Contents

Search

continuous glucose monitor (Dexcom G5 CGM; G4 Platinum CGM System with Dexcom Share system, Flash glucose monitoring system, Eversense)

Indications: - improves glycemic control in younger & older patients with diabetes mellitus type 1 [10] - postprandial hyperglycemia - dawn phenomenon - overnight hypoglycemia - FDA-approved for insulin dosing [6] - type-2 diabetes requiring insulin [7] Procedure: - intermittently scanned continuous glucose monitors (isCGM) must be scanned manually with a receiver or smartphone, - more expensive real-time continuous glucose monitors (rtCGM) automatically send readings to a receiver or smartphone every few minutes - rtCGM improves glycemic control vs isCGM for type 1 diabetics [13] - below describes real-time continuous glucose monitors (rtCGM) - a small, wire-like sensor inserted subcutaneously that provides continuous data on glucose levels - worn externally with continuous display an estimate of blood glucose levels, & the direction & rate of change of these estimates - the Dexcom Share system displays data from the G4 Platinum CGM System using two apps: one installed on the patient's mobile device (cell phone) & one installed on the mobile device of another person - using Dexcom Share's mobile medical app, the user can designate people "followers" with whom to share their CGM data - the app receives real-time CGM data directly from the G4 Platinum System CGM receiver & transmits it to a Web-based storage location. The app of the "followers" can then download the CGM data & display it in real-time - "flash" glucose monitor [5] - worn on back of upper arm - uses a sensor that lasts for 14 days - does not require home calibration - captures glucose readings every 15 minutes - "reader" waved over the sensor receives & displays data & stores it for up to 90 days [5] - FreeStyle Libre Flash Glucose Monitoring System [8] - does not require fingerstick for calibration - Eversense Continuous Glucose Monitoring (CGM) system includes a fully implantable sensor to detect glucose, which can be worn for up to 90 days: sends readings every 5 minutes to a mobile app to warn users of hyperglycemia or hypoglycemia [9] Clinical significance: - "flash" glucose monitor [5] - increases frequency of glucose checks - decreases hypoglycemia in patients with diabetes mellitus type 1 - improves glycemic conterol in type 2 diabetes treated with basal insulin without prandial insulin [11] - in diabetics treated with insulin, hypoglycemia is common but generally asymptomatic [17]

General

glucose monitor

References

  1. FDA News Release. January 23, 2015 FDA permits marketing of first system of mobile medical apps for continuous glucose monitoring. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm431385.htm
  2. FDA News Release: Feb. 3, 2014 FDA approves pediatric use of Dexcom's G4 Platinum continuous glucose monitoring system. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm384495.htm
  3. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  4. Klonoff DC, Buckingham B, Christiansen JS et al Continuous glucose monitoring: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011 Oct;96(10):2968-79. PMID: 21976745 corresponding NGC guideline withdrawn Feb 2017
  5. Bolinder J, Antuna R, Geelhoed-Duijvestijn P et al. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: A multicentre, non-masked, randomised controlled trial. Lancet 2016 Sep 12; PMID: 27634581 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31535-5/abstract - Thabit H, Bally L, Hovorka R et al. Available at a flash: A new way to check glucose. Lancet 2016 Sep 12; PMID: 27634582 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31582-3/abstract
  6. Tucker ME FDA Okays Use of Dexcom G5 CGM for Insulin Dosing. Medscape. December 20, 2016 http://www.medscape.com/viewarticle/873528 - FDA News Release. December 20, 2016 FDA expands indication for continuous glucose monitoring system, first to replace fingerstick testing for diabetes treatment decisions. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm534056.htm
  7. Beck RW, Riddlesworth TD, Ruedy K et al Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial. Ann Intern Med. Aug 22, 2017. PMID: 28828487 http://annals.org/aim/article/2649297/continuous-glucose-monitoring-versus-usual-care-patients-type-2-diabetes - Arguello V, Freeby M Continuous Glucose Monitoring in Patients With Type 2 Diabetes Receiving Insulin Injections: Does This Mean Continuous Glucose Monitoring for Everyone? Ann Intern Med. Aug 22, 2017. PMID: 28828490 http://annals.org/aim/article/2650838/continuous-glucose-monitoring-patients-type-2-diabetes-receiving-insulin-injections
  8. FDA News Release. September 27, 2017 FDA approves first continuous glucose monitoring system for adults not requiring blood sample calibration. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm577890.htm
  9. FDA News Release. June 21, 2018 FDA approves first continuous glucose monitoring system with a fully implantable glucose sensor and compatible mobile app for adults with diabetes. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm611454.htm
  10. Laffel LM, Kanapka LG, Beck RW et al Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 DiabetesA Randomized Clinical Trial. JAMA. 2020;323(23):2388-2396 PMID: 32543683 https://jamanetwork.com/journals/jama/article-abstract/2767160 - Pratley RE, Kanapka LG, Rickels MR et al Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults With Type 1 DiabetesA Randomized Clinical Trial. JAMA. 2020;323(23):2397-2406 PMID: 32543682 https://jamanetwork.com/journals/jama/article-abstract/2767159 - Agarwal S, Cappola AR. Continuous Glucose Monitoring in Adolescent, Young Adult, and Older Patients With Type 1 Diabetes. JAMA. 2020;323(23):2384-2385 PMID: 32543670 https://jamanetwork.com/journals/jama/article-abstract/2767140
  11. Martens T, Beck RW, Bailey R et al Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin. A Randomized Clinical Trial. JAMA. Published online June 2, 2021 PMID: 34077499 https://jamanetwork.com/journals/jama/fullarticle/2780593 - Peek ME, Thomas CC Broadening Access to Continuous Glucose Monitoring for Patients With Type 2 Diabetes. JAMA. Published online June 2, 2021 PMID: 34077505 https://jamanetwork.com/journals/jama/fullarticle/2780595
  12. Karter AJ, Parker MM, Moffet HH et al Association of Real-time Continuous Glucose Monitoring With Glycemic Control and Acute Metabolic Events Among Patients With Insulin-Treated Diabetes. JAMA. Published online June 2, 2021 PMID: 34077502 https://jamanetwork.com/journals/jama/fullarticle/2780594
  13. Visser MM, Charleer S, Fieuws S et al. Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): A 6-month, prospective, multicentre, randomised controlled trial. Lancet 2021 Jun 12; 397:2275 PMID: 34089660 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00789-3/fulltext
  14. Maiorino MI, Signoriello S, Maio A et al Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in Diabetes: A Systematic Review With Meta-analysis of Randomized Controlled Trials. Diabetes Care. 2020 May;43(5):1146-1156. PMID: 32312858
  15. Battelino T, Danne T, Bergenstal RM et al Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019 Aug;42(8):1593-1603. PMID: 31177185 PMCID: PMC6973648 Free PMC article
  16. Kieu A, King J, Govender RD, Ostlundh L The Benefits of Utilizing Continuous Glucose Monitoring of Diabetes Mellitus in Primary Care: A Systematic Review. J Diabetes Sci Technol. 2023 May;17(3):762-774. PMID: 35100891 PMCID: PMC10210096 Free PMC article
  17. Divilly P, Martine-Edith G, Zaremba N et al. Relationship between sensor-detected hypoglycemia and patient-reported hypoglycemia in people with type 1 and insulin-treated type 2 diabetes: The Hypo-METRICS study. Diabetes Care 2024 Oct; 47:1769-1777. PMID: 39207738 PMCID: PMC11417281 Free PMC article. https://diabetesjournals.org/care/article/47/10/1769/157168/Relationship-Between-Sensor-Detected-Hypoglycemia