante, ventajas y desventajas de esta terapia, así como el impacto clínico del uso del MCG en tiempo real (MCG-TR) en pacientes en tratamiento con múltiples dosis o sistemas de infusión subcutánea de insulina.

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Biografía del autor

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Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia. Hospital Universitario San Ignacio, Bogotá, Colombia. Unidad de Endocrinología

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Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia. Hospital Universitario San Ignacio, Bogotá, Colombia. Unidad de Endocrinología

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Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia. Hospital Universitario San Ignacio, Bogotá, Colombia. Unidad de Endocrinología

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Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia.

Citas

1. Group UPDS (UKPDS). blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet [Internet]. 1998;352(9131):837- 53. Available from: http://discovery.ucl.ac.uk/1310755/
2. Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep;329(14):977-86.
3. Danne T, Nimri R, Battelino T, Bergenstal RM, Close KL, DeVries JH, et al. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017;40(12):1631-40.
4. Hoeks LBEA, Greven WL, de Valk HW. Real-time continuous glucose monitoring system for treatment of diabetes: A systematic review. Diabet Med. 2011;28(4):386-94.
5. Claus Vogelmeier, M.D., Bettina Hederer, M.D., Thomas Glaab, M.D., Hendrik Schmidt PD, Maureen P.M.H. Rutten-van Mölken, Ph.D., Kai M. Beeh, M.D., Klaus F. Rabe, M.D., and Leonardo M. Fabbri MD, Investigators for the P-C. New England Journal. Clin Trials. 2010;363:411-22.
6. Pickup JC, Freeman SC, Sutton AJ. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: Meta-analysis of randomised controlled trials using individual patient data. Bmj. 2011;343(7815).
7. Gómez Medina AM, Marín Sánchez A. Monitorización continua de glucosa en tiempo real: Imprescindible su uso combinado con infusión continua de insulina. Av en Diabetol. 2011;27(4):143-50.
8. Bruttomesso D. Technological Advances in the Treatment of Type 1 Diabetes. 2014. 81-98 p.
9. Rodbard D. Continuous Glucose Monitoring: A Review of Successes, Challenges, and Opportunities. Diabetes Technol Ther [Internet]. 2016;18(S2):S2-3-S2-13. Available from: http://online.liebertpub.com/doi/10.1089/dia.2015.0417
10. Keenan DB, Mastrototaro JJ, Voskanyan G, Steil GM. Delays in minimally invasive continuous glucose monitoring devices: A review of current technology. J Diabetes Sci Technol. 2009;3(5):1207-14.
11. Kubiak T, Hermanns N, Schreckling HJ, Kulzer B, Haak T. Assessment of hypoglycaemia awareness using continuous glucose monitoring. Diabet Med. 2004;21(5):487-90.
12. Gómez AM, Carrillo DCH, Velandia OMM. Devices for continuous monitoring of glucose: Update in technology. Med Devices Evid Res. 2017;10:215-24.
13. Gómez AM, Marín Sánchez A, Muñoz OM, Colón Peña CA. Precisión numérica y clínica de la monitorización continua de glucosa en pacientes colombianos en terapia con bomba de infusión de insulina con suspensión automática en hipoglucemia. Endocrinol y Nutr. 2015;62(10):485-92.
14. Pfützner A, Klonoff DC, Pardo S, Parkes JL. Technical aspects of the Parkes error grid. J Diabetes Sci Technol. 2013;7(5):1275-81.
15. 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 [Internet]. 2016;22(2):231-61. Available from: http:// journals.aace.com/doi/10.4158/EP151124.CS
16. Aberer F, Hajnsek M, Rumpler M, Zenz S, Baumann PM, Elsayed H, et al. Evaluation of subcutaneous glucose monitoring systems under routine environmental conditions in patients with type 1 diabetes. Diabetes, Obes Metab. 2017;19(7):1051-5.
17. Kropff J, DeVries JH. Continuous Glucose Monitoring, Future Products, and Update on Worldwide Artificial Pancreas Projects. Diabetes Technol Ther [Internet]. 2016;18(S2):S2-53-S2-63. Available from: http://online.liebertpub.com/doi/10.1089/dia.2015.0345
