The Application of Continuous Glucose Monitoring Endpoints in Clinical Research: Analysis of Trends and Review of Challenges.

Introduction: Considerable efforts to standardize continuous glucose monitoring (CGM) have occurred in recent years. The aim was to perform an analysis of clinical studies in clinicaltrials.gov to evaluate trends in CGM endpoint adoption.

Methods: Clinicaltrials.gov was searched for studies of drugs, devices and combination products containing CGM terms posted from 2012 to 2023. 1269 studies were returned and 954 were excluded. 315 studies were divided into two periods (P1 [2012-2017] and P2 [2018-2023]) and differences analyzed using descriptive statistics and two-tailed tests.

Results: There was a significant 60.3% increase in total clinical studies from P1 (121) to P2 (194). Phase 2 and Phase 3 Studies both saw significant increases of 125.8 and 169.2%, respectively, in P2. Adult-only studies predominated in both periods, with a 40.4% increase in P2. Studies that included pediatric populations, although smaller in number, increased significantly. Most studies were nonindustry-funded, and studies in this category saw a significant 80.0% increase in P2. However, industry-only funded studies also increased significantly by 78.4% in P2 in the same period. Studies of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) increased by 55.8% and 26.9%, respectively, but increases were not statistically significant. Studies of nondiabetes-related indications did increase significantly (233.3%). 27.6% of studies used CGM-derived metrics as primary endpoints (PE). Studies that used time in range (TIR) increased by 222.4% in P2, which was significant. Conversely studies that used mean amplitude of glycemic excursions (MAGE) decreased significantly by 71.3%.

Conclusion: Our data provide evidence of significant increases in the application of CGM endpoints in clinical studies in the last six years, including studies with TIR as the PE. Increases have been driven largely by academia, but our data show that industry is starting to follow suit. The significant increase in studies that included pediatrics is encouraging.