Real-time continuous glucose monitoring (RT-CGM) is the latest technological breakthrough in diabetes care. Despite its limitations of lag time between sensor and blood glucose, the need for calibration, false detection of and failure to detect hypoglycemia, and mild discomfort or skin irritation reported in some users, RT-CGM is a highly beneficial tool that can be used to detect nocturnal or unrecognized hypoglycemia and glycemic variability. This, in turn, can lead to better treatment decisions, which may improve metabolic control and decrease the incidence and progression of diabetes complications. The RT-CGM devices are fairly accurate and easy to use. It is not difficult to establish a clinical RT-CGM program in the office. However, it requires persistence and an understanding of the patient's perspective of using RT-CGM so it can be presented and taught appropriately. This article discusses the benefits and limitations of RT-CGM and establishment of a RT-CGM program in the clinical setting.
KovatchevBGonder-FrederickLACoxDJClarkeWL. Evaluating the accuracy of continuous glucose-monitoring sensors: continuous glucose-error grid analysis illustrated by TheraSense Freestyle Navigator data. Diabetes Care.2004;27 (8): 1922–8.
2.
FarhyLSKovatchevBPGonder-FrederickLACoxDJAndersonSMClarkeWL. Accuracy of FreeStyle Navigator and MiniMed CGMS during euglycemia and induced hypoglycemia. Washington, DC: ADA; 2006.
3.
BodeBGrossKRikaloNSchwartzSWahlTPageCGrossTMastrototaroJ. Alarms based on real-time sensor glucose values alert patients to hypo- and hyperglycemia: the guardian continuous monitoring system. Diabetes Technol Ther.2004;6 (2): 105–13.
4.
GandrudLXingDKollmanCBlockJMKunselmanBWilsonDMBuckinghamBA. The Medtronics Minimed Gold continuous glucose monitoring system: an effective means to discover hypo- and hyperglycemia in children under 7 years of age. Diabetes Technol Ther.2007;9 (4): 307–16.
5.
The Diabetes Research in Children Network (DirecNet) Study Group. The accuracy of the CGMS in children with type 1 diabetes: results of the diabetes research in children network (DirecNet) accuracy study. Diabetes Technol Ther.2003;5 (5): 781–9.
6.
GargSZisserHSchwartzSBaileyTKaplanREllisSJovanovicL. Improvement in glycemic excursions with a transcutaneous, realtime continuous glucose sensor: a randomized controlled trial. Diabetes Care.2006;29 (1): 44–50.
7.
MaiaFFAraujoLR. Accuracy, utility and complications of continuous glucose monitoring system (CGMS) in pediatric patients with type 1 diabetes. J Pediatr (Rio J).2005;81 (4): 293–7.
8.
PorterPKeatingBByrneGJonesTW. Incidence and predictive criteria of nocturnal hypoglycemia in young children with insulin-dependent diabetes mellitus. J Pediatr.1997;130 (3): 339–41.
9.
CryerPE. Diverse causes of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med.2004;350 (22): 2272–9.
10.
FanelliCPorcellatiFPampanelliSBolliGB. Insulin therapy and hypoglycaemia: the size of the problem. Diabetes Metab Res Rev.2004;20Suppl 2: S32–42.
11.
CryerPDavisSNShamoonH. Hypoglycemia in diabetes. Diabetes Care.2003;26 (6): 1902–12.
12.
Dagogo-JackSRattarasarnCCryerPE. Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Diabetes.1994;43 (12): 1426–34.
13.
ChicoAVidal-RíosPSubiràMNovialsA. The continuous glucose monitoring system is useful for detecting unrecognized hypoglycemias in patients with type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control. Diabetes Care.2003;26 (4): 1153–7.
14.
LudvigssonJHanasR. Continuous subcutaneous glucose monitoring improved metabolic control in pediatric patients with type 1 diabetes: a controlled crossover study. Pediatrics2003;111 (5 Pt 1): 933–8.
15.
The Diabetes Research in Children Network (DirecNet) Study GroupBuckinghamBBeckRWTamborlaneWVXingDKollmanCFiallo-ScharerRMaurasNRuedyKJTanseyMWeinzimerSAWysockiT. Continuous glucose monitoring in children with type 1 diabetes. J Pediatr.2007;151 (4): 388–93.
16.
HirschIBBrownleeM. Should minimal blood glucose variability become the gold standard of glycemic control?. J Diabetes Complications.2005;19 (3): 178–81.
17.
BolliGB. Glucose variability and complications. Diabetes Care.2006;29: 1707–9.
18.
HirschIB. Glycemic variability: it's not just about A1C anymore!Diabetes Technol Ther.2005;7 (5): 780–3.
19.
BrownleeMHirschIB. Glycemic variability: a hemoglobin A1c-independent risk factor for diabetic complications. JAMA.2006;295 (14): 1707–8.
20.
CerielloA. The possible role of postprandial hyperglycaemia in the pathogenesis of diabetic complications. Diabetologia.2003;46Suppl 1: M9–16.
HallerMJStalveyMSSilversteinJH. Predictors of control of diabetes: monitoring may be the key. J Pediatr.2004;144 (5): 660–1.
23.
