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Review
. 2016 Mar;12(1):24-30.
doi: 10.17925/EE.2016.12.01.24. Epub 2016 Mar 15.

The Rationale for Continuous Glucose Monitoring-based Diabetes Treatment Decisions and Non-adjunctive Continuous Glucose Monitoring Use

David Price  1 , Tomas Walker  1
Affiliations
Review

The Rationale for Continuous Glucose Monitoring-based Diabetes Treatment Decisions and Non-adjunctive Continuous Glucose Monitoring Use

David Price et al. Eur Endocrinol. 2016 Mar.

Abstract

Self-monitoring of blood glucose (SMBG) is now recognised as a core component of diabetes self-management. However, there are many limitations to SMBG use in individuals with diabetes who are treated with intensive insulin regimens. Many individuals do not test at the recommended frequencies. Additionally, because SMBG only provides a blood glucose reading at a single point in time, hypoglycaemia and hyperglycaemia can easily go undetected, limiting the user's ability to take corrective action. Inaccuracies due to user error, environmental factors and weaknesses in SMBG system integrity further limit the utility of SMBG. Real-time continuous glucose monitoring (CGM) displays the current glucose, direction and velocity of glucose change and provides programmable alarms. This trending information and 'around-the-clock' vigilance provides a significant safety advantage relative to SMBG. No published clinical studies have evaluated outcomes when CGM is used as a replacement for SMBG; however, recent in silico studies support this indication. This article reviews the limitations of SMBG and discusses recent evidence that supports CGM-based decisions as an effective approach to managing insulin-treated diabetes.

Keywords: Continuous glucose monitoring (CGM); continuous subcutaneous insulin infusion (CSII); glucose monitoring; glucose trend; multiple-dose insulin (MDI); rate of change; self-monitoring of blood glucose (SMBG).

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Conflict of interest statement

Disclosure: David Price and Tomas Walker are employees of Dexcom, Inc.

Figures

Figure 1:
Figure 1:. An Example of Uncertainty in Diabetes Management Decisions Based on Episodic Self-Monitoring of Blood Glucose
Figure 2:
Figure 2:. Continuous Glucose Monitoring Displays Current Glucose, Glucose Direction, Alert Thresholds and Velocity of Change
Figure 3:
Figure 3:. Hypoglycaemic and Hyperglycaemic Outcomes from Treatment Modalities
CGM = continuous glucose monitoring; MARD = mean absolute relative difference; ROC = rate of change. Source: Modified from Kovatchev BP, et al. Diabetes Technol Ther, 2015;17:177–86
See this image and copyright information in PMC

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