Use Of Real-time Continuous Glucose Monitoring Research Articles

Realtime Continuous Glucose Monitoring in Children and Adolescents— An Overview of the Current Technology and its Impact on Patient Outcomes

Continuous glucose monitoring (CGM) systems, available for patient use since 1999, and realtime continuous glucose monitoring (RT-CGM) systems, available since 2006, have helped optimize diabetes management. Previously, RT-CGM studies found benefits mainly in patients with type 1 diabetes over the age of 25. Children and adolescents often present a challenge when managing type 1 diabetes. However, it is now apparent that RT-CGM has clear benefits in these age groups as well as in adults. Not only have studies shown improvements in glycemic control in this population, they have also demonstrated parental satisfaction with the technology. Challenges with RT-CGM use still exist and must be addressed. Nevertheless, RT-CGM is a beneficial tool to assist in diabetes management, and its use should be encouraged in the majority of pediatric patients with type 1 diabetes.

Advantages and Disadvantages of Realtime Continuous Glucose Monitoring in People with Type 2 Diabetes

Previous research has shown that realtime continuous glucose monitoring (RT-CGM) is a useful clinical and lifestyle aid for people with type 1 diabetes. However, its usefulness and efficacy for people with type 2 diabetes is less known and potentially controversial, given the continuing controversy over the efficacy of self-monitoring of blood glucose (SMBG) in this cohort. This article reviews theextantliterature on RT-CGM for people with type 2 diabetes, and enumerates several of the advantages and disadvantages of this technology from the perspective of providers and patients. Even patients with type 2 diabetes who are not using insulin and/or are relatively well controlled on oral medications have been shown to spend a significant amount of time each day in hyperglycemia. Additional tools beyond SMBG are necessary to enable providers and patients to clearly grasp and manage the frequency and amplitude of glucose excursions in people with type 2 diabetes who are not on insulin. While SMBG is useful for measuring blood glucose levels, patients do not regularly check and SMBG does not enable many to adequately manage blood glucose levels or capture marked and sustained hyperglycemic excursions. RT-CGM systems, valuable diabetes management tools for people with type 1 diabetes or insulin-treated type 2 diabetes, have recently been used in type 2 diabetes patients. Theextantstudies, although few, have demonstrated that the use of RT-CGM has empowered people with type 2 diabetes to improve their glycemic control by making and sustaining healthy lifestyle choices.

Glycemic Variability: Measurement and Utility in Clinical Medicine and Research—One Viewpoint

One cannot control average glucose levels unless one firstreducesglycemicvariability! Thissounds intuitively obvious 1,2 and can also be demonstrated rigorously, mathematically. 3 If the mean glucose level were 100mg/dL but the SD were 40mg/dL, one could predict that there would be an unacceptable incidence of severe hypoglycemia even though the mean glucose is in the euglycemic range. Clinicians must understand glycemic variability both qualitatively and quantitatively and endeavor to reduce that variability before trying to reduce the mean level of blood glucose. This applies to blood glucose as measured by self-monitoring of blood glucose (SMBG), laboratory measurements of venous samples or arterial blood, and interstitial glucose as measured by continuous glucose monitoring (CGM). When titrating a medication such as basal insulin, it is essential to know the between-day (within-subject) variability in fasting plasma glucose to be able to set the target glucose level appropriately so that risk of hypoglycemia is at an acceptable level. Unfortunately, these estimates of glycemic variability are rarely obtained. Glycemic variability also serves as one facet of the quality of glycemic control—another reason to quantify gly

Real-Life Utilization of Real-Time Continuous Glucose Monitoring: The Complete Picture

Very few studies to date have analyzed the reasons why some people do not use real-time continuous glucose monitoring (RT-CGM) continuously, especially given its positive glycemic outcomes, or choose not to wear it at all, even after learning about its benefits. A questionnaire was designed to assess real-life use of and issues surrounding RT-CGM. Hemoglobin A1c (HbA1c) and duration of sensor use were also obtained from the patients' charts. Fifty-eight subjects with type 1 diabetes (T1DM), average age 15.0 ± 4.8 years, T1DM duration 5.7 ± 3.8 years, HbA1c 8.8 ± 2.1%, 50% with RT-CGM, were included in the analysis. Hemoglobin A1c was lower with increased RT-CGM use. Real-time continuous glucose monitoring was ordered to improve control. Users liked the continuous data. The most disliked part was pain and discomfort. Occasional users described RT-CGM as annoying, a hassle, and interfering with their lives. Reasons for discontinuing RT-CGM included problematic equipment and inaccuracy (64%), intrusion in life (36%), and insurance issues (29%). Twenty-one percent of nonusers reported RT-CGM to be inconvenient or a hassle or just did not want it. Fifty-two percent of subjects continue to use RT-CGM despite reported problems. Real-time continuous glucose monitoring is a beneficial tool for improving glycemic control, and many use it despite reported problems and hassles with current devices. However, this technology has not been wholeheartedly embraced by many individuals with T1DM, especially in youngsters, because of issues mentioned here. Based on the findings of this study, it is hoped that improvements will be made to RT-CGM technology so that more people with diabetes will embrace this beneficial tool.

