Practical Aspects of Real-Time Continuous Glucose Monitors

Abstract

Real-time continuous glucose monitoring (RT-CGM) provides new dimension to diabetes management. However, there are many challenges to using RT-CGM successfully. This article aims to present how RT-CGM is integrated into diabetes clinical practice at the Yale Children’s Diabetes Program (YCDP). The authors provide factors to consider when choosing one of the commercially available RT-CGM systems and a discussion of key strategies for successful use of RT-CGM for families. Careful training and troubleshooting strategies will ensure the most positive experience possible for a family using RT-CGM.

The role of continuous glucose monitoring in the care of children with type 1 diabetes

“…It is important for families to understand at the outset of CGM use that this technology will not reduce the need to invest effort in diabetes management. In fact, use of RT-CGM is often more time consuming for patients because it forces them to constantly focus on diabetes care [13,42]. Consequently, it is important to offer achievable plans with realistic expectations for patients so they can experience some successes with the technology from the start.…”

“…Larger centers with “diabetes technology clinics” typically start only a few children per month on CGM due to the time and resources needed for training [13]. Some clinics offer classes that introduce the concept of CGM, provide hands-on exposure to the equipment, and then prescribe CGM for patients and families expressing interest and motivation.…”

“…These issues can potentially discourage clinics from supporting CGM in any form. Other challenges include finding the right combination of adhesive and skin site preparation with sensors sometimes falling off early or causing excessive skin irritation [13,47], and “nuisance alarms” that interfere with daily activities. These alarms may go off in the middle of the night for low or high blood sugars and may not correlate with blood glucose meter readings or be set at appropriate thresholds [42].…”

“…Differences in blood sugar readings from the CGM and blood glucose meters, and the “false alarms” that result, can be frustrating to patients and their families [13]. The mean absolute relative difference (MARD) between sensor readings and reference glucose levels can vary by as much as 20%; such variations are especially troubling in the hypoglycemic range [14-16].…”

MANAGEMENT OF ENDOCRINE DISEASE: Beneficial effect of real-time continuous glucose monitoring system on glycemic control in type 1 diabetic patients: systematic review and meta-analysis of randomized trials

“…Each system consists of a glucose oxidase-based electrochemical sensor, which is placed subcutaneously and replaced every 3-7 days. Interstitial glucose measurements are sent continuously from the sensor to a receiver through advanced radio frequency wireless technology (4).…”