Continuous glucose monitoring (CGM) is an essential tool for modern diabetes therapy. Randomized controlled studies have provided evidence that hemoglobin A1c (HbA1c) results can be improved in patients with type 1 diabetes with elevated baseline HbA1c when using CGM frequently enough and that the frequency and duration of hypoglycemic events can be reduced in patients with satisfactory baseline HbA1c. The CGM group within the Working Group Diabetes Technology (AGDT) of the German Diabetes Association (DDG) has defined evidence-based indications for the practical use of CGM in this consensus statement related to hypoglycemia (frequent, severe, or nocturnal) or hypoglycemia unawareness, insufficient metabolic control despite use of all possible therapeutic options and patient compliance, pregnancy associated with inadequate blood glucose results, and the need for more than 10 blood glucose measurements per day. Contraindications and defined preconditions for the successful use of CGM should be considered.
RebrinKSteilGMvan AntwerpWPMastrototaroJJ, Subcutaneous glucose predicts plasma glucose independent of insulin: Implications for continuous monitoring. Am J Physiol.1999;277 (3 Pt 1): E561–71.
4.
VaddirajuSBurgessDJTomazosIJainFCPapadimitrakopoulosF.Technologies for continuous glucose monitoring: Current problems and future promises. J Diabetes Sci Technol.2010;4 (6): 1540–62.
5.
FreckmannGSchmidCBaumstarkAPleusSLinkMHaugC.System accuracy evaluation of 43 blood glucose monitoring systems for self-monitoring of blood glucose according to DIN EN ISO 15197. J Diabetes Sci Technol.2012;6 (5): 1060–75.
6.
MazzeRSStrockEStoutPRacchiniJWesleyDBorgmanS.A novel methodology to evaluate continuous glucose monitoring accuracy and clinical representation of glucose exposure and variability. Diabetes.2007;56Suppl 1: A107.
7.
KulcuETamadaJAReachGPottsROLeshoMJ, Physiological differences between interstitial glucose and blood glucose measured in human subjects. Diabetes Care.2003;26 (8): 2405–9.
8.
JungheimKKoschinskyT.Glucose monitoring at the arm: Risky delays of hypoglycemia and hyperglycemia detection. Diabetes Care.2002;25 (6): 956–60.
9.
KovatchevBPShieldsDBretonM.Graphical and numerical evaluation of continuous glucose sensing time lag. Diabetes Technol Ther.2009;11 (3): 139–43.
10.
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.
11.
TanseyMJBeckRWBuckinghamBAMaurasNFiallo-ScharerRXingDKillmanCTamborlaneWVRuedyKJ; Diabetes Research in Children Network (DirecNet) Study Group. Accuracy of the modified continuous glucose monitoring system (CGMS) sensor in an outpatient setting: Results from a Diabetes Research in Children Network (DirecNet) study. Diabetes Technol Ther.2005 Feb; 7 (1): 109–14.
12.
KovatchevBHeinemannLAndersonSClarkeW.Comparison of the numerical and clinical accuracy of four continuous glucose monitors. Diabetes Care.2008;31: 1160–4.
13.
ClarkeWLAndersonSFarhyLBretonMGonder-FrederickLCoxDKovatchevB.Evaluating the clinical accuracy of two continuous glucose sensors using continuous glucose-error grid analysis. Diabetes Care.2005;28 (10): 2412–7.
14.
GargSKVoelmleMKGottliebP. Feasibility of 10-day use of a continuous glucose-monitoring system in adults with type 1 diabetes. Diabetes Care.2009;32 (3): 436–8.
15.
MastrototaroJOundararajanSCooperKShahR.Accuracy of real-time continuous glucose monitoring in the MiniMed Paradigm System. Diabetes.2007;56Suppl 1: A422.
16.
MazzeRSStrockEBorgmanSWesleyDStoutPRacchiniJ.Evaluating the accuracy, reliability, and clinical applicability of Continuous Glucose Monitoring (CGM): Is CGM ready for real time?Diabetes Technol Ther.2009;11 (1): 11–8.
GargSKSmithJBeatsonCLopez-BacaBVoelmleMGottliebPA, Comparison of accuracy and safety of the SEVEN and the Navigator continuous glucose monitoring systems. Diabetes Technol Ther.2009;11 (2): 65–72.
19.
