Impact of CGM on the management of hypoglycemia problems: overview and secondary analysis of the HypoDE study
Open accessAbstract
Hypoglycemia remains the limiting factor of near-normal glucose control in people with diabetes using insulin therapy. Continuous glucose monitoring (CGM) may be able to avoid hypoglycemia and support the management of hypoglycemia problems in clinical care. Real-time continuous glucose monitoring (rtCGM) systems provide alerts if certain predetermined hypo- or hyperglycemic thresholds are exceeded. The combination of rtCGM systems with insulin pumps allows insulin delivery to be suspended if glucose falls below certain predefined thresholds. This might also support avoidance of hypoglycemia. More sophisticated closed-loop systems allow a semiautomatic insulin dosage, which also have the potential for the prevention of hypoglycemia. In this overview, we discuss and illustrate (1) the efficacy of CGM for intervention in people with hypoglycemia problems and for the avoidance of biochemical as well as clinical hypoglycemia; (2) the potential of CGM technology for the identification of people with diabetes who are at risk for hypoglycemia problems; and (3) the implications of the current state of the art for future research regarding CGM and hypoglycemia. As an example, how rtCGM data can facilitate identification of people with diabetes and an elevated risk of hypoglycemia, a secondary analysis of the HypoDE data is presented. We conclude that CGM technology can assist in the reliable identification of people with diabetes who are at risk for hypoglycemia problems, is a powerful intervention for the avoidance of mild as well as severe hypoglycemia, and can also stimulate research on the course of hypoglycemia problems.
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CGM can reveal asymptomatic hypoglycemia and help identify patterns and precipitants of hypoglycemic events and provide alarms that can warn individuals of falling glucose so that they can intervene.
“CGM can reveal asymptomatic hypoglycemia and help identify patterns and precipitants of hypoglycemic events and provide alarms that can warn individuals of falling glucose so that they can intervene (150,151).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [151]
The ‘Can CGM Facilitate Diagnosis of Hypoglycemia Problems?’ section says CGM detects previously unrecognized asymptomatic episodes, and ‘Is rtCGM an Effective Intervention to Reduce Hypoglycemia Problems?’ describes alerts and glucose trends that allow an immediate response. The paper also describes glucose histories that can reveal patterns, but the passages do not establish that CGM identifies the precipitants of individual hypoglycemic events. (LLM, conf=0.84)
Experimental — accuracy not yet measuredWith the advent of sensor-augmented CGM and CGM-assisted pump therapy, there has been a promise of alarm-based prevention of hypoglycemia.
“With the advent of sensor-augmented CGM and CGM-assisted pump therapy, there has been a promise of alarm-based prevention of hypoglycemia (108,109).”
From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [108]
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References 45 · Cited by 66
Research works printed but not linked: 6
- [9]9. McCrimmon RJ, Deary IJ, Frier BM. Appraisal of mood and per- sonality during hypoglycaemia. Physiol Behav. 1999;67:27-33.
- [24]24. Frier BM. Impaired awareness of hypoglycaemia. In: Frier BM, Fisher M, eds. Hypoglycaemia in Clinical Diabetes. Vol. 2. Chichester, UK: John Wiley; 2007:141-170.
- [33]33. Heinemann L, Freckmann G, Ehrmann D, et al. Real-time con- tinuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a mul- ticentre, randomised controlled trial. Lancet. 2018;391:1367- 1377.
- [39]39. Heinemann L, Deiss D, Hermanns N, et al. HypoDE: research design and methods of a randomized controlled study evaluat- ing the impact of real-time CGM usage on the frequency of CGM glucose values <55 mg/dl in patients with type 1 diabe- tes and problematic hypoglycemia treated with multiple daily injections. J Diabetes Sci Technol. 2015;9:651-662.
- [42]42. Fanelli CG, Epiphano L, Rambotti AM, et al. Meticulos preven- tion of hypoglycemia normalizes the glycemic thresholds and magnitude of most neuroendocrine responses to symptoms of, and cognitive function during hypoglycemia in intensively treated patients with short term IDDM. Diabetes. 1992;42:1683-1689.
- [44]44. Parker AIW, Jimenez J, A., Graham C. Effect of Sharing Continuous Glucose Monitoring Data from Young Children With Diabetes on CGM Usage and Hypoglycemic Exposure. New York, NY: Wiley; 2017.
- Authors
- Hermanns, N., Heinemann, L., Freckmann, G., Waldenmaier, D., & Ehrmann, D.
- Affiliations
- German Diabetes Center Mergentheim (DE)
- Science-Consulting in Diabetes GmbH, Düsseldorf, Germany
- Universität Ulm (DE)
- Forschungsinstitut der Diabetes Akademie Mergentheim (DE)
- Corresponding author
- Hermanns, Norbert
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2019-03-06
- Volume
- 13
- Issue
- 4
- Pages
- 636-644
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC6610605
- OpenAlex
- W2922205739
- Semantic Scholar
- 26584a37b26a421a89d2a8024ffc23e3dd3f22cd
- Cited by
- 66
- References
- 45
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 11 · 2023: 10 · 2022: 11 · 2021: 7 · 2020: 4 · 2019: 4
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- continuous glucose monitoring, hypoglycemia, diabetes mellitus, insulin therapy, real-time CGM, insulin pump, artificial pancreas
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Humans, Hypoglycemia, Blood Glucose Self-Monitoring
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