Despite recent advances in therapy, achieving adequate glycemic control may be difficult for a large number of patients with diabetes. Real-time (RT)-continuous glucose monitoring (CGM) has the potential to improve glycemic control through immediate feedback to the properly trained patient. However, limitations exist both in interpreting the results of published randomized clinical trials on CGM use and in extrapolating the results to the diabetes population at large. This review summarizes the evidence for use, identifies suitable candidates, describes optimal implementation, and employs case scenarios in order to emphasize practical aspects of RT-CGM use in adults. Establishment of expectations and comprehensive education in intensive insulin therapy and RT-CGM use are necessary for successful implementation. Because the technology has been shown to be most useful in patients who are actively viewing and responding to RT data, patients should receive explicit instructions for active self-adjustment of insulin and lifestyle elements. While the technology is improving, false alarms remain a significant barrier to optimal use. The utility of RT-CGM for patients with severe hypoglycemia or hypoglycemia unawareness has not been established. Finally, studies are needed to determine the sustainability of improvements in glycemic control, as well as cost-effectiveness and practicality of implementation into busy real-world practice.
Changes in ocular blood flow occur in systemic diseases. A high peak systolic velocity (PSV) in the ophthalmic artery (OA) has been observed in diabetes mellitus and hypertension, conditions often associated with high tissue renin-angiotensin system (RAS) activity and reduced renal plasma flow (RPF). Since our group has demonstrated that sodium restriction ( a high RAS state ) is associated with a decrease in RPF which is correctable with ACE inhibition, we hypothesized that sodium restriction would result in higher ophthalmic PSV. Sixteen healthy volunteers (age 46.2±13.2, male 69%, white 75%, BMI 26±3.7) were placed on a low sodium (LS) diet (10 mmol/day) for 1 week followed by high sodium (HS) diet (200 mmol/day). Sodium balance was assessed by 24hr urine collection. BP, RPF (PAH clearance) and OA hemodynamic measurements (Multigon, NY) were made after overnight fasting and rest in the supine position. Sodium restriction did not affect BP (systolic/diastolic LS: 121/73 ± 12/7 vs HS: 122/72 ± 15/9 mmHg, mean ± SD, NS) or heart rate (69 ± 16 vs 70 ± 15/min, NS). As expected, RPF was lower on LS compared with HS (599.2 ± 89.8 vs 633.4 ± 93.5ml/min/1.73 m 2 , p=0.006). Sodium restriction was associated with higher OA peak (38.8 ± 6.4 vs 33.2 ± 6.0 cm/sec, p=0.018) and mean (19.7±2.9 vs 17.1±3.5, p=0.003) systolic velocity ( Figure ). There was no change in end-diastolic velocity (10.6±2.5 vs 9.7±2.4, p=0.266) with sodium restriction. In conclusion, sodium restriction was associated with an increase in OA peak and mean systolic velocity in healthy individuals. Further studies are required to investigate the potential relevance of our results to diabetic and hypertensive retinopathy.
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