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CADTH Health Technology Review
Authors; Angela M. Barbara, and Aleksandra Grobelna.
Diabetes is a chronic condition in which the body is not able to produce enough insulin and/or properly use insulin.1 The body needs insulin to use sugar as an energy source.1 Type 1 diabetes is an autoimmune condition in which the insulin-producing beta cells of the pancreas are destroyed by the immune system.1 Type 1 diabetes is often diagnosed in childhood and common presenting symptoms include frequent urination, excessive thirst, weight loss, and diabetic ketoacidosis (a potentially life-threatening complication of diabetes in which acids called ketones build up to dangerous levels in the body).2,3 In addition, hypoglycemia-related changes can have a negative impact on the quality of life of people with type 1 diabetes and lead to hypoglycemia fears.4 Type 2 diabetes is a condition that occurs when the body does not make enough insulin and/or does not respond to the insulin it makes.1 In the early stages of type 2 diabetes, there may be no symptoms or only mild symptoms that can go unnoticed.5 When symptoms are present, they can include frequent urination, excessive thirst and hunger, fatigue, blurry vision, slow-healing wounds, and tingling, pain, or numbness in the hands and/or feet.5
Approximately 3 million Canadians have diagnosed diabetes.6 The most common type of diabetes in adults is type 2 diabetes, accounting for approximately 90% of adults living with diabetes in Canada.7 In children and youth aged younger than 20 years in Canada, type 1 diabetes accounts for at least 85% of diabetes cases.6
All people living with type 1 diabetes and some people with type 2 diabetes need to take insulin to keep blood glucose levels within the target range.1,8 There are many ways insulin therapy can be delivered, including multiple daily injections and insulin pumps.8 Blood glucose monitoring is used in combination with insulin therapy to adjust insulin doses and maintain glucose control.9 The traditional method for blood glucose monitoring is self-monitoring of blood glucose (SMBG) using a glucometer (also called capillary blood glucose monitoring).10 SMBG requires a fingerstick to take a blood sample, which can be painful and time-consuming.11 Some people living with diabetes find it difficult to practice SMBG at the recommended rates (e.g., 6 to 10 times per day).9 Additionally, nocturnal or asymptomatic hypoglycemia (low blood glucose) may not be recognized through SMBG.11 Severe hypoglycemia can lead to coma or death.11
Continuous glucose monitoring (CGM) systems continuously measure the glucose concentration in the interstitial fluid and transfer the data to a receiver which displays the results.11 These devices represent an alternative to SMBG for people living with diabetes. CGM systems typically consist of 3 components: a sensor inserted into the deepest layer of the skin, a transmitter attached to the sensor, and a receiver (monitor or smartphone) that displays the results.11,12 There are 2 types of CGM systems available for personal use: real-time CGM (rtCGM) and intermittently scanned CGM (isCGM, also known as flash glucose monitoring).11 rtCGM systems (e.g., Dexcom G6, Guardian Connect) measure the glucose values and automatically display a recent value.11 rtCGM devices have the capability for alerts and alarms for current and/or impending glycemic events, such as hyperglycemia or hypoglycemia.13 Some older rtCGM systems (e.g., Dexcom G5) require daily calibration with SMBG, whereas newer devices (e.g., Dexcom G6) do not.13,14 The rtCGM sensor application site is typically the abdomen or gluteus area.11,15
Diabetes is regarded as a burdensome disease for health care systems because of the time and resource costs related to the management of diabetes and its complications.6 The direct cost to the Canadian health care system for type 1 and type 2 diabetes was $3.8 million in 2020 and is estimated to climb to $4.9 million in 2030.16 The financial burden of rtCGM use in patients is also high.17 Many people in Canada with diabetes pay more than 3% of their income, or more than $1,500 per year, for prescribed medications, devices, and supplies; these out-of-pocket costs affect treatment adherence.16
In 2022, CADTH reviewed the clinical and cost-effectiveness of CGM in 3 rapid reviews: rtCGM compared to isCGM for people with diabetes,18 rtCGM compared to SMBG for people with type 1 diabetes,19 and rtCGM versus SMBG for people with type 2 diabetes.20 The purpose of this rapid review is to summarize and critically appraise evidence-based guidelines regarding the use of rtCGM in people living with type 1 or type 2 diabetes.
What are the evidence-based guidelines regarding the use of real-time continuous glucose monitoring in adult and pediatric populations living with type 1 or type 2 diabetes?
A limited literature search was conducted by an information specialist on key resources including MEDLINE, Embase, the Cochrane Database of Systematic Reviews, the International HTA Database, and the websites of Canadian and major international health technology agencies, as well as a focused internet search. The search strategy comprised both controlled vocabulary, such as the National Library of Medicine’s MeSH (Medical Subject Headings), and keywords. The main search concepts were continuous glucose monitoring (CGM), real-time continuous glucose monitoring (rtCGM), type 1 diabetes, and type 2 diabetes. No filters were applied to limit the retrieval by study type. Comments, newspaper articles, editorials, letters, and conference abstracts were excluded.
Where possible, retrieval was limited to the human population. The search was completed on July 12, 2022, and limited to English-language documents published since January 1, 2017.
One reviewer screened citations and selected studies. In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved and assessed for inclusion. The final selection of full-text articles was based on the inclusion criteria presented in Table 1.
Selection Criteria.
Articles were excluded if they did not meet the selection criteria outlined in Table 1 or were published before 2020. Guidelines for pregnant people living with type 1 or type 2 diabetes were excluded. Guidelines with unclear methodology were also excluded.
The included publications were critically appraised by 1 reviewer using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument21 for guidelines. Summary scores were not calculated for the included studies; rather, the strengths and limitations of each included publication were described narratively.
A total of 879 citations were identified in the literature search. Following screening of titles and abstracts, 874 citations were excluded and 5 potentially relevant reports from the electronic search were retrieved for full-text review. Six potentially relevant publications were retrieved from the grey literature search for full-text review. Of these 11 potentially relevant articles, 5 publications were excluded for various reasons, and 6 evidence-based guidelines met the inclusion criteria and were included in this report. Appendix 1 presents the PRISMA22 flow chart of the study selection.
Additional references of potential interest are provided in Appendix 5.
Six evidence-based guidelines10,23-27 were included in this report.
Five guidelines10,23-25,27 reported their methodology in separate publications.28-31 These documents were used to supplement the information summarized in this report.
The American Diabetes Association (ADA) Standards of Medical Care for Diabetes23 were updated in 2022. An extensive literature search was performed, and relevant literature was reviewed through July 1, 2021, with critical updates through August 1, 2021 considered. Recommendations were revised based on new evidence, new considerations for standard of care practices, or to clarify prior recommendations or revise wording to match the strength of the published evidence. Recommendations were assigned letter ratings depending on the quality of the evidence: A for well-conducted randomized controlled trials (RCTs) that are adequately powered or have compelling non-experimental evidence; B for well-conducted cohort studies or case-control studies; C for poorly controlled or uncontrolled studies or conflicting evidence with the weight of evidence supporting the recommendation; or E for expert census or clinical experience. The ADA Standards of Care23 were reviewed by ADA’s clinical staff leadership, and underwent annual review and approval by the board of directors.