Fiallo-ScharerR; Diabetes Research in Children Network Study Group. Eight-point glucose testing versus the continuous glucose monitoring system in evaluation of glycemic control in type 1 diabetes. J Clin Endocrinol Metab.2005;90 (6): 3387–91.
24.
BoyneMSilverDMKaplanJSaudekCD. Timing of changes in interstitial and venous blood glucose measured with a continuous subcutaneous glucose sensor. Diabetes2003;52 (110): 2790–4.
25.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med.1993;329 (14): 977–86.
26.
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med.2000;342 (6): 381–9.
27.
DanneTMortensenHBHougaardPLynggaardHAanstootHJChiarelliFDanemanDDorchyHGarandeauPGreeneSAHoeyHHollRWKaprioEAKocovaMMartulPMatsuuraNRobertsonKJSchoenleEJSøvikOSwiftPGTsouRMVanelliMAmanJ; For the Hvidøre Study Group on Childhood Diabetes. Persistent differences among centers over 3 years in glycemic control and hypoglycemia in astudy of 3,805 children and adolescents with type 1 diabetes from the Hvidore Study Group. Diabetes Care.2001: 24 (8): 1342–7.
28.
HoeyHAanstootHJChiarelliFDanemanDDanneTDorchyHFitzgeraldMGarandeauPGreeneSHollRHougaardPKaprioEKocovaMLynggaardHMartulPMatsuuraNMcGeeHMMortensenHBRobertsonKSchoenleESovikOSwiftPTsouRMVanelliMAmanJ. Good metabolic control is associated with better quality of life in 2,101 adolescents with type 1 diabetes. Diabetes Care2001;24 (11): 1923–8.
29.
KaufmanFRGibsonLCHalvorsonMCarpenterSFisherLKPitukcheewanontP. A pilot study of the continuous glucose monitoring system: clinical decisions and glycemic control after its use in pediatric type 1 diabetic subjects. Diabetes Care.2001;24 (12): 2030–4.
30.
The Diabetes Control and Complications Trial Research Group TDR. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. J Pediatr.1994;125 (2): 177–88.
31.
SteilGRebrinKMastrototaroJBernabaBSaadMF. Determination of plasma glucose during rapid glucose excursions with a subcutaneous glucose sensor. Diabetes Technol Ther.2003;5 (1): 27–31.
32.
DeissDBolinderJRivelineJPBattelinoTBosiETubiana-RufiNKerrDPhillipM. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care.2006;29 (12): 2730–2.
33.
MaiaFFAraújoLR. Efficacy of continuous glucose monitoring system (CGMS) to detect postprandial hyperglycemia and unrecognized hypoglycemia in type 1 diabetic patients. Diabetes Res Clin Pract.2007;75 (1): 30–4.
34.
MetzgerMLeibowitzGWainsteinJGlaserBRazI. Reproductibility of glucose measurements using the glucose sensor. Diabetes Care.2002;25: 1185–91.
35.
The Diabetes Research in Children Network (DirecNet) Study Group TDR. FreeStyle navigator continuous glucose monitoring system use in children with type 1 diabetes using glargine-based multiple daily dose regimens: results of a pilot trial. Diabetes Care.2008;31 (3): 525–7.
36.
BolandEMonsodTDeluciaMBrandtCAFernandoSTamborlaneWV. Limitations of conventional methods of self-monitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes. Diabetes Care.2001;24 (11): 1858–62.
37.
TanenbergRBodeBLaneWLevetanCMestmanJHarmelAPTobianJGrossTMastrototaroJ. Use of the Continuous Glucose Monitoring System to guide therapy in patients with insulin-treated diabetes: a randomized controlled trial. Mayo Clin Proc.2004;79 (12): 1521–6.
38.
PickupJ. Sensitive glucose sensing in diabetes. Lancet2000;355 (9202): 426–7.
39.
TamadaJAGargSJovanovicLPitzerKRFermiSPottsRO. Noninvasive glucose monitoring: comprehensive clinical results. Cygnus Research Team. JAMA.1999;282 (19): 1839–44.
40.
SternbergFMeyerhoffCMennelFJMayerHBischofFPfeifferEF. Does fall in tissue glucose precede fall in blood glucose?. Diabetologia.1996;39 (5): 609–12.
41.
CheyneEHCavanDAKerrD. Performance of a continuous glucose monitoring system during controlled hypoglycaemia in healthy volunteers. Diabetes Technol Ther.2002;4 (5): 607–13.
ZungAZadikZ. Continuous subcutaneous glucose monitoring in children with type 1 diabetes. Pediatrics.2001;107 (2): 222–6.
46.
GuerciBFloriotMBöhmePDurainDBenichouMJellimannSDrouinP. Clinical performance of CGMS in type 1 diabetic patients treated by continuous subcutaneous insulin infusion using insulin analogs. Diabetes Care.2003;26 (3): 582–9.
47.
Djakoure-PlatonoffCRadermerckerRReachGSlamaGSelamJI. Accuracy of the continuous glucose monitoring system in inpatient and outpatient conditions. Diabetes Metab.2003;29 (2 Pt 1): 159–62.
48.
WongLBuckinghamBAKunselmanBIstocELeachJPurvisR. Extended use of a new continuous glucose monitoring system with wireless data transmission in children with type 1 diabetes mellitus. Diabetes Technol Ther.2006;8 (2): 139–45.