18. Vaddiraju S, Burgess DJ, Tomazos I, Jain FC, Papadimitrakopoulos F. Technologies for continuous glucose monitoring: Current problems and future promises. J Diabetes Sci Technol. 2010;4(6):1540-62.
19. Bailey T, Bode BW, Christiansen MP, Klaff LJ, Alva S. The Performance and Usability of a Factory-Calibrated Flash Glucose Monitoring System. Diabetes Technol Ther [Internet]. 2015;17(11):787-94. Available from: http://online.liebertpub.com/doi/pdfplus/10.1089/dia.2014.0378
20. 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(1):55-73.
21. Juvenille Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J. [Internet]. 2008;359(14):1464-76. Available from: http://www.ncbi.nlm.nih.gov/m/pubmed/18779236/%5Cn o http://www.ncbi.nlm.nih.gov/pubmed/18779236
22. Beck RW, Riddlesworth T, Ruedy K, Ahmann A, Bergenstal R, Haller S, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections. Jama [Internet]. 2017;317(4):371. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.19975
23. Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C. Continuous Glucose Monitoring in Older Adults With Type 1 and Type 2 Diabetes Using Multiple Daily Injections of Insulin: Results From the DIAMOND Trial. J Diabetes Sci Technol. 2017;11(6):1138-46.
24. Riddle MC, Bakris G, Blonde L, Boulton AJM, D ’alessio D, De Groot M, et al. Introduction: Standards of Medical Care in Diabetes—2018. Diabetes Care [Internet]. 2018;41(Supplement 1):S1-2. Available from: http://care.diabetesjournals.org/lookup/doi/10.2337/dc18-Sint01
25. Conceição J, Dores J, Araújo F, Laires PA, Carr RD, Brodovicz K, et al. Severe hypoglycaemia among patients with type 2 diabetes requiring emergency hospital admission: The Hypoglycaemia In Portugal Observational Study- Emergency Room (HIPOS-ER). Diabetes, Obes Metab. 2018;20(1):50-9.
26. Hung YC, Lin CC, Chen HJ, Chang MP, Huang KC, Chen YH, et al. Severe hypoglycemia and hip fracture in patients with type 2 diabetes: a nationwide population-based cohort study. Osteoporos Int. 2017;28(7):2053-60.
27. Aronson R, Goldenberg R, Boras D, Skovgaard R, Bajaj H. The Canadian Hypoglycemia Assessment Tool Program: Insights Into Rates and Implications of Hypoglycemia From an Observational Study. Can J Diabetes [Internet]. 2016;1-7. Available from: http://dx.doi.org/10.1016/j.jcjd.2017.01.007
28. Lee AK, Warren B, Lee CJ, Mcevoy JW, Matsushita K, Huang ES, et al. The Association of Severe Hypoglycemia With Incident Cardiovascular Events and Mortality in Adults With Type 2 Diabetes. 2017;(7):1-8.
29. Pieber TR, Marso SP, McGuire DK, Zinman B, Poulter NR, Emerson SS, et al. DEVOTE 3: temporal relationships between severe hypoglycaemia, cardiovascular outcomes and mortality. Diabetologia. 2018;61(1):58-65.
30. Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet. 2016;388(10057):2254-63.
31. Stephan Matthaei. An Evaluation of Novel Glucose Sensing Technology on Hypoglycaemia in Type 1 Diabetes (IMPACT) [Internet]. NCT02232698. 2017 [cited 2017 May 29]. Available from: https://clinicaltrials.gov/ct2/show/NCT02232698
32. Bergenstal RM, Klonoff DC, Garg SK, Bode BW, Meredith M, Slover RH, et al. Threshold-Based Insulin-Pump Interruption for Reduction of Hypoglycemia. N Engl J Med [Internet]. 2013;369(3):224-32. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1303576
33. Gómez AM, Marín Carrillo LF, Muñoz Velandia OM, Rondón Sepúlveda MA, Arévalo Correa CM, Mora Garzón E, et al. Long-Term Efficacy and Safety of Sensor Augmented Insulin Pump Therapy with Low-Glucose Suspend Feature in Patients with Type 1 Diabetes. Diabetes Technol Ther [Internet]. 2016;19(2):dia.2016.0332. Available from: http://online.liebertpub.com/doi/10.1089/dia.2016.0332
34. Choudhary P, Olsen BS, Conget I, Welsh JB, Vorrink L, Shin JJ. Hypoglycemia Prevention and User Acceptance of an Insulin Pump System with Predictive Low Glucose Management. Diabetes Technol Ther [Internet]. 2016;18(5):288-91. Available from: http://online.liebertpub.com/doi/10.1089/dia.2015.0324