The 3 National Institute for Health and Care Excellence (NICE) guidelines10,24,25 were updated in 2022 and informed by systematic reviews of clinical effectiveness and cost-effectiveness. Systematic searches until May 2021 for relevant RCTs, systematic reviews of RCTs, and economic evaluations were undertaken. The NICE guidelines10,24,25 used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the quality of the evidence. The quality of evidence was graded from very low to high, and reflected the strength of recommendations in the wording (i.e., “offer/advise” was used for strong recommendations with clear evidence of benefit, while “consider” was used if the evidence was less certain). The committee discussed the evidence and drafted the recommendations. The committee moved from the evidence to each recommendation and discussed any issues that influenced their decision-making. In line with the GRADE principles on “evidence to decisions”, summaries of the discussions described the relative value placed on outcomes, benefits and harms, resource use, and the overall quality of the evidence.10,24,25
The American Association of Clinical Endocrinology (AACE) guideline26 was published in 2021 and informed by systematic searches between January 2012 and February 2021 for systematic reviews, RCTs, and non-randomized studies. Levels of evidence were assigned to included studies according to established AACE evidence ratings: strong (RCT or meta-analysis of only RCTs), intermediate (meta-analysis of non-randomized studies, network meta-analysis, non-randomized studies, epidemiological studies), or weak (discovery science, economic studies, case series, case reports, preclinical studies, basic science).26 These ratings informed the confidence and strength of evidence in aggregate for each recommendation: grades A (very strong), B (strong), C (not strong), and D (primarily based on expert opinion). Clinical questions provided the framework for the guidelines with answers in the form of recommendations. Final recommendations were based on discussion and unanimous consensus.26
The 2021 Diabetes Canada guideline on glucose monitoring in adults and children with diabetes27 was an update to the 2018 recommendations for monitoring glycemic control. This 2021 report was developed based on a systematic search of the literature published from November 2017 to October 2020 to retrieve relevant articles published since the last literature search of the original report. The full-text citations and critical appraisal reports were prepared by the McMaster Evidence Review and Synthesis Team and reviewed by the expert working group, who graded the evidence and drafted the revised recommendations. Evidence levels were designated as follows: 1A for evidence obtained from a systematic review or meta-analysis of high-quality RCTs or an appropriately designed RCT with adequate power to answer the research question; 1B for a non-randomized clinical trial or cohort study with indisputable results; 2 for an RCT or systematic review that does not meet level 1 criteria; 3 for a non-randomized clinical trial or cohort study or systematic review or meta-analysis of non-randomized trials or cohort studies; and 4 for other studies. Grading of recommendations was based on the level of the best evidence: A (the best evidence was at level 1); B (level 2); C (level 3); and D (required best evidence at level 4 or consensus). The steering committee reviewed the cited evidence independently and suggested revisions to the draft recommendations and the text.27 Final recommendations were unanimously approved by the steering committee.27
The ADA guideline23 and AACE guideline26 were designed for use in the US. The 3 NICE guidelines10,24,25 were intended to be applied in England. The Diabetes Canada guideline27 was developed for Canada.
The target populations of 3 guidelines23,26,27 were adults and children living with diabetes. The other 3 guidelines targeted adults with type 1 diabetes,10 adults with type 2 diabetes,25 and children and young people with type 1 diabetes.10
The intended users of 5 guidelines10,23,24-26 were health care professionals and other key stakeholders. For the NICE guidelines,10,24,25 the intended users also included people living with type 1 or type 2 diabetes, and their families and carers. The intended users of the Diabetes Canada guideline27 were not explicitly reported, but can be deduced to be people living with diabetes and their health care providers.27
Recommendations that specified rtCCM in the 6 guidelines10,23-27 were included. Five guidelines10,23-26 made recommendations regarding any CGM systems, which include rtCGM and isCGM. Due to the large number and nature of these recommendations (e.g., general usage, patient education, discussing patient concerns),10,23-26 only specific recommendations regarding the use of rtCGM were considered relevant for this report.
In the evidence synthesis for all guidelines,10,23-27 the comparator was SMBG.
rtCGM was also compared to isCGM in the evidence synthesis for all guidelines.10,23-27 isCGM systems (e.g., FreeStyle Libre) measure glucose levels every minute and store 1 value every 15 minutes. isCGM systems need to be actively scanned to display glucose information.11 Only the most recent 8 hours of data are retained in isCGM systems and, therefore, the person using the system must scan the sensor at least every 8 hours to avoid data gaps.13
The primary outcomes in the 3 NICE guidelines10,24,25 were hemoglobin A1C, time spent in target glucose range estimates, hypoglycemia, glycemic variability, mortality, and diabetic ketoacidosis. Secondary outcomes were other adverse events, mental health outcomes, awareness of hypoglycemia, adherence, and quality of life.10,24,25 The 3 NICE guidelines10,24,25 also considered cost-effectiveness.
Three guidelines23,26,27 did not report on the outcomes considered during development, or if and which outcomes were eligible during selection of supporting evidence; however, evidence on hemoglobin A1C,23,26,27 time in range estimates,26,27 hypoglycemia,23,26,27 quality of life,23,26,27 and adverse events (e.g., severe hypoglycemia,26,27 hospitalizations,23 emergency department visits23) were mentioned in the recommendations and/or supporting evidence.23,26,27
Additional details regarding the characteristics of included publications are provided in Appendix 2.
An overview of the critical appraisal of the included guidelines is summarized in the following text. Additional details regarding the strengths and limitations of the included guidelines are provided in Appendix 3.
