Continuous glucose monitoring in type 1 diabetes
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REVIEW
Continuous glucose monitoring in type 1 diabetes Nelly Mauras • Larry Fox • Kimberly Englert Roy W. Beck
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Received: 7 June 2012 / Accepted: 19 July 2012 Ó Springer Science+Business Media, LLC 2012
Abstract Continuous glucose monitors (CGM), devices that can measure interstitial glucose in ‘‘real time,’’ have become widely available particularly for use in patients with diabetes, and their accuracy and ease of use have greatly improved over the last decade. A number of large and well-controlled clinical trials have firmly established their usefulness in improving metabolic control (as measured by HbA1C) and decreasing time spent in hypoglycemia in adults; however, data have been less robust proving benefit in children and adolescents. Benefits are clearly linked to near-continuous wear. Insulin dosing algorithms based on CGM glucose trends have proven useful in dissecting the large volume of data generated daily by these devices, although these are imperfect tools, particularly in children. The technology is likely to be most useful when integrated with insulin pump delivery systems (sensor augmented). In this review, we concentrate on the analysis of published results of the largest trials in adults and children, including the very young, with diabetes.
with type 1 diabetes (T1D) on insulin therapy. In children with T1D, the blinded administration of insulin, without glucose data, is one of the most common reasons for inaccurate insulin dosing and poor diabetes control, particularly in adolescents. The development of continuous glucose monitors (CGM) using subcutaneous sensors that can measure glucose in ‘‘real time’’ was first received with great enthusiasm in the T1D community, followed by some skepticism about their usefulness and accuracy. The pendulum of opinions has settled somewhere in the middle as the science and technology of CGM have, fortunately, markedly improved over the last decade, allowing for more accurate and easier to use sensors. However, studies examining the objective benefits of CGM have yielded mixed results, and benefits of their use are both age and intensity of use dependent. This is the subject of this review.
How they measure glucose and how accurately? Keywords Continuous glucose sensors Adolescents Children Diabetes control Quality of life Introduction One of the principal challenges in the care of patients with diabetes is the clinical burden that self-monitoring of the blood glucose (SMBG) represents, particularly for those N. Mauras (&) L. Fox K. Englert Nemours Children’s Clinic, 807 Children’s Way, Jacksonville, FL 32207, USA e-mail: [email protected] R. W. Beck Jaeb Center for Health Research, Tampa, FL, USA
The CGM devices consist of three parts, a sensor, transmitter, and receiver; some receivers are integrated with insulin pumps. The sensor is inserted under the skin using an automatic device and sits in the fatty layer of skin immersed in interstitial glucose. The sensor emits a tiny electric current in response to glucose oxidation and the tran
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