35. van Beers CAJ, DeVries JH, Kleijer SJ, Smits MM, Geelhoed-Duijvestijn PH, Kramer MHH, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial. Lancet Diabetes Endocrinol. 2016;4(11):893-902.
36. Heinemann L, Freckmann G, Ehrmann D, Faber-Heinemann G, Guerra S, Waldenmaier D, et al. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): A multicentre, randomised controlled trial. Lancet [Internet]. 2018;6736(18):1- 11. Available from: http://dx.doi.org/10.1016/S0140-6736(18)30297-6
37. Monnier L, Colette C, Owens DR. The application of simple metrics in the assessment of glycaemic variability. Diabetes Metab [Internet]. 2018;1-7. Available from: https://doi.org/10.1016/j.diabet.2018.02.008
38. Kramer CK, Choi H, Zinman B, Retnakaran R. Glycemic variability in patients with early type 2 diabetes: The impact of improvement in ??-cell function. Diabetes Care. 2014;37(4):1116-23.
39. Kilpatrick ES, Rigby AS, Goode K, Atkin SL. Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycaemia in type 1 diabetes. Diabetologia. 2007;50(12):2553-61.
40. Johnson SL, McEwen LN, Newton CA, Martin CL, Raskin P, Halter JB, et al. The impact of continuous subcutaneous insulin infusion and multiple daily injections of insulin on glucose variability in older adults with type 2 diabetes. J Diabetes Complications. 2011;25(4):211-5.
41. 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 [Internet]. 2016;dc161769. Available from: http://care.diabetesjournals.org/lookup/doi/10.2337/dc16-1769
42. Gómez AM, Muñoz OM, Marin A, Fonseca MC, Rondon M, Robledo Gómez MA, et al. Different Indexes of Glycemic Variability as Identifiers of Patients with Risk of Hypoglycemia in Type 2 Diabetes Mellitus. J Diabetes Sci Technol [Internet]. 2018;(40):193229681875810. Available from: http://journals.sagepub.com/doi/10.1177/1932296818758105
43. Kovatchev B, Cobelli C. Glucose variability: Timing, risk analysis, and relationship to hypoglycemia in diabetes. Diabetes Care. 2016;39(4):502-10.
44. Henao-Carrillo DC, Muñoz OM, Gómez AM, Rondón M, Colón C, Chica L, et al. Reduction of glycemic variability with Degludec insulin in patients with unstable diabetes. J Clin Transl Endocrinol [Internet]. 2018;12(April):8-12. Available from: https://www.sciencedirect.com/science/article/pii/ S2214623718300206
45. Guerci B, Monnier L, Serusclat P, Petit C, Valensi P, Huet D, et al. Continuous glucose profiles with vildagliptin versus sitagliptin in add-on to met- formin: Results from the randomized Optima study. Diabetes Metab [Internet]. 2012;38(4):359-66. Available from: http://dx.doi.org/10.1016/j.diabet.2012.06.001
46. Lane, W., Weinrib, J., Hale C. The effect of addition of liraglutide to high-dose intensive insulin therapy: a randomized prospective trial. Diabetes, Obes Andm. 2014;6-11.
47. Jamiołkowska M, Jamiołkowska I, Łuczyński W, Tołwińska J, Bossowski A, Głowińska Olszewska B. Impact of Real-Time Continuous Glucose Monitoring Use on Glucose Variability and Endothelial Function in Adolescents with Type 1 Diabetes: New Technology—New Possibility to Decrease Car- diovascular Risk? J Diabetes Res [Internet]. 2016;2016:1-8. Available from: http://www.hindawi.com/journals/jdr/2016/4385312/
48. Tumminia A, Crimi S, Sciacca L, Buscema M, Frittitta L, Squatrito S, et al. Efficacy of real-time continuous glucose monitoring on glycaemic control and glucose variability in type 1 diabetic patients treated with either insulin pumps or multiple insulin injection therapy: A randomized controlled crossover trial. Diabetes Metab Res Rev. 2015;31(1):61-8.
49. Secher A, Ringholm L, Andersen H, Damm P, Mathiesen E. The Effect of Real- Time Continuous Glucose Monitoring in Pregnant Women With Diabetes. Diabetes Care. 2013;36:1877.
50. Feig DS, Donovan LE, Corcoy R, Murphy KE, Amiel SA, Hunt KF, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes (CON- CEPTT): a multicentre international randomised controlled trial. Lancet. 2017;390(10110):2347-59.