With respect to scope and purpose, all guidelines10,23-27 provided a clear description of their objectives and specified the target populations. The clinical research questions covered by the guidelines were reported in 4 guidelines,10,24-26 but not in the ADA23 and Diabetes Canada27 guidelines.
The guideline development groups were comprised of clinical and methodological experts from multidisciplinary areas for all guidelines.10,23-27 The NICE guidelines10,24,25 included at least 2 lay members (patients with type 1 or type 2 diabetes and caregivers) on their guideline committees, and sought involvement from people with type 1 or 2 diabetes who use health and care services, family members, caregivers, and the public. For 3 guidelines,23,26,27 the views and preferences of the target population were not sought and there was no mention of patient, parent, or caregiver representation or consultation.23,26,27
With respect to rigour of guideline development, systematic methods were used to search for evidence in all guidelines.10,23-27 The NICE guidelines10,24,25 provided full details of the strategy used to search for evidence. The ADA and Diabetes Canada guidelines23,27 provided very brief details of their methodology; specifically, the undertaking of a literature review and the search time frame. However, it was not specified how the literature review process was carried out (e.g., databases searched, main search terms, inclusion criteria, how relevant studies were selected) in these 2 guidelines.23,27 The authors of the AACE guideline26 conducted literature searches in 1 database (i.e., PubMed), which may have resulted in omission of relevant information.
The link between the individual recommendations and supporting evidence was not completely evident in 5 guidelines.10,23-27 Rather, each report10,23-27 provided a section on the overall evidence for CGM or rtCGM. Therefore, the reasoning used to reach the individual recommendations was not always clear. Four guidelines10,24-26 were externally reviewed by experts before publication, but 2 guidelines did not report how the guideline was validated.23,27
All guidelines10,23-27 provided specific, unambiguous, and easily identifiable recommendations. The potential resource implications of applying the recommendations were considered in 4 guidelines,10,24-26 but not in the ADA23 and Diabetes Canada27 guidelines.
Four guidelines10,24-26 described their procedure for updating their guidelines. While it was reported that the ADA guideline23 underwent an annual review, the procedure for guideline updates was not explicitly described.
Regarding editorial independence, it was uncertain whether the views of the funding body influenced the content of the included guidelines.10,23-27 For each guideline,10,23-27 the funding was provided by the professional organization (i.e., ADA, NICE, AACE, Diabetes Canada) that was responsible for creating the guidelines, and there was no explicit statement that the views of the funding body had not influenced the guideline. However, all guidelines10,23-27 reported the competing interests of their authors.
In summary, the 3 NICE guidelines10,24,25 followed a detailed process for developing the recommendations based on the criteria outlined in the AGREE II instrument.21 The methodology of the AACE guideline26,27had some limitations. The ADA23 and Diabetes Canada27 guidelines did not report sufficient detail regarding the methodology used for developing their recommendations.
Additional details regarding the strengths and limitations of included publications are provided in Appendix 3.
Appendix 4 presents the main study findings and authors’ conclusions.
The ADA Standards of Care23 recommended rtCGM for adults with type 1 diabetes for diabetes management based on level A evidence (well-conducted and adequately powered RCTs; strength of recommendation not reported).
The NICE guideline for adults with type 1 diabetes10 made a strong recommendation for the use rtCGM (level of evidence not reported). The NICE guideline10 also strongly recommended the use of SMBG if a person could not or did not want to use rtCGM (level of evidence not reported).
The Diabetes Canada guideline27 recommended rtCGM for adults with type 1 diabetes who were willing and able to use rtCGM devices on a near-daily basis (grade A recommendation, based on well-conducted RCTs). rtCGM was recommended versus SMBG (grade A recommendation, based on well-conducted RCTs) and isCGM (grade B recommendation, based on low- to moderate-quality RCTs).
The AACE guideline26 strongly recommended rtCGM over isCGM for persons with diabetes (type not specified) with problematic hypoglycemia who required predictive alarms/alerts based on low- to intermediate-quality evidence. The AACE guideline26 also very strongly recommended rtCGM for persons aged 65 years and older with insulin-requiring diabetes (type not specified), based on intermediate-quality evidence.
