Real time continuous glucose monitoring: how does it work in real life?

Abstract

P atients (>90% type 1 diabetes) using real timecontinuous glucose monitoring (RT-CGM) for more than 3 months were asked to complete a questionnaire on type and duration of diabetes, self-reported complications, subjective reasons for RT-CGM use, source of payment for RT-CGM, personal income, time on the sensor, but also information such as perceived burden of diabetes, admissions for severe hypoglycaemia or ketoacidosis before and since commencing RT-CGM use. Of the 150 patients supplied with the questionnaire it was completed by 89%. Compliance was high with 77% reporting RT-CGM use ≥75% of the time. The proportion of patients having an HbA 1c of ≤7% increased from 33% to 73% (p<0.001). Severe hypoglycaemia and hospital admissions for hypoglycaemia and ketoacidosis also decreased significantly. Patient satisfaction with the device was high. The impact of living with diabetes in daily life improved from 4.1 to 3.4 (p<0.001). The hypoglycaemia alarm was most appreciated.In summary, we confirm that RT-CGM can be a valuable tool to support patients in the self-management of their type 1 diabetes in real life practice if they are willing and able to use the device at least 75% of the time. Br J Diabetes Vasc Dis 2011;11:145-149.

Technology Use in Transition-Age Patients With Type 1 Diabetes

“…43 Surveys of both current and former CGM users illustrate perceived beneficial aspects such as improved sense of safety, motivation and confidence to manage diabetes, and avoidance of serious hypoglycemia but also report problems with accuracy, usability, intrusiveness, alarms, and insurance issues leading to inconsistent use or discontinuation altogether. [44][45][46] Device features and educational programs that succeed with younger children or older adults may fail in the transition-age group. Unfortunately there is still a paucity of literature specifically examining barriers to technology use and acceptance in transition-age youth.…”

Design and rationale of the IN CONTROL trial: the effects of real-time continuous glucose monitoring on glycemia and quality of life in patients with type 1 diabetes mellitus and impaired awareness of hypoglycemia

“…Real-time continuous glucose monitoring systems measure interstitial glucose levels and provide this information every five or ten minutes, with a delay of approximately 8 to 15 minutes [ 24 – 26 ]. The added value lies in the display of trends and alarms that can be set to warn for impending hypo- or hyperglycemia [ 27 , 28 ]. RT-CGM is associated with an improvement of glycemic control [ 27 , 29 – 41 ] and shorter duration of hypoglycemic episodes [ 42 – 44 ].…”

“…In most studies either recent severe hypoglycemia was among the exclusion criteria [ 29 ] or the frequency of severe hypoglycemia at baseline was not mentioned [ 37 , 40 , 46 ]. Studies done in subjects with normal hypoglycemia awareness already indicate that use of RT-CGM might improve the impact of T1DM on daily life [ 28 ] and might increase treatment satisfaction [ 47 ], although an effect on the fear of hypoglycemia is not apparent [ 48 ]. Since experiencing the issues mentioned above might especially be the case for patients with IAH, it is not unlikely that use of RT-CGM might improve the quality of life in those patients.…”