BaileyTSBrazgRCooperKGauthamRVJanowskiRKaufmanFRLeeWDShahRWelshJBZisserH.Performance evaluation of the Medtronic MiniMed Enlite subcutaneous glucose sensor. Diabetes.2011;60Suppl 1: A238.
20.
NogueiraKGauthamRCooperKShahR.The Medtronic ENLITE Sensor: The next step towards fingerstick replacement. Diabetes Technol Ther.2011;13: 257.
21.
BookRZhangT.Long term performance of a prototype 4th generation continuous glucose monitoring (CGM) device. Diabetes.2011;60Suppl 1: A257.
22.
DeissDBolinderJRivelineJ PBattelinoTBosiETubiana-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.
23.
HirschIBAbelsethJBodeBWFischerJSKaufmanFRMastrototaroJParkinCGWolpertHABuckinghamBA, Sensor-augmented insulin pump therapy: Results of the first randomized treat-to-target study. Diabetes Technol Ther.2008;10 (5): 377–83.
24.
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, TamborlaneWVBeckRWBodeBWBuckinghamBChaseHPClemonsRFiallo-ScharerRFoxLAGilliamLKHirschIBHuangESKollmanCKowalskiAJLaffelLLawrenceJMLeeJMaurasNO'GradyMRuedyKJTanseyMTsalikianEWeinzimerSWilsonDMWolpertHWysockiTXingD.Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med.2008;359 (14): 1464–76.
25.
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, BeckRWHirschIBLaffelLTamborlaneWVBodeBWBuckinghamBChasePClemonsRFiallo-ScharerRFoxLAGilliamLKHuangESKollmanCKowalskiAJLawrenceJMLeeJMaurasNO'GradyMRuedyKJTanseyMTsalikianEWeinzimerSAWilsonDMWolpertHWysockiTXingD.The effect of continuous glucose monitoring in well-controlled type 1 diabetes. Diabetes Care.2009;32 (8): 1378–83.
26.
O'ConnellMADonathSO'NealDNColmanPGAmblerGRJonesTWDavisEACameronFJ, Glycaemic impact of patient-led use of sensor-guided pump therapy in type 1 diabetes: A randomised controlled trial. Diabetologia.2009;52 (7): 1250–7.
27.
RaccahDSulmontVReznikYGuerciBRenardEHanaireHJeandidierNNicolinoM.Incremental value of continuous glucose monitoring when starting pump therapy in patients with poorly controlled type 1 diabetes: The RealTrend study. Diabetes Care.2009;32 (12): 2245–50.
28.
HermanidesJNørgaardKBruttomessoDMathieuCFridADayanCMDiemPFermonCWentholtIMHoekstraJBDeVriesJH, Sensor-augmented pump therapy lowers HbA(1c) in suboptimally controlled type 1 diabetes; a randomized controlled trial. Diabet Med.2011;28 (10): 1158–67.
29.
BergenstalRMTamborlaneWVAhmannABuseJBDaileyGDavisSNJoyceCPeoplesTPerkinsBAWelshJBWilliSMWoodMA; STAR 3 Study Group. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med.2010;363 (4): 311–20.
30.
BattelinoTPhillipMBratinaNNimriROskarssonPBolinderJ. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care.2011;34 (4): 795–800.
31.
BattelinoTCongetIOlsenBSchütz-FuhrmannIHommelEHoogmaRSchierlohUSulliNBolinderJ; SWITCH Study Group. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: A randomised controlled trial. Diabetologia.2012;55 (12): 3155–62.
32.
Diabetes Research in Children Network (DirecNet) Study Group. Youth and parent satisfaction with clinical use of the GlucoWatch G2 Biographer in the management of pediatric type 1 diabetes. Diabetes Care.2005;28 (8): 1929–35.
33.
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Validation of measures of satisfaction with and impact of continuous and conventional glucose monitoring. Diabetes Technol Ther.2010;12 (9): 679–84.
34.
GorlasS.Abrechnung der kontinuierlichen Blutzuckermessung. Dtsch Ärzteblatt.2010;107 (27): A–1374.
35.
BuckinghamBCobryEClintonPGageVCaswellKKunselmanECameronFChaseHP, Preventing hypoglycemia using predictive alarm algorithms and insulin pump suspension. Diabetes Technol Ther.2009;11 (2): 93–7.
36.