The ADA Standards of Care23 recommended rtCGM for adults with type 2 diabetes for diabetes management, based on level A evidence (strength of recommendation not reported).
The NICE guideline for adults with type 2 diabetes25 recommended rtCGM as an alternative to isCGM if available for the same or lower cost, based on evidence indicating that the benefit was less than certain.
The Diabetes Canada guideline27 recommended rtCGM for adults with type 2 diabetes using basal-bolus therapy who had not achieved their hemoglobin A1C target and were willing and able to use rtCGM devices (grade A recommendation, based on well-conducted RCTs).
The AACE guideline26 strongly recommended rtCGM over isCGM for persons with diabetes (type not specified) with problematic hypoglycemia who required predictive alarms/alerts based on low- to intermediate-quality evidence. The AACE guideline26 also very strongly recommended rtCGM for persons 65 years of age and older with insulin-requiring diabetes (type not specified) based on intermediate-quality evidence.
The ADA Standards of Care23 recommended rtCGM for youth with type 1 diabetes for diabetes management, based on level B evidence (well-conducted cohort studies).
The NICE guideline for children and young people with type 1 diabetes24 made a strong recommendation for the use of rtCGM (level of evidence not reported). The NICE guideline also made a strong recommendation for offering children and young people with type 1 diabetes a choice of rtCGM device, with a list of factors to consider when choosing a device (e.g., device accuracy, access to specific technologies, fear of hypoglycemia, device calibration, predictability of child or young person’s activity, and blood glucose levels). The NICE guideline24 also strongly recommended the use of isCGM for children and young people with type 1 diabetes who were unable to use rtCGM or expressed a clear preference for isCGM (level of evidence not reported). A strong recommendation was also made for the use capillary blood glucose monitoring for persons who could not or did not want to use rtCGM or isCGM (level of evidence not reported).24
The Diabetes Canada guideline27 recommended rtCGM for children with type 1 diabetes who were willing and able to use rtCGM devices on a near daily basis (grade A recommendation, based on well-conducted RCTs).
The ADA Standards of Care23 recommended rtCGM for youth with type 2 diabetes for diabetes management, based on expert consensus or clinical expertise (in the absence of evidence from clinical studies).
The ADA Standards of Care23 recommended that rtCGM be used as close to daily as possible for maximum benefit, based on level A evidence. The ADA guideline23 also recommended periodic use of rtCGM or isCGM in circumstances where continuous use was not appropriate, desired, or available. The level of evidence supporting this recommendation was reported as C (poorly controlled or uncontrolled studies, or conflicting evidence), but the evidence itself was not reported.23
Four guidelines10,23,25,27 recommended rtCGM for people who had the ability to use rtCGM devices. For examples, the ADA Standards of Care23 made recommendations for adults and youth “who are capable of using devices safely (either by themselves or with a caregiver)” and the NICE guidelines for adults with type 110 and type 2 diabetes25 made recommendations for alternatives to rtCGM for people who “cannot use” rtCGM.10 However, there was no further information or guidance provided in the guideline documents regarding how the clinician should determine if patients meet these requirements.10,23,25
CGM technologies are changing very quickly with increasing overlap between rtCGM and isCGM, as features such as predictive alerts or alarms (available in rtCGM devices) are added to newer isCGM devices.10 The guideline authors acknowledged this, and therefore did not make recommendations on using specific devices, as such recommendations would soon be out of date.10,23,24
The Diabetes Canada guideline23 was developed for the Canadian context, but was assessed as having a number of limitations due to incomplete reporting of the methods. The other 5 guidelines10,23-26 were developed for use in the US23,26 or England10,24,25; therefore, the generalizability of the recommendations to the Canadian context was unclear.
This report comprised 6 evidence-based guidelines10,23-27 regarding the use of rtCGM in people living with type 1 or type 2 diabetes.