51. Ramirez-Rincon A, Hincapie-García J, Arango CM, Aristizabal N, Castillo E, Hincapie G, et al. Clinical Outcomes After 1 Year of Augmented Insulin Pump Therapy in Patients with Diabetes in a Specialized Diabetes Center in Medellín, Colombia. Diabetes Technol Ther [Internet]. 2016;18(11):713-8. Available from: http://online.liebertpub.com/doi/10.1089/dia.2016.0166
52. Gómez AM, Marín Carrillo LF, Arévalo Correa CM, Muñoz Velandia OM, Rondón Sepúlveda MA, Silva Herrera JL, et al. Maternal-Fetal Outcomes in 34 Pregnant Women with Type 1 Diabetes in Sensor-Augmented Insu- lin Pump Therapy. Diabetes Technol Ther [Internet]. 2017;19(7):417-22. Available from: http://online.liebertpub.com/doi/10.1089/dia.2017.0030
53. Restrepo-Moreno M, Ramirez-Rincon A, Hincapie-Garcia J, Palacio A, Mon- salve-Arango C, Aristizabal-Henao N, et al. Maternal and perinatal outcomes in pregnant women with type 1 diabetes treated with continuous subcutaneous insulin infusion and real time continuous glucose monitoring in two specialized centers in Medellin, Colombia. J Matern Fetal Neonatal Med. 2018 Mar;31(6):696-700.
54. Quitian H, Gomez A, Garcia Peña A, Arciniegas J, Iragorri N, Mantilla B, et al. Cost-Utility Analysis of Continuous Infusion Pump With Integrated Monitoring Compared With Multiple Daily Injection Treatment for Patients 15-Years or Older With Type 1 Diabetes Mellitus In Colombia. Value Heal [Internet]. 2015;18(7):A360. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1098301515027692
55. Roze S, Saunders R, Brandt AS, de Portu S, Papo NL, Jendle J. Health-economic analysis of real-time continuous glucose monitoring in people with Type 1 diabetes. Diabet Med. 2015;32(5):618-26.
56. Deiss D, Bolinder J, Riveline JP, Battelino T, Bosi E, Tubiana-Rufi N, et al. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care. 2006;29(12):2730-2.
57. Hirsch IB, Abelseth J, Bode BW, Fischer JS, Kaufman FR, Mastrototaro J, et al. Sensor-Augmented Insulin Pump Therapy: Results of the First Randomized Treat-to-Target Study. Diabetes Technol Ther [Internet]. 2008;10(5):377- 83. Available from: http://online.liebertpub.com/doi/abs/10.1089/dia.2008.0068
58. O’Connell MA, Donath S, O’Neal DN, Colman PG, Ambler GR, Jones TW, et al. Glycaemic impact of patient-led use of sensor-guided pump therapy in type 1 diabetes: A randomised controlled trial. Diabetologia. 2009;52(7):1250-7.
59. Denis R, Véronique S, Yves R, Bruno G, Eric R, Hélène H, et al. 11-Incre- mental Value of Continuous Glucose Monitoring When Starting Pump Therapy in Patients With Poorly Controlled Type 1 Diabetes. Diabetes Care. 2009;32(12):2245-2250.
60. Šoupal J, Petruželková L, Flekač M, Pelcl T, Matoulek M, Daňková M, et al. Comparison of Different Treatment Modalities for Type 1 Diabetes, Including Sensor-Augmented Insulin Regimens, in 52 Weeks of Follow-Up: A COMISAIR Study. Diabetes Technol Ther [Internet]. 2016;18(9):532-8. Available from http://online.liebertpub.com/doi/10.1089/dia.2016.0171
61. Conget I, Battelino T, Giménez M, Gough H, Castañeda J, Bolinder J. The SWITCH Study (Sensing With Insulin pump Therapy to Control HbA1c): Design and Methods of a Randomized Controlled Crossover Trial on Sensor-Augmented Insulin Pump Efficacy in Type 1 Diabetes Suboptimally Controlled with Pump Therapy. Diabetes Technol Ther [Internet]. 2011;13(1):49-54. Available from: http://online.liebertpub.com/doi/abs/10.1089/dia.2010.0107
62. Lind M, Polonsky W, Hirsch IB, Heise T, Bolinder J, Dahlqvist S, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections the gold randomized clinical trial. JAMA - J Am Med Assoc. 2017;317(4):379-87.
Publicado
2018-08-17
##submission.howToCite##
GÓMEZ, Ana María et al. Relevancia del monitoreo continuo de glucosa en la práctica clínica: revisión de la evidencia. Revista Colombiana de Endocrinología, Diabetes & Metabolismo, [S.l.], v. 5, n. 3, p. 33-42, ago. 2018. ISSN 2389-9786. Disponible en: <http://revistaendocrino.org/index.php/rcedm/article/view/432>. Fecha de acceso: 22 abr. 2019
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Articulos de Revisión