Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Diabetes Reports
Published in: Current Diabetes Reports 5/2013

01-10-2013 | Treatment of Type 1 Diabetes (JR Unger, Section Editor)

Continuous Glucose Monitoring: Current Use and Future Directions

Authors: Daniel DeSalvo, Bruce Buckingham

Published in: Current Diabetes Reports | Issue 5/2013

Login to get access

Abstract

Continuous glucose monitoring (CGM) is an emerging technology that provides a continuous measure of interstitial glucose levels. In addition to providing a more complete pattern of glucose excursions, CGMs utilize real-time alarms for thresholds and predictions of hypo- and hyperglycemia, as well as rate of change alarms for rapid glycemic excursions. CGM users have been able to improve glycemic control without increasing their risk of hypoglycemia. Sensor accuracy, reliability, and wearability are important challenges to CGM success and are critical to the development of an artificial pancreas (or closed-loop system).
Literature
1.
Davis EA, Keating B, Byrne GC, et al. Hypoglycemia: incidence and clinical predictors in a large population-based sample of children and adolescents with IDDM. Diabetes Care. 1997;20:22–5.
2.
Mastrototaro JJ. The MiniMed continuous glucose monitoring system. Diabetes Technol Ther. 2000;2 Suppl 1:S13–8.PubMedCrossRef
3.
Feldman B, Brazg R, Schwartz S, et al. A continuous glucose sensor based on wired enzyme technology —results from a 3-day trial in patients with type 1 diabetes. Diabetes Technol Ther. 2003;5:769–79.
4.
Garg S, Zisser H, Schwartz S, et al. Improvement in glycemic excursions with a transcutaneous, real-time continuous glucose sensor: a randomized controlled trial. Diabetes Care. 2006;29:44–50.
5.
Hirsch IB, Abelseth J, Bode BW, et al. Sensor-augmented insulin pump therapy: results of the first randomized treat-to-target study. Diabetes Technol Ther. 2008;10:377–83.
6.
Tamborlane WV, Beck RW, Bode BW, et al. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359:1464–76.
7.
• Tamborlane W, Beck R, Laffel L. Continuous glucose monitoring and type 1 Diabetes. N Engl J Med. 2009;360:1901–192. This landmark study of CGM demonstrated that almost daily use of CGM is required to achieve significant improvements in A1c levels without increasing the risk of hypoglcyemia, and adults were more consistent with CGM use compared with children and adolescents.
8.
Deiss D, Bolinder J, Riveline JP, et al. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care. 2006;29:2730–2.
9.
O'Connell MA, Donath S, O'Neal DN, et al. Glycaemic impact of patient-led use of sensor-guided pump therapy in type 1 diabetes: a randomised controlled trial. Diabetologia. 2009;52:1250–7.
10.
Chase HP, Beck RW, Xing D, et al. Continuous glucose monitoring in youth with type 1 diabetes: 12-month follow-up of the Juvenile Diabetes Research Foundation continuous glucose monitoring randomized trial. Diabetes Technol Ther. 2010;12:507–15.PubMedCrossRef
11.
• Bergenstal RM, Tamborlane WV, Ahmann A, et al. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med. 2010;363:311–20. This is the largest randomized trial of CGM use and demonstrated that sensor augmented pump therapy achieved significant improvements in A1c levels along with a very low incidence of severe hypoglycemic events in children, adolescents, and adults.PubMedCrossRef
12.
Buckingham B, Wilson DM, Lecher T, et al. Duration of nocturnal hypoglycemia prior to seizures. Diabetes Care. 2008;31:2110–2.
13.
Cobry E, McFann K, Messer L, et al. Timing of meal insulin boluses to achieve optimal postprandial glycemic control in patients with type 1 diabetes. Diabetes Technol Ther. 2010;12:173–7.PubMedCrossRef
14.