Of the included guidelines, 410,23,26,27 recommended the use of rtCGM by adults, including seniors (who are at significantly higher risk for severe hypoglycemia compared to younger people),23,26 for the management of type 1 diabetes. This recommendation is aligned with the findings of the 2022 CADTH report on the clinical effectiveness and cost-effectiveness of rtCGM in type 1 diabetes.19 The report concluded that rtCGM may have been favoured over SMBG in improving hemoglobin A1C, time in range outcomes, and severe hypoglycemia in adults with type 1 diabetes. The CADTH report19 also found that rtCGM may be more cost-effective in the long term compared to SMBG in adults with type 1 diabetes.19
Four guidelines23,25-27 recommended the use of rtCGM by adults with type 2 diabetes. This recommendation reflects the results of the 2022 CADTH report on the effectiveness of type 2 diabetes that rtCGM20 may provide positive effects on hemoglobin A1C, with low rates of severe adverse events. However, the CADTH report found that rtCGM was not cost-effective compared to SMBG in people with type 2 diabetes.20
Three guidelines23,24,27 recommended the use of rtCGM for children and young people with type 1 diabetes. This also reflects the findings of the 2022 CADTH report on the effectiveness of type 1 diabetes19 that rtCGM may provide positive effects on hemoglobin A1C, time in range, time above range, and treatment satisfaction in children and pediatric patients with type 1 diabetes.
Overall, the strength of these recommendations ranged from less than certain to very strong and were based on evidence that ranged in quality from very low to high.10,23,26,27 The quality of the clinical and cost-effectiveness evidence of rtCGM (as assessed by systematic review authors) was also found to range from very low to high-quality in the 2 CADTH reports on type 1 and type 2 diabetes.19,20 Recommendations emphasized patient choice and suggested that adherence to rtCGM was likely to be higher if the device was matched to a person’s needs and preferences.10,23-25,27
The authors of the Diabetes Canada guideline27 and the NICE guideline for children and young people24 acknowledged that there was a lack of evidence on the clinical effectiveness of rtCGM in children and young people with type 2 diabetes. The CADTH report on the clinical and cost-effectiveness of rtCGM in type 2 diabetes20 also reported no evidence in pediatric patients. Diabetes Canada27 and NICE24 did not make recommendations for the use of rtCGM for children and young people with type 2 diabetes. Rather the NICE guideline24 made a recommendation for research on continuous glucose monitoring in children and young people living with type 2 diabetes. On the other hand, the ADA guideline23 recommended rtCGM for youth with type 2 diabetes based on expert consensus and/or clinical expertise, in the absence of evidence of clinical effectiveness.
Five guidelines23,24,25,26,27 recommended rtCGM more favourably than isCGM for diabetes management. The NICE guideline for adults with type 1 diabetes10 recommended both rtCGM and isCGM, due to the very low certainty of the evidence on comparative clinical effectiveness between the 2 CGM technologies.
In general, there was agreement across guidelines on the use of rtCGM for the management of type 1 and 2 diabetes in adults and pediatric populations. However, the variation in the strengths of recommendations and heterogeneity in the quality of evidence should be considered when interpreting the findings of this report. Guidelines developed with rigorous methodology that are specific to the Canadian context would provide additional guidance in use of rtCGM for diabetes management in a more local context.
American Association of Clinical Endocrinology
American Diabetes Association
Appraisal of Guidelines for Research and Evaluation
continuous glucose monitoring
intermittently scanned continuous glucose monitoring
National Institute for Health and Care Excellence
real-time continuous glucose monitoring
randomized controlled trial
self-monitoring of blood glucose
Selection of Included Studies.
Characteristics of Included Guidelines.
Note that this appendix has not been copy-edited.
Strengths and Limitations of Guidelines Using AGREE II.
Note that this appendix has not been copy-edited.
Summary of Recommendations in Included Guidelines.
Note that this appendix has not been copy-edited.
Disclaimer: The information in this document is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. While patients and others may access this document, the document is made available for informational purposes only and no representations or warranties are made with respect to its fitness for any particular purpose. The information in this document should not be used as a substitute for professional medical advice or as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision-making process. The Canadian Agency for Drugs and Technologies in Health (CADTH) does not endorse any information, drugs, therapies, treatments, products, processes, or services.
While care has been taken to ensure that the information prepared by CADTH in this document is accurate, complete, and up to date as at the applicable date the material was first published by CADTH, CADTH does not make any guarantees to that effect. CADTH does not guarantee and is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in any third-party materials used in preparing this document. The views and opinions of third parties published in this document do not necessarily state or reflect those of CADTH.
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About CADTH: CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs, medical devices, diagnostics, and procedures in our health care system.
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Questions or requests for information about this report can be directed to Requests@CADTH.ca
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