Clinical experience with continuous glucose monitoring in adults.
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.
Fabiato
Kristin
K
UNC Highgate Diabetes and Endocrinology Clinic, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 25799, USA.
Buse
John
J
Duclos
Michelle
M
Largay
Joseph
J
Izlar
Camille
C
O'Connell
Thomas
T
Stallings
Jennifer
J
Dungan
Kathleen
K
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007328:Insulin / Q000627:therapeutic use; D008019:Life Style; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods*; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin