Long-Term Follow-Up of continuous glucose monitoring for diabetic neuropathy
DOI:
https://doi.org/10.5281/zenodo.22812621Keywords:
continuous glucose monitoring, diabetic neuropathy, glycemic variability, time in range, long-term follow-upAbstract
Background: Continuous glucose monitoring (CGM) has transformed glycemic surveillance, and longitudinal evidence links CGM-derived metrics, particularly time-in-range and glycemic variability, to the trajectory of diabetic neuropathy [6,13].
Objective: This review synthesizes long-term follow-up evidence on CGM use and diabetic neuropathy, examining how sustained glucose control and variability relate to nerve conduction, symptom burden, and neuropathy progression.
Methods: We synthesized randomized CGM trials, prospective cohort studies with multi-year follow-up, and mechanistic literature addressing glycemic variability, time-in-range, and diabetic neuropathy in type 1 and type 2 diabetes.
Findings: Sustained CGM use improves time-in-range and reduces variability relative to self-monitored glucose [7,8], and DCCT/EDIC follow-up shows that early sustained control durably lowers neuropathy incidence over decades [20,21]; CGM-derived variability correlates with nerve conduction slowing independent of mean glycemia [17,18].
Conclusions: Long-term CGM use supports glycemic stability that plausibly slows neuropathy progression, but dedicated trials linking CGM metrics directly to neuropathy endpoints remain limited; practice should combine CGM-guided variability reduction with standardized neuropathy screening [26,27].
References
Ziegler, D., Papanas, N., Vinik, A.I., Shaw, J.E. (2014) Epidemiology of polyneuropathy in diabetes and prediabetes. Handbook of Clinical Neurology, 126: 3-22. DOI: 10.1016/B978-0-444-53480-4.00001-1
Callaghan, B.C., Cheng, H.T., Stables, C.L., Smith, A.L., Feldman, E.L. (2012) Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurology, 11(6): 521-534. DOI: 10.1016/S1474-4422(12)70065-0
Feldman, E.L., Callaghan, B.C., Pop-Busui, R., Zochodne, D.W., Wright, D.E., Bennett, D.L., et al. (2019) Diabetic neuropathy. Nature Reviews Disease Primers, 5(1): 41. DOI: 10.1038/s41572-019-0092-1
Vinik, A.I., Nevoret, M.L., Casellini, C., Parson, H. (2013) Diabetic neuropathy. Endocrinology and Metabolism Clinics of North America, 42(4): 747-787. DOI: 10.1016/j.ecl.2013.06.001
Callaghan, B.C., Gao, L., Li, Y., Zhou, X., Reynolds, E., Banerjee, M., et al. (2018) Diabetes and obesity are the main metabolic drivers of peripheral neuropathy. Annals of Clinical and Translational Neurology, 5(4): 397-405. DOI: 10.1002/acn3.531
The Diabetes Control and Complications Trial Research Group. (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine, 329(14): 977-986. DOI: 10.1056/NEJM199309303291401
Beck, R.W., Riddlesworth, T., Ruedy, K., Ahmann, A., Bergenstal, R., Haller, S., et al. (2017) Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. JAMA, 317(4): 371-378. DOI: 10.1001/jama.2016.19975
Lind, M., Polonsky, W., Hirsch, I.B., Heise, T., Bolinder, J., Dahlqvist, S., et al. (2017) 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, 317(4): 379-387. DOI: 10.1001/jama.2016.19976
Heinemann, L., Freckmann, G., Ehrmann, D., Faber-Heinemann, G., Guerra, S., Waldenmaier, D., et al. (2018) 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, 391(10128): 1367-1377. DOI: 10.1016/S0140-6736(18)30297-6
Monnier, L., Mas, E., Ginet, C., Michel, F., Villon, L., Cristol, J.P., et al. (2006) Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA, 295(14): 1681-1687. DOI: 10.1001/jama.295.14.1681
Siegelaar, S.E., Holleman, F., Hoekstra, J.B., DeVries, J.H. (2010) Glucose variability; does it matter? Endocrine Reviews, 31(2): 171-182. DOI: 10.1210/er.2009-0021
Fullerton, B., Jeitler, K., Seitz, M., Horvath, K., Berghold, A., Siebenhofer, A. (2014) Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. Cochrane Database of Systematic Reviews, (2): CD009122. DOI: 10.1002/14651858.CD009122.pub2
Battelino, T., Danne, T., Bergenstal, R.M., Amiel, S.A., Beck, R., Biester, T., et al. (2019) Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care, 42(8): 1593-1603. DOI: 10.2337/dci19-0028
