title: The impact of continuous glucose monitoring on low interstitial glucose values and low blood glucose values assessed by point-of-care blood glucose meters: results of a crossover trial.
abstract: In a randomized crossover trial the impact of continuous glucose monitoring (CGM) was tested on the occurrence of low blood glucose values measured by point of care (POC) measurement and on low glucose values measured by CGM in the interstitial fluid. A total of 41 type 1 diabetic patients (age 42.0 ± 11.4 years, diabetes duration 15.3 ± 10.1 years, A1c 8.2 ± 1.4%) used a CGM system (Dexcom SEVEN PLUS system) twice. In first study phase (CGM blind), patients were blind regarding the CGM current glucose levels and were not alerted when critical glucose values were reached. In the second phase (CGM real time), patients had access to current glucose levels and were alerted if critical glucose values were reached. During CGM real time the proportion of hypoglycemic POC blood glucose values were significantly reduced (7.5 ± 5.6% vs 10.1 ± 7.5%; P = .04), whereas the proportion of euglycemic blood glucose values were significantly enhanced (73.7 ± 18.3% vs 68.3 ± 12.1%; P = .01). The duration of low glucose periods in the interstitial fluid was significantly lower in the CGM real time phase (125 ± 89 vs 181 ± 125 minutes per day; P = .005). The time until a low blood glucose was detected by POC measurement was shortened by 33.2 ± 76.1 minutes (P = .03). The study demonstrated that CGM is able to not only reduce duration of hypoglycemia measured by CGM in interstitial fluid, but also reduce the proportion of low POC blood glucose measurements. In addition, hypoglycemia can be detected earlier.
authors.affiliation: Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany Diabetes Center Mergentheim, Bad Mergentheim, Germany hermanns@diabetes-zentrum.de.
authors.forename: Norbert
authors.initials: N
authors.lastname: Hermanns
authors.affiliation: Diabetes Center Mergentheim, Bad Mergentheim, Germany.
authors.forename: Beatrix
authors.initials: B
authors.lastname: Schumann
authors.affiliation: Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany Diabetes Center Mergentheim, Bad Mergentheim, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kulzer
authors.affiliation: Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany Diabetes Center Mergentheim, Bad Mergentheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Haak
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation*; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D042241:Early Diagnosis; D004867:Equipment Design; D045604:Extracellular Fluid / Q000378:metabolism*; D005858:Germany; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: continuous glucose monitoring; hypoglycemia; type 1 diabetes