OBJECTIVE -To evaluate whether the continuous glucose monitoring system (CGMS; MiniMed, Sylmar, CA) is useful for investigating the incidence of unrecognized hypoglycemias in type 1 and type 2 diabetic patients and for improving metabolic control in type 1 diabetic patients. RESEARCH DESIGN AND METHODS-A total of 70 diabetic subjects (40 type 1 and 30 type 2 subjects) were monitored using the CGMS. The number of unrecognized hypoglycemias was registered. Furthermore, the 40 type 1 diabetic patients whose treatment was modified in accordance with the information obtained from the CGMS were compared with a control group of 35 different type 1 diabetic patients using intensive capillary glucose measurements. HbA 1c levels were measured before the monitoring period and 3 months later.RESULTS -The CGMS detected unrecognized hypoglycemias in 62.5% of the type 1 diabetic patients and in 46.6% of the type 2 diabetic patients. We found that 73.7% of all events occurred at night. HbA 1c concentrations decreased significantly in both the group of type 1 diabetic subjects monitored with the CGMS (from 8.3 Ϯ 1.6 to 7.5 Ϯ 1.2%, P Ͻ 0.01) and the control group (from 8.0 Ϯ 1.4 to 7.5 Ϯ 0.8%, P Ͻ 0.01). The greatest reduction was observed in the subgroup of patients who started continuous subcutaneous insulin infusion therapy, both in the CGMS-monitored and control groups (from 9.4 Ϯ 2 to 7.2 Ϯ 1.4% and from 8.1 Ϯ 1.8 to 7.1 Ϯ 0.6%, respectively).CONCLUSIONS -The CGMS is useful for detecting unrecognized hypoglycemias in type 1 and type 2 diabetic subjects; however, it is not better than standard capillary glucose measurements for improving metabolic control of type 1 diabetic subjects, regardless of the therapeutic regimen. Diabetes Care 26:1153-1157, 2003S ome relevant prospective studies have demonstrated that good metabolic control of diabetes decreases the risk of chronic complications (1,2).Intensive therapeutic regimens with multiple insulin injections (MIIs) combined with frequent measurements of capillary blood glucose levels are known to be the most useful ways of achieving good metabolic control. It is also known that intensive regimens can increase the number of hypoglycemias and that the perception of autonomic symptomatology may decrease over time.It is often difficult to achieve optimal control (3,4), despite intensive insulin therapy and frequent self-monitoring of blood glucose, partly because of the limitations of the glycemic profile obtained from intermittent fingersticks (5). A new Holter-style sensor system recently came on the market (continuous glucose monitoring system [CGMS]; MiniMed) for continuously measuring glucose concentrations in subcutaneous tissue (6). This system has been validated by several reports (7,8) and has been shown to provide a good correlation between blood and interstitial glucose levels (9 -11). The continuous glucose profile obtained using this system is easy for physicians to interpret, thus patient treatment can be modified and glucose control improved. Recent studies have show...

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