Selecting the Appropriate Continuous Glucose Monitoring System – a Practical Approach

Abstract

Two types of continuous glucose monitoring (CGM) systems are currently available for daily diabetes self-management: real-time CGM and intermittently scanned CGM. Both approaches provide continuous measurement of glucose concentrations in the interstitial fluid; however, each has its own unique features that can impact their usefulness and acceptability within specific patient groups. This article explores the strengths and limitations of each approach and provides guidance to healthcare professionals in selecting the CGM type that is most appropriate to the individual needs of their patients.

Physiological Closed-Loop Control (PCLC) Systems: Review of a Modern Frontier in Automation

“…For many years, the predominant method for this daily testing was self-monitoring of blood glucose (SMBG) by so-called "finger-stick" devices [31], [33], which require drawing a small sample of blood during every test. Initially accepted for their marked improvement over urine testing equipment, use of these finger-stick devices causes pain, and measurements can be uncomfortable or unsafe (due to blood spill) to perform in public [31]. While significantly less accurate than accredited laboratory testing [32], these portable diagnostic tools have enabled diabetics to maintain tighter glycemic control by regular assessment of their blood glucose levels, especially prior to meals, sleep, and insulin dosing.…”

“…This consistent availability of current data has led to several important features that are impossible with traditional SMBG. First, many rtCGM systems allow users to set alarms that indicate or even predict the onset of hypoglycemia, allowing diabetics to increase their carbohydrate/glucose intake and avoid hypoglycemia, which is especially useful for those suffering from hypoglycemia unawareness [31]. Second, many rtCGM systems allow users to automatically share data/trends with caregivers and physicians, having important implications for young children and their parents [31], as well as elderly and disabled individuals who are living alone.…”

“…First, many rtCGM systems allow users to set alarms that indicate or even predict the onset of hypoglycemia, allowing diabetics to increase their carbohydrate/glucose intake and avoid hypoglycemia, which is especially useful for those suffering from hypoglycemia unawareness [31]. Second, many rtCGM systems allow users to automatically share data/trends with caregivers and physicians, having important implications for young children and their parents [31], as well as elderly and disabled individuals who are living alone. Finally, rtCGM systems not only provide improved predictive measures for users through real-time measurements, measurement histories, and predicted glycemic trajectories, many of these systems can be interfaced with portable insulin infusion systems to automatically suspend insulin dosing when near or approaching hypoglycemia [31], [34].…”

“…Second, many rtCGM systems allow users to automatically share data/trends with caregivers and physicians, having important implications for young children and their parents [31], as well as elderly and disabled individuals who are living alone. Finally, rtCGM systems not only provide improved predictive measures for users through real-time measurements, measurement histories, and predicted glycemic trajectories, many of these systems can be interfaced with portable insulin infusion systems to automatically suspend insulin dosing when near or approaching hypoglycemia [31], [34]. Combinations of rtCGM and insulin infusion systems, known as sensor augmented pump (SAP) therapy, are further enabling improved overnight glycemic control, and represent a step toward wide-spread acceptance of closed-loop insulin therapy systems.…”

Continuous detection of glucose and insulin in live animals

“…Although fasting insulin in non-diabetic patients (~40 pM) is below this limit, an LOD of 93 pM is sufficient to track the pharmacokinetics of post-prandial insulin. Although the LOD will need to be further optimized to detect hypoglycemia (LOD=2.2 mM) 36 , our glucose detection limits cover both the euglycemic range and relevant hyperglycemic range. We then introduced different concentrations of glucose and insulin in a whole blood sample and used the RT-ELISA device to monitor these analytes for approximately 30 mins (Figure 4).…”