Danne, T., Nimri, R., Battelino, T., Bergenstal, R.M., Close, K.L., DeVries, J.H., et al. (2017) International consensus on use of continuous glucose monitoring. Diabetes Care, 40(12): 1631-1640. DOI: 10.2337/dc17-1600
Polonsky, W.H., Hessler, D., Ruedy, K.J., Beck, R.W. (2017) The impact of continuous glucose monitoring on markers of quality of life in adults with type 1 diabetes: further findings from the DIAMOND randomized clinical trial. Diabetes Care, 40(6): 736-741. DOI: 10.2337/dc17-0133
Beck, R.W., Bergenstal, R.M., Cheng, P., Kollman, C., Carlson, A.L., Johnson, M.L., et al. (2019) The relationships between time in range, hyperglycemia metrics, and HbA1c. Journal of Diabetes Science and Technology, 13(4): 614-626. DOI: 10.1177/1932296818822496
Bragd, J., Adamson, U., Backlund, L.B., Lins, P.E., Moberg, E., Oskarsson, P. (2008) Can glycaemic variability, as calculated from blood glucose self-monitoring, predict the development of complications in type 1 diabetes over a decade? Diabetes and Metabolism, 34(6): 612-616. DOI: 10.1016/j.diabet.2008.06.005
Jaiswal, M., Divers, J., Dabelea, D., Isom, S., Bell, R.A., Martin, C.L., et al. (2017) Prevalence of and risk factors for diabetic peripheral neuropathy in youth with type 1 and type 2 diabetes: SEARCH for Diabetes in Youth Study. Diabetes Care, 40(9): 1226-1232. DOI: 10.2337/dc17-0179
van Beers, C.A.J., DeVries, J.H., Kleijer, S.J., Smit, M.M., Geelhoed-Duijvestijn, P.H., Kramer, M.H.H., et al. (2016) Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial. Lancet Diabetes and Endocrinology, 4(11): 893-902. DOI: 10.1016/S2213-8587(16)30193-0
Martin, C.L., Albers, J.W., Pop-Busui, R., DCCT/EDIC Research Group. (2014) Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care, 37(1): 31-38. DOI: 10.2337/dc13-2114
Nathan, D.M., DCCT/EDIC Research Group. (2014) The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care, 37(1): 9-16. DOI: 10.2337/dc13-2112
Callaghan, B.C., Little, A.A., Feldman, E.L., Hughes, R.A. (2012) Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database of Systematic Reviews, (6): CD007543. DOI: 10.1002/14651858.CD007543.pub2
Ang, L., Jaiswal, M., Martin, C., Pop-Busui, R. (2014) Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Current Diabetes Reports, 14(9): 528. DOI: 10.1007/s11892-014-0528-7
Tesfaye, S., Chaturvedi, N., Eaton, S.E., Ward, J.D., Manes, C., Ionescu-Tirgoviste, C., et al. (2005) Vascular risk factors and diabetic neuropathy. New England Journal of Medicine, 352(4): 341-350. DOI: 10.1056/NEJMoa032782
Malik, R.A., Tesfaye, S., Newrick, P.G., Walker, D., Rajbhandari, S.M., Siddique, I., et al. (2005) Sural nerve pathology in diabetic patients with minimal but progressive neuropathy. Diabetologia, 48(3): 578-585. DOI: 10.1007/s00125-004-1663-5
Pop-Busui, R., Boulton, A.J.M., Feldman, E.L., Bril, V., Freeman, R., Malik, R.A., et al. (2017) Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care, 40(1): 136-154. DOI: 10.2337/dc16-2042
Tesfaye, S., Boulton, A.J.M., Dyck, P.J., Freeman, R., Horowitz, M., Kempler, P., et al. (2010) Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care, 33(10): 2285-2293. DOI: 10.2337/dc10-1303
Pratley, R.E., Kanapka, L.G., Rickels, M.R., Ahmann, A., Aleppo, G., Beck, R., et al. (2020) Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial. JAMA, 323(23): 2397-2406. DOI: 10.1001/jama.2020.6928
Bergenstal, R.M., Klonoff, D.C., Garg, S.K., Bode, B.W., Meredith, M., Slover, R.H., et al. (2013) Threshold-based insulin-pump interruption for reduction of hypoglycemia. New England Journal of Medicine, 369(3): 224-232. DOI: 10.1056/NEJMoa1303576
Reddy, M., Jugnee, N., El Laboudi, A., Spanudakis, E., Anantharaja, S., Oliver, N. (2018) A randomized controlled pilot study of continuous glucose monitoring and flash glucose monitoring in people with type 1 diabetes and impaired awareness of hypoglycaemia. Diabetic Medicine, 35(4): 483-490. DOI: 10.1111/dme.13561
Charleer, S., De Block, C., Van Huffel, L., Verhaegen, A., Matthys, C., Mathieu, C., et al. (2020) Quality of life and glucose control after 1 year of nationwide reimbursement of intermittently scanned continuous glucose monitoring in adults living with type 1 diabetes. Diabetes Care, 43(2): 389-397. DOI: 10.2337/dc19-1610
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