DanneTKordonouriOHolderMHaberlandHGolembowskiSRemusKBläsigSWadienTZierowSHartmannRThomasA.Prevention of hypoglycemia by using low glucose suspend function in sensor-augmented pump therapy. Diabetes Technol Ther.2011;13 (11): 1129–34.
37.
PickupJC, Semi-closed-loop insulin delivery systems: Early experience with low-glucose insulin suspend pumps. Diabetes Technol Ther.2011;13 (7): 695–8.
38.
ChoudharyPShinJWangYEvansMLHammondPJKerrDShawJAPickupJCAmielSA, Insulin pump therapy with automated insulin suspension in response to hypoglycemia: Reduction in nocturnal hypoglycemia in those at greatest risk. Diabetes Care.2011;34 (9): 2023–5.
39.
AgrawalPWelshJBKannardBAskariSYangQKaufmanFR, Usage and effectiveness of the low glucose suspend feature of the Medtronic Paradigm Veo insulin pump. J Diabetes Sci Technol.2011;5 (5): 1137–41.
40.
GargSBrazgRLBaileyTSBuckinghamBASloverRHKlonoffDCShinJWelshJBKaufmanFR, Reduction in duration of hypoglycemia by automatic suspension of insulin delivery: The in-clinic ASPIRE study. Diabetes Technol Ther.2012;14 (3): 205–9.
41.
LudvigssonJHanasR.Continuous subcutaneous glucose monitoring improved metabolic control in pediatric patients with type 1 diabetes: A controlled crossover study. Pediatrics.2003;111 (5 Pt 1): 933–8.
42.
KestiläKKEkbladUURönnemaaT.Continuous glucose monitoring versus self-monitoring of blood glucose in the treatment of gestational diabetes mellitus. Diabetes Res Clin Pract.2007;77 (2): 174–9.
43.
LagardeWHBarrowsFPDavenportMLKangMGuessHACalikogluAS, Continuous subcutaneous glucose monitoring in children with type 1 diabetes mellitus: A single-blind, randomized, controlled trial. Pediatr Diabetes.2006;7 (3): 159–64.
44.
AllenNAFainJABraunBChipkinSR, Continuous glucose monitoring counseling improves physical activity behaviors of individuals with type 2 diabetes: A randomized clinical trial. Diabetes Res Clin Pract.2008;80 (3): 371–9.
45.
YatesKMiltonA HasnatDearKAmblerG.Continuous glucose monitoring-guided insulin adjustment in children and adolescents on near-physiological insulin regimens: A randomized controlled trial. Diabetes Care.2006;29 (7): 1512–7.
46.
MurphyHRRaymanGLewisKKellySJohalBDuffieldKFowlerDCampbellPJTempleRC, Effectiveness of continuous glucose monitoring in pregnant women with diabetes: Randomised clinical trial. BMJ.2008;337: a1680.
47.
AhmetADagenaisSBarrowmanNJCollinsCJLawsonML, Prevalence of nocturnal hypoglycemia in pediatric Type 1 diabetes: A pilot study using continuous glucose monitoring. J Pediatr.2011;159 (2): 297–302.
48.
Diabetes Research In Children Network (DirecNet) Study Group, BuckinghamBXingDWeinzimerSFiallo-ScharerRKollmanCMaurasNTsalikianETamborlaneWWysockiTRuedyKBeckR.Use of the DirecNet Applied Treatment Algorithm (DATA) for diabetes management with a real-time continuous glucose monitor (the FreeStyle Navigator). Pediatr Diabetes.2008;9 (2): 142–7.
49.
CookeDHurelSJCasbardASteedLWalkerSMeredithSNunnAJMancaASculpherMBarnardMKerrDWeaverJUAhlquistJNewmanSP, Randomized controlled trial to assess the impact of continuous glucose monitoring on HbA(1c) in insulin-treated diabetes (MITRE Study). Diabet Med.2009;26 (5): 540–7.
50.
Diabetes Research in Children Network Study Group, WeinzimerSXingDTanseyMFiallo-ScharerRMaurasNWysockiTBeckRTamborlaneWRuedyK.Prolonged use of continuous glucose monitors in children with type 1 diabetes on continuous subcutaneous insulin infusion or intensive multiple-daily injection therapy. Pediatr Diabetes.2009;10 (2): 91–6.
51.
