Latest CPG Evidence Levels Show Highest Confidence Rating in Clinical Outcomes for rtCGM Devices

The latest Diabetes Canada Clinical Practice Guidelines (CPG) update shows stronger recommendations for real-time continuous glucose monitoring (rtCGM) systems, like the Dexcom G6 Continuous Glucose Monitoring (CGM) System, compared to intermittently-scanned continuous glucose monitoring (isCGM) devices. To develop the CPG, Diabetes Canada formed an Expert Committee of 135 professional volunteers from diverse practice settings across the country.

Each recommendation was assigned a grade based on:

• the best available evidence level,
• its methodological strength, and
• its applicability to the Canadian population.

Here, we’ll take a closer look at the methodology to help clarify the grades, evidence levels, and research used to determine these guidelines.

What Does the Grading System Mean?

Each recommendation of the Clinical Practice Guidelines has been assigned a grade based on the best available evidence level, its methodological strength, and its applicability to the Canadian population. Each recommendation was reviewed by an Independent Methods Review member and had to be approved by the Steering Committee and Executive Committee, with 100% consensus. A high grade (Grade A) reflects a high degree of confidence that, following the recommendation, will lead to the desired clinical outcome.

Grading of recommendation explained:

• Grade A recommendations are based on the best evidence which met the Level 1A/1B criteria:
  • Level 1A: Systematic overview or meta-analysis of high-quality randomized clinical trials (RCTs), or appropriately designed RCT with adequate power to answer the question posed by investigators.
  • Level 1B: Non-randomized clinical trial or cohort study with indisputable results.
• Grade B recommendations are based on the best evidence at Level 2:
  • Level 2: RCT or systematic overview that does not meet Level 1 criteria.
• Grade C recommendations are based on the best evidence at Level 3:
  • Level 3: Non-randomized clinical trial or cohort study; systematic overview or meta-analysis of level 3 studies.
• Grade D recommendations are based on the best evidence at Level 4 (Other) or consensus.

Download a Grading Summary

Updated CPG Promotes High Confidence in rtCGM

In the updated 2021 Clinical Practice Guidelines, interventions supported by Grade A, Level 1 evidence, and confirmed as appropriate through clinical experience, are now written as “should be used” in place of the previous language of “may be offered.”

rtCGM products, like Dexcom G6, are now supported by many Grade A, Level 1 evidence recommendations, unlike competing isCGM products, improving clinical confidence in the ongoing benefits of rtCGM systems like Dexcom G6 for both Type 1 and Type 2 patients living with diabetes.

View the Guidelines