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Review
. 2019 Jun 27;19(8):50.
doi: 10.1007/s11892-019-1177-7.

Advanced Technology in the Management of Diabetes: Which Comes First-Continuous Glucose Monitor or Insulin Pump?

Christopher T Martin  1 , Amy B Criego  2 , Anders L Carlson  3 , Richard M Bergenstal  4
Affiliations
Review

Advanced Technology in the Management of Diabetes: Which Comes First-Continuous Glucose Monitor or Insulin Pump?

Christopher T Martin et al. Curr Diab Rep. .

Abstract

Purpose of review: In this article, we consider advanced technologies for the management of diabetes.

Recent findings: Specifically, we pose the question of which should come first: an insulin pump (CSII) or a continuous glucose monitor (CGM)? Historical perspective on both insulin delivery and glucose measurement is provided. Recently published clinical trials are reviewed. Practical issues including quality of life, patient education, and out-of-pocket cost are discussed. Based on available evidence and clinical experience, we favor CGM as a first-line technology recommendation for the treatment of type 1 diabetes (T1D).

Keywords: Continuous glucose monitor; Diabetes; Hemoglobin A1C; Hypoglycemia; Insulin pump; Time in range.

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Conflict of interest statement

Christopher T. Martin reports consulting fees and stock from MicroOptx Inc. In addition, he is co-inventor of patent US20180333085A1 “Aqueous humor monitoring devices and methods” pending to MicroOptx Inc.

Amy B. Criego reports grants and other from Abbott Diabetes Care, other from Eli Lilly, grants from Medtronic, other from Senseonics, and grants from DexCom.

Anders L. Carlson is employed by HealthPartners Institute/Park Nicollet Health Services and they have contracts with Abbott, Medtronic, Dexcom, Novo Nordisk, Sanofi, and Insulet for his services as a research investigator and/or consultant. No personal income from any of these services goes to Anders L. Carlson.

Richard M. Bergenstal has received research support, consulted, or has been on the scientific advisory board for Abbott Diabetes Care, DexCom, Hygieia, Johnson & Johnson, Eli Lilly, Medtronic, Novo Nordisk, Onduo, Roche, Sanofi, Senseonics, and United Healthcare. His employer, non-profit HealthPartners Institute, contracts for his services and no personal income goes to Richard M. Bergenstal.

Figures

Fig. 1
Fig. 1
Device %MARD vs year commercially available
Fig. 2
Fig. 2
Representative Ambulatory Glucose Profile. (©2019 International Diabetes Center at Park Nicollet, Minneapolis, MN. Used with permission. See AGPreport.org for more information)
Fig. 3
Fig. 3
Summary of recently published CGM trials demonstrating reduction in time spent with glucose < 70 mg/dL and %CV as compared with SMBG
Fig. 4
Fig. 4
Estimated Initial and ongoing out-of-pocket costs of various diabetes treatment approaches. Refer to Supplemental Table 2 for pricing appendix
See this image and copyright information in PMC

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