BaileyTSZisserHCGargSK, Reduction in hemoglobin A1C with real-time continuous glucose monitoring: Results from a 12-week observational study. Diabetes Technol Ther.2007;9 (3): 203–10.
52.
KordonouriOPankowskaERamiBKapellenTCoutantRHartmannRLängeKKnipMDanneT.Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: Results of the Paediatric Onset Study (ONSET) after 12 months of treatment. Diabetologia.2010;53 (12): 2487–95.
53.
DanneTde ValkHWKrachtTWalteKGeldmacherRSölterLvon dem BergeWWelshZKBuglerJRLangeKKordonouriO.Reducing glycaemic variability in type 1 diabetes self-management with a continuous glucose monitoring system based on wired enzyme technology. Diabetologia.2009;52 (8): 1496–503.
54.
GargSZisserHSchwartzSBaileyTKaplanREllisSJovanovicL.Improvement in glycemic excursions with a transcutaneous, real-time continuous glucose sensor: A randomized controlled trial. Diabetes Care.2006;29 (1): 44–50.
55.
PickupJCFreemanSCSuttonAJ, Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: Meta-analysis of randomised controlled trials using individual patient data. BMJ.2011;343: d3805.
56.
FloydBDChandraPHallSPPhillipsCOAlema-MensahEStrayhornGOfiliEUmpierrezG.Comparative analysis of the efficacy and safety of continuous glucose monitoring and self-monitoring blood glucose in type 1 diabetes mellitus. Diabetes.2009;59Suppl 1: A33.
57.
RysPMuchaAKoprowskiMNowickiMMaleckiMT. Efficacy and safety of continuous glucose monitoring systems vs self-monitoring blood glucose in patients with type 1 diabetes mellitus: A systematic review and meta-analysis. Diabetologia.2011;54Suppl 1: S116.
58.
LangendamMLuijfYMHooftLDevriesJHMuddeAHScholtenRJ, Continuous glucose monitoring systems for type 1 diabetes mellitus (Review). Cochrane Database Syst Rev.2012;1: CD008101.
59.
American Diabetes Association. Standards of medical care in diabetes–2012. Diabetes Care.2012;35Suppl 1: S11–63.
60.
American Diabetes Association. Summary of revisions for the 2009 Clinical Practice Recommendations. Diabetes Care.2009;32Suppl 1: S3–5.
61.
RodbardHWBlondeLBraithwaiteSSBrettEMCobinRHHandelsmanYHellmanRJellingerPSJovanovicLGLevyPMechanickJIZangenehF; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract.2007;13Suppl 1: 1–68.
62.
National Institute for Health and Clinical Excellence. Diagnosis and management of type 1 diabetes in children, young people and adults. Clinical guidelines, CG15. http://www.nice.org.uk/Guidance/CG15.
63.
HirschIBArmstrongDBergenstalRMBuckinghamBChildsBPClarkeWLPetersAWolpertH.Clinical application of emerging sensor technologies in diabetes management: Consensus guidelines for continuous glucose monitoring (CGM). Diabetes Technol Ther.2008;10 (4): 232–46.
64.
HammondPJAmielSADayanCMKerrDPickupJCShawJACampbellFMGreeneSAHindmarshPC, ABCD position statement on continuous glucose monitoring: Use of glucose sensing in outpatient clinical diabetes care. Pract Diab Int.2010;27: 66–8.
65.
AnderssonMEliassonBGustafssonJHanasR.Guidelines for the clinical use of CGM in Sweden. Letter to Tandvårds-Och Läkemedelsförmånsverket, 2009.
AdanaMRRiglaM.Position statement on continuous glucose monitoring. Av Diabetol.2009;25 (2): 96–8.
68.
BenhamouPYCatargiBDelenneBGuerciBHanaireHJeandidierNLeroyRMeyerLPenfornisARadermeckerRPRenardEBaillot-RudoniSRivelineJPSchaepelynckPSola-GazagnesASulmontVTubiana-RufiNDurainDMantovaniISola-GazagnesARivelineJP; Société Francophone du Diabète; Société Française d'Endocrinologie; EVAluation dans le Diabète des Implants ACtifs Group. Real-time continuous glucose monitoring (CGM) integrated into the treatment of type 1 diabetes: Consensus of experts from SFD, EVADIAC and SFE Diabetes Metab.2012;38Suppl 4: S67–83.