Smith CB, Choudhary P, Pernet A, et al. Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit. Diabetes Care. 2009;32:1196–8.PubMedCrossRef
15.
Tsalikian E, Tamborlane W, Xing D, et al. Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes. Diabetes Care. 2009;32:1954–9.PubMedCrossRef
16.
Jones TW, Porter P, Sherwin RS, et al. Decreased epinephrine responses to hypoglycemia during sleep. N Engl J Med. 1998;338:1657–62.PubMedCrossRef
17.
Ly TT, Hewitt J, Davey R, et al. Improving epinephrine responses in hypoglycemia unawareness with real-time continuous glucose monitoring in adolescents with type 1 diabetes. Diabetes Care. 2011;34:50–2.PubMedCrossRef
18.
Mesotten D, Van den Berghe G. Clinical potential of insulin therapy in critically ill patients. Drugs. 2003;63:625–36.PubMedCrossRef
19.
Finfer S, Chittock DR, Su S, et al. Intensive vs conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.PubMedCrossRef
20.
Holzinger U, Warszawska J, Kitzberger R, et al. Real-time continuous glucose monitoring in critically ill patients: a prospective randomized trial. Diabetes Care. 2010;33:467–72.PubMedCrossRef
21.
Agus MS, Steil GM, Wypij D, et al. Tight glycemic control vs standard care after pediatric cardiac surgery. N Engl J Med. 2012;367:1208–19.PubMedCrossRef
22.
Harris DL, Battin MR, Weston PJ, Harding J. Continuous glucose monitoring in newborn babies at risk of hypoglycemia. J Pediatr. 2010;157:198–202. e1.PubMedCrossRef
23.
Hay Jr WW, Rozance PJ. Continuous glucose monitoring for diagnosis and treatment of neonatal hypoglycemia. J Pediatr. 2010;157:180–2.PubMedCrossRef
24.
Schiaffini R, Brufani C, Russo B, et al. Abnormal glucose tolerance in children with cystic fibrosis: the predictive role of continuous glucose monitoring system. Eur J Endocrinol. 2010;162:705–10.PubMedCrossRef
25.
Hershkovitz E, Rachmel A, Ben-Zaken H, Phillip M. Continuous glucose monitoring in children with glycogen storage disease type I. J Inherit Metab Dis. 2001;24:863–9.PubMedCrossRef
26.
White FJ, Jones SA. The use of continuous glucose monitoring in the practical management of glycogen storage disorders. J Inherit Metab Dis. 2011;34:631–42.PubMedCrossRef
27.
Steil GM, Rebrin K, Mastrototaro J, et al. Determination of plasma glucose during rapid glucose excursions with a subcutaneous glucose sensor. Diabetes Technol Ther. 2003;5:27–31.PubMedCrossRef
28.
Cengiz E, Sherr JL, Weinzimer SA, Tamborlane WV. New-generation diabetes management: glucose sensor-augmented insulin pump therapy. Expert Rev Med Devices. 2011;8:449–58.PubMedCrossRef
29.
Rebrin K, Sheppard Jr NF, Steil GM. Use of subcutaneous interstitial fluid glucose to estimate blood glucose: revisiting delay and sensor offset. J Diabetes Sci Technol. 2010;4:1087–98.PubMed
30.
Voskanyan G, Keenan B, Mastrototaro J, Steil G. Putative delays in interstitial fluid (ISF) glucose kinetics can be attributed to the glucose sensing systems used to measure them rather than the delay in ISF glucose itself. J Diabetes Sci Technol. 2007;1:639–44.PubMed
31.
Keenan DB, Mastrototaro JJ, Zisser H, et al. Accuracy of the Enlite 6-day glucose sensor with guardian and Veo calibration algorithms. Diabetes Technol Ther. 2012;14:225–31.PubMedCrossRef
32.
Christiansen M, Bailey T, Watkins E. A new-generation continuous glucose monitoring system: improved accuracy and reliability compared with a previous-generation system. Diabetes Technol. Ther. 2013;15:1–8.
33.
Gifford R, Batchelor MM, Lee Y, et al. Mediation of in vivo glucose sensor inflammatory response via nitric oxide release. J Biomed Mater Res A. 2005;75:755–66.PubMed
34.
Klueh U, Kaur M, Qiao Y, Kreutzer D. Critical role of tissue mast cells in controlling long-term glucose sensor function in vivo. Biomaterials. 2010;31:4540–51.PubMedCrossRef
35.