Real time continuous glucose monitoring: how does it work in real life?

Patients (>90% type 1 diabetes) using real time- continuous glucose monitoring (RT-CGM) for more than 3 months were asked to complete a questionnaire on type and duration of diabetes, self-reported complications, subjective reasons for RT-CGM use, source of payment for RT-CGM, personal income, time on the sensor, but also information such as perceived burden of diabetes, admissions for severe hypoglycaemia or ketoacidosis before and since commencing RT-CGM use. Of the 150 patients supplied with the questionnaire it was completed by 89%. Compliance was high with 77% reporting RT-CGM use ≥75% of the time. The proportion of patients having an HbA1c of ≤7% increased from 33% to 73% (p<0.001). Severe hypoglycaemia and hospital admissions for hypoglycaemia and ketoacidosis also decreased significantly. Patient satisfaction with the device was high. The impact of living with diabetes in daily life improved from 4.1 to 3.4 (p<0.001). The hypoglycaemia alarm was most appreciated. In summary, we confirm that RT-CGM can be a valuable tool to support patients in the self-management of their type 1 diabetes in real life practice if they are willing and able to use the device at least 75% of the time.

In Pursuit of an Ideal – A Perspective on Non-Invasive Continuous Glucose Monitoring

Diabetes is one of the most common non-communicable diseases globally, and is the fourth or fifth leading cause of death in many countries. Medical technology for the management of diabetes has advanced steadily since the discovery of insulin in the early 20th century. Today, individuals with diabetes benefit from home-use blood glucose meters, continuous insulin pumps and, most recently, continuous glucose monitoring (CGM). Numerous studies have shown that frequent use of real-time CGM can improve glycaemic control with reduced risk of hypoglycaemia. However, current CGM devices have not been wholeheartedly embraced, limiting their potential. A CGM device that is accurate, non-invasive, pain-free and non-intrusive to daily activities could drive increased adoption and use of CGM, potentially improving health and quality of life for many individuals living with diabetes.

Responses to Continuous Glucose Monitoring in Subjects with Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion or Multiple Daily Injections

We compared changes in response to unmasking of continuous glucose monitoring (CGM) in subjects with type 1 diabetes who use multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Use of real-time CGM (DexCom [San Diego, CA] SEVEN was studied in 38 subjects using CSII and 26 using MDI. CGM output was masked during Week 1 and unmasked during Weeks 2 and 3. We evaluated changes in 16 criteria for quality of glycemic control and eight criteria for glycemic variability. All 24 criteria showed highly statistically significant improvement when considered simultaneously (P < 0.000001). For subjects using CSII, 18 of 24 criteria improved significantly (nominal P < 0.05); for subjects using MDI, 16 of 24 criteria improved significantly (P < 0.05). Twelve of the comparisons remained significant (P < 0.05) after applying the overconservative Bonferroni correction for multiple comparisons. The percentage of glucose values within the range 80-140 mg/dL increased by 19% and 17% relative to their control values (Week 1) for subjects using MDI and CSII, respectively. Mean glucose, overall SD (SD(T)), SD between daily means (SD(dm)), mean amplitude of glycemic excursion (MAGE), and mean of daily differences (MODD) improved significantly. Responses to CGM display were not significantly different between the MDI and CSII subject groups for any of the 24 criteria considered individually or in groups of eight, 16, or 24. CGM has similar effectiveness in subjects with type 1 diabetes using either CSII or MDI.

Practical aspects of real-time continuous glucose monitors: the experience of the Yale Children's Diabetes Program.

Real-time continuous glucose monitoring (RT-CGM) provides new dimension to diabetes management. However, there are many challenges to using RT-CGM successfully. This article aims to present how RT-CGM is integrated into diabetes clinical practice at the Yale Children's Diabetes Program (YCDP). The authors provide factors to consider when choosing one of the commercially available RT-CGM systems and a discussion of key strategies for successful use of RT-CGM for families. Careful training and troubleshooting strategies will ensure the most positive experience possible for a family using RT-CGM.

