Clinical Experience with Continuous Glucose Monitoring in Adults

Abstract

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.

Education on sensor-augmented pump use improves glucose control in type 1 diabetic patients

“…Our data, as with those obtained in other studies [3][4][5][6][7], support the hypothesis that education on the use of continuous information on glucose levels from a subcutaneous sensor, combined with insulin-pump delivery, can improve glucose levels in patients who fail to achieve sufficient control with state-of-the-art insulin therapy. However, given our study design, it is difficult to differentiate which part of the metabolic improvement was due to the new technology itself and which was due to the better overall management/education of the patient.…”

“…However, no significant changes in indices of glucose variability were detected, perhaps because of the rather small number of participants in the study (Table 1). No severe hypoglycaemia or ketosis occurred during the follow-up, and no adverse events related to sensor-augmented pump use were reported.Our data, as with those obtained in other studies [3][4][5][6][7], support the hypothesis that education on the use of …”

“…Our data, as with those obtained in other studies [3][4][5][6][7], support the hypothesis that education on the use of…”

The interrelationship of HbA1c and real-time continuous glucose monitoring in children with type 1 diabetes

“…This phenomenon is the well-known Hawthorne effect studied in many fields of science, and already described in relationship to CGM as well [35].…”

Metabolic Control Targets for Patients with Type 1 Diabetes in Clinical Practice

“…The implementation of these technologies requires public health systems that have sufficient resources to initiate treatment and to ensure appropriate monitoring by the users. Further studies are needed on cost and effectiveness of these systems (Cummins et al, 2010;Fabiato et al, 2009;Huang et al, 2010).…”