Klueh U, Liu Z, Feldman B, et al. Metabolic biofouling of glucose sensors in vivo: role of tissue microhemorrhages. J Diabetes Sci Technol. 2011;5:583–95.PubMed
36.
Klueh U, Liu Z, Feldman B, Kreutzer D. Importance of interleukin-1 and interleukin-1 receptor antagonist in short-term glucose sensor function in vivo. J Diabetes Sci Technol. 2010;4:1073–86.PubMed
37.
Helton KL, Ratner BD, Wisniewski NA. Biomechanics of the sensor-tissue interface-effects of motion, pressure, and design on sensor performance and foreign body response-part II: examples and application. J Diabetes Sci Technol. 2011;5:647–56.PubMed
38.
Gilligan BJ, Shults MC, Rhodes RK, Updike SJ. Evaluation of a subcutaneous glucose sensor out to 3 months in a dog model. Diabetes Care. 1994;17:882–7.PubMedCrossRef
39.
Buckingham BA, Kollman C, Beck R, et al. Evaluation of factors affecting CGMS calibration. Diabetes Technol Ther. 2006;8:318–25.PubMedCrossRef
40.
Kamath A, Mahalingam A, Brauker J. Analysis of time lags and other sources of error of the DexCom SEVEN continuous glucose monitor. Diabetes Technol Ther. 2009;11:689–95.PubMedCrossRef
41.
Mazze RS, Strock P, Borgman S, et al. Evaluating the accuracy, reliability, and clinical applicability of continuous glucose monitoring (CGM): is CGM ready for real-time? Diabetes Technol Ther. 2009;11:11–8.PubMedCrossRef
42.
Kordonouri O, Pankowska E, Kami B, et al. 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;53:2487–95.PubMedCrossRef
43.
Ramchandani N, Arya S, Ten S, Bhandari S, et al. Real-life utilization of real-time continuous glucose monitoring: the complete picture. J Diabetes Sci Technol. 2011;5:860–70.PubMed
44.
Vaddiraju S, Burgess DJ, Tomazos I, et al. Technologies for continuous glucose monitoring: current problems and future promises. J Diabetes Sci Technol. 2010;4:1540–62.PubMed
45.
Gough DA, Kurnosa LS, Routh TL, et al. Function of an implanted tissue glucose sensor for more than 1 year in animals. Sci Transl Med. 2010;2:42–53.CrossRef
46.
Cobelli C, Renard E, Kovatchev BP, et al. Pilot studies of wearable outpatient artificial pancreas in type 1 diabetes. Diabetes Care. 2012;35:e65–7.PubMedCrossRef
47.
Wilinska ME, Budiman HS, Taub MB, et al. Overnight closed-loop insulin delivery with model predictive control: assessment of hypoglycemia and hyperglycemia risk using simulation studies. J Diabetes Sci Technol. 2009;3:1109–20.PubMed
48.
Castle JR, Pitts A, Hanavan K, et al. The accuracy benefit of multiple amperometric glucose sensors in people with type 1 diabetes. Diabetes Care. 2012;35:706–10.PubMedCrossRef
Metadata
Title
Continuous Glucose Monitoring: Current Use and Future Directions
Authors
Daniel DeSalvo
Bruce Buckingham
Publication date
01-10-2013
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 5/2013
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-013-0398-4

Other articles of this Issue 5/2013

Current Diabetes Reports 5/2013 Go to the issue

Transplantation (A Pileggi, Section Editor)

Transplantation of Xenogeneic Islets: Are We There Yet?

Treatment of Type 1 Diabetes (JR Unger, Section Editor)

Hypoglycemia in Patients with Type 1 Diabetes: Epidemiology, Pathogenesis, and Prevention

Treatment of Type 1 Diabetes (JR Unger, Section Editor)

Screening, Prevention, and Ambitious Management of Diabetic Macular Edema in Patients with Type 1 Diabetes

Transplantation (A Pileggi, Section Editor)

Anti-Inflammatory Strategies to Enhance Islet Engraftment and Survival

Pathogenesis of Type 1 Diabetes (D Dabelea, Section Editor)

Human Intestinal Microbiota and Type 1 Diabetes

Pathogenesis of Type 1 Diabetes (D Dabelea, Section Editor)

Epigenetic Regulation of Pancreatic Islets
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits