Two types of continuous glucose monitoring (CGM) systems are now available: real-time CGM (rtCGM) and intermittently scanned (isCGM). Current rtCGM systems automatically transmit a continuous stream of glucose data to the user, provide alerts and active alarms, and transmit glucose data (trend and numerical) in real time to a receiver, smart watch, or smartphone. The current isCGM system provides the same type of glucose data but requires the user to purposely scan the sensor to obtain information, and it does not have alerts and alarms. Both CGM technologies have significant advantages over self-monitoring of blood glucose; however, differences in the features and capabilities of the two approaches must be considered when guiding patient selection of the system that meets their individual needs.

Clinical use of continuous glucose monitoring (CGM) devices has grown over the past 15 years from a niche concept to becoming standard of care for patients with type 1 diabetes (T1D). With the December 2016 Food and Drug Administration approval for diabetes treatment decisions directly from CGM values (nonadjunctive use) without finger-stick confirmation, the uptake and scope of CGM use will likely further expand. With this expansion, it is important to consider the role and impact of CGM technology in specific settings and high-risk populations, such as the young and the elderly. In pediatric patients, CGM concerns include limited body surface area, difficulty keeping sensors adhered, and the role of nonadjunctive use in the school setting. In older adults, Medicare did not, until very recently, cover CGM devices and as such, their use had been limited by lack of reimbursement. As CGM use will likely expand in clinical practice given the nonadjunctive indication, guidelines and recommendations for clinical practice are warranted. In this article, we discuss recent research on CGM use in the special populations of children and older adults and provide initial guidelines for nonadjunctive use in clinical practice.Keywords: Continuous glucose monitoring, Nonadjunctive use, Type 1 diabetes. CGM IntroductionC ontinuous glucose monitoring (CGM) devices have grown over the past 15 years from a niche concept to the standard of care for patients with type 1 diabetes (T1D). While traditional blood glucose monitoring (BGM) allowed for multiple, episodic snapshots of glycemia at various points in time, CGM data provide patients, caregivers, and medical providers with a 24-h ''glycemic video'' showing where glucose is, where it has been, and a prediction of where it may be going. In addition, many CGM systems now allow for digital remote monitoring, through which caregivers are able to view a patient's CGM tracing on their own smartphone and receive alerts based on individualized thresholds and trend parameters, a feature particularly useful in the pediatric population. 1Over the past 5 years, there has been substantial improvement in CGM performance leading to greater uptake and use in a broader spectrum of patients.2 Studies on earlygeneration CGM systems showed usage rates of about 5%-20% of patients with rates below 10% in the pediatric, adolescent, and young adult populations. 3,4 More recent data from the T1D exchange (T1DX) have shown growth in CGM use from 17% to 25% of patients, with particularly large increases in use among preschool-aged and early school-aged children.5 CGM barriers include dislike of on-body devices, cost, and insurance coverage. With the Food and Drug Administration (FDA) approval in December 2016 for management decisions that include insulin dosing from CGM values (nonadjunctive dosing), the scope and use of CGM will likely expand further as the benefit increases relative to burden.7 As CGM use expands, especially regarding nonadjunctive use, it is important to consider the role and im...

No abstract

No abstract