scholarly journals Commentary Regarding Shapiro, “Nonadjunctive Use of Continuous Glucose Monitors for Insulin Dosing: Is It Safe?”

2017 ◽  
Vol 11 (4) ◽  
pp. 839-841 ◽  
Author(s):  
David Price
Keyword(s):  
Social Media ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Treatment Decisions ◽  
Diabetes Treatment ◽  
Continuous Glucose Monitors

The FDA recently expanded the approved use of Dexcom’s G5 Mobile continuous glucose monitoring (CGM) system to allow for diabetes treatment decisions. This decision is expected to reduce the burden of SMBG testing and increase the adoption and persistent use of CGM. The safety of nonadjunctive CGM use was questioned because of sporadic large discrepancies between CGM and SMBG values. These data were viewed in the context of complaints found in the FDA MAUDE database and social media postings. This commentary provides additional perspective on the inferences that can be drawn from these reports and the risk of nonadjunctive use of CGM data.

scholarly journals The Changing Landscape of Glycemic Targets: Focus on Continuous Glucose Monitoring

2020 ◽  
Author(s):  
Pamela R. Kushner ◽  
Davida F. Kruger
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Treatment Decisions ◽  
Diabetes Treatment ◽  
Good Glycemic Control ◽  
Patients With Diabetes ◽  
Time In Range ◽  
Glycemic Targets

Continuous glucose monitoring (CGM) provides comprehensive assessment of daily glucose measurements for patients with diabetes and can reveal high and low blood glucose values that may occur even when a patient’s A1C is adequately controlled. Among the measures captured by CGM, the percentage of time in the target glycemic range, or “time in range,” (typically 70–180 mg/dL) has emerged as one of the strongest indicators of good glycemic control. This review examines the shift to using CGM to assess glycemic control and guide diabetes treatment decisions, with a focus on time in range as the key metric of glycemic control.

scholarly journals The Changing Landscape of Glycemic Targets: Focus on Continuous Glucose Monitoring

2020 ◽  
Author(s):  
Pamela R. Kushner ◽  
Davida F. Kruger
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Treatment Decisions ◽  
Diabetes Treatment ◽  
Good Glycemic Control ◽  
Patients With Diabetes ◽  
Time In Range ◽  
Glycemic Targets

Continuous glucose monitoring (CGM) provides comprehensive assessment of daily glucose measurements for patients with diabetes and can reveal high and low blood glucose values that may occur even when a patient’s A1C is adequately controlled. Among the measures captured by CGM, the percentage of time in the target glycemic range, or “time in range,” (typically 70–180 mg/dL) has emerged as one of the strongest indicators of good glycemic control. This review examines the shift to using CGM to assess glycemic control and guide diabetes treatment decisions, with a focus on time in range as the key metric of glycemic control.

scholarly journals Delays in Minimally Invasive Continuous Glucose Monitoring Devices: A Review of Current Technology

2009 ◽  
Vol 3 (5) ◽  
pp. 1207-1214 ◽  
Author(s):  
D. Barry Keenan ◽  
John J. Mastrototaro ◽  
Gayane Voskanyan ◽  
Garry M. Steil
Keyword(s):  
Blood Glucose ◽  
Minimally Invasive ◽  
Continuous Glucose Monitoring ◽  
Ex Vivo ◽  
Time Lag ◽  
Glucose Monitoring ◽  
Time Lags ◽  
Continuous Glucose Monitor ◽  
Continuous Glucose Monitors

Through the use of enzymatic sensors—inserted subcutaneously in the abdomen or ex vivo by means of microdialysis fluid extraction—real-time minimally invasive continuous glucose monitoring (CGM) devices estimate blood glucose by measuring a patient's interstitial fluid (ISF) glucose concentration. Signals acquired from the interstitial space are subsequently calibrated with capillary blood glucose samples, a method that has raised certain questions regarding the effects of physiological time lags and of the duration of processing delays built into these devices. The time delay between a blood glucose reading and the value displayed by a continuous glucose monitor consists of the sum of the time lag between ISF and plasma glucose, in addition to the inherent electrochemical sensor delay due to the reaction process and any front-end signal-processing delays required to produce smooth traces. Presented is a review of commercially available, minimally invasive continuous glucose monitors with manufacturer-reported device delays. The data acquisition process for the Medtronic MiniMed (Northridge, CA) continuous glucose monitoring system—CGMS® Gold—and the Guardian® RT monitor is described with associated delays incurred for each processing step. Filter responses for each algorithm are examined using in vitro hypoglycemic and hyperglycemic clamps, as well as with an analysis of fast glucose excursions from a typical meal response. Results demonstrate that the digital filters used by each algorithm do not cause adverse effects to fast physiologic glucose excursions, although nonphysiologic signal characteristics can produce greater delays.

scholarly journals Role of Continuous Glucose Monitoring in Diabetes Treatment

2018 ◽  
Author(s):  
Irl Hirsch ◽  
Tadej Battelino ◽  
Anne Peters ◽  
James Chamberlain ◽  
Grazia Aleppo ◽  
...  
Keyword(s):  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Diabetes Treatment

scholarly journals Therapy Adjustments Based on Trend Arrows Using Continuous Glucose Monitoring Systems

2019 ◽  
Vol 13 (4) ◽  
pp. 763-773 ◽  
Author(s):  
Ralph Ziegler ◽  
Simone von Sengbusch ◽  
Jens Kröger ◽  
Oliver Schubert ◽  
Petra Werkmeister ◽  
...  
Keyword(s):  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Glucose Control ◽  
Glucose Monitoring ◽  
Treatment Decisions ◽  
Individual Therapy ◽  
General Treatment ◽  
Monitoring Systems ◽  
Appropriate Treatment ◽  
Glucose Curve

Continuous glucose monitoring (CGM) systems use trend arrows to accurately display the anticipated glucose curve for the user. These are used for both “real-time” glucose monitoring and for intermittent scanning glucose monitoring. Trend arrow data are used by people with diabetes to make corrections to their glucose control. It is essential that they are correctly interpreted when adjusting insulin doses and to ensure that appropriate treatment decisions are made. The aim of this article is to provide general treatment guidance for diabetes teams and for people with diabetes using CGM in the context of trend arrows. This is based on previous recommendations for interpreting trend arrows without losing sight of the need for individual therapy adjustment.

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