Continuous Glucose Monitoring Technology for Personal Use

The purpose of this article is to describe the development and implementation of an educational program for the initiation of real-time continuous glucose monitoring (CGM) technology for personal use, not 3-day CGMS diagnostic studies. The education program was designed to meet the needs of patients managing their diabetes with either diabetes medications or insulin pump therapy in an outpatient diabetes education center using a team-based approach. Observational research, complemented by literature review, was used to develop an educational program model and teaching strategies. Diabetes educators, endocrinologists, CGM manufacturer clinical specialists, and patients with diabetes were also interviewed for their clinical observations and experience. The program follows a progressive educational model. First, patients learn in-depth about real-time CGM technology by attending a group presensor class that provides detailed information about CGM. This presensor class facilitates self-selection among patients concerning their readiness to use real-time CGM. If the patient decides to proceed with real-time CGM use, CGM initiation is scheduled, using a clinic-centered protocol for both start-up and follow-up. Successful use of real-time CGM involves more than just patient enthusiasm or interest in a new technology. Channeling patient interest into a structured educational setting that includes the benefits and limitations of real-time CGM helps to manage patient expectations.

Educating Families on Real Time Continuous Glucose Monitoring

The purpose of this article is to describe the process of educating families and children with type 1 diabetes on real time continuous glucose monitoring (RT-CGM) and to note the similarities and differences of training patients using continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI). A total of 30 CSII participants and 27 MDI participants were educated using the Navigator RT-CGM in a clinical trial. Time spent with families for visits and calls was tracked and compared between patient groups. The Diabetes Research in Children Network (DirecNet) educators were surveyed to assess the most crucial, time intensive, and difficult educational concepts related to CGM. Of the 27 MDI families, an average of 9.6 hours was spent on protocol-prescribed visits and calls (not measured in CSII) and 2 hours on participant-initiated contacts over 3 months. MDI families required an average of 5.4 more phone contacts over 3 months than CSII families. According to the DirecNet educators, lag time and calibrations were the most crucial teaching concepts for successful RT-CGM use. The most time was spent on teaching technical aspects, troubleshooting, and insulin dosing. The most unanticipated difficulties were skin problems including irritation and the sensor not adhering well. Educators who teach RT-CGM should emphasize lag time and calibration techniques, technical device training, and sensor insertion. Follow-up focus should include insulin dosing adjustments and skin issues. The time and effort required to introduce RT-CGM provided an opportunity for the diabetes educators to reemphasize good diabetes care practices and promote self-awareness and autonomy to patients and families.

Real-Time Continuous Glucose Monitoring Together with Telemedical Assistance Improves Glycemic Control and Glucose Stability in Pump-Treated Patients

Real-time continuous glucose monitoring (CGM) has recently been incorporated into routine diabetes management because of the potential advantages it offers for glycemic control. The aim of our study was to evaluate the impact of the use of real-time CGM together with a telemedicine system in hemoglobin A1c and glucose variability in patients with type 1 diabetes treated with insulin pumps. Ten patients (five women, 41.2 [range, 21-62] years old, duration of diabetes 14.9 [range, 3-52] years) were included in this randomized crossover study. Patients used the DIABTel telemedicine system throughout the study, and real-time CGM was used for 3 days every week during the intervention phase. At the end of the control phase, a blind 3-day CGM was performed. Glucose variability was evaluated using the Glucose Risk Index (GRI), a comparative analysis of continuous glucose values over two consecutive hours. Hemoglobin A1c decreased significantly (8.1 +/- 1.1% vs. 7.3 +/- 0.8%; P = 0.007) after the intervention phase, while no changes were observed during the control phase. The mean number of daily capillary glucose readings was higher during the intervention phase (4.7 +/- 1.1 vs. 3.8 +/- 1.0; P < 0.01), because of an increase in random analyses (1.22 +/- 0.3 vs. 0.58 +/- 0.1; P < 0.01), and there was also a significant increase in the mean number of bolus doses per day (5.23 +/- 1.1 vs. 4.4 +/- 0.8; P < 0.05). The GRI was higher during the control phase than during the experimental phase (9.6 vs. 6.25; P < 0.05). Real-time CGM in conjunction with the DIABTel system improves glycemic control and glucose stability in pump-treated patients with type 1 diabetes.

Establishing a continuous glucose monitoring program.

Real-time continuous glucose monitoring (RT-CGM) devices provide detailed information on glucose patterns and trends, and alarms that alert the patient to both hyper- and hypoglycemia. This technology can dramatically improve the day-to-day management of patients with diabetes and promises to be a major advance in diabetes care. The safe and effective use of RT-CGM in diabetes management rests on an understanding of several physiological as well as technological issues. This article outlines the key issues that should be addressed in the training curriculum for patients starting on RT-CGM: (1) physiologic lag between interstitial and blood glucose levels and the implications for device calibration, and interpretation and use of data in diabetes management; (2) practical considerations with the use of sensor alarms and caveats in the setting of alarm thresholds; and (3) potential risk for hypoglycemia related to excessive postprandial bolusing by RT-CGM users, and the practical implications for patient training.