Real-Time Continuous Glucose Monitoring in Adult Outpatients

Abstract

With real-time continuous glucose monitoring (RTCGM), the patient has a continuous picture of glucose concentrations -dynamic information with important predictive value. It is in fact a typical 'patient-oriented' tool that permits a more aggressive therapeutic approach and makes it easier to adapt therapy immediately. Currently approved RTCGM devices consist of three main components: a glucose sensor, a transmitter, and a receiver monitor. The system is defined as minimally invasive because it requires insertion into the subcutaneous cellular tissue of a fine needle to measure the glucose in the interstitial fluid directly or via an external sensor. A correct selection of patients is one of the most important factors in determining a successful application of this innovative technology. For this purpose, there are already consensus statements in a number of countries with regard to the indications of these systems. The criteria for identification of candidates are usually divided into three main categories: pediatric/adolescent, adult patients (both in the general population of type 1 diabetes and in specific settings), and pregnant women or women in the preconception period. RTCGM opens up extremely interesting prospects that are destined to radically change the concept of clinical self-management of diabetes. Considering the technical progress towards overcoming the current limitations (essentially: not optimal accuracy, invasiveness, and costs) which currently prevent its widespread use, we can expect wide diffusion of this form of monitoring in the coming years.

Electrochemical Glucose Biosensors for Diabetes Care

“…Identification of the undiscovered hypoglycemia is an important goal [235,239,240] that is made difficult and less reliable by the performance of the available systems in the hypoglycemic range and the occurrence of signal deviations, or dropouts, especially at night [235]. A personal CGM system may be used by the HCP in the same way as a professional system [241] and must then meet similar requirements for download and evaluation of the saved results. There is no stringent requirement for cleaning and disinfection of any reusable part, however, as long as the system is used as a single patient system and not as a multiple patient system.…”