Page 152 - Glucose Monitoring Devices

153
References

with proven improvements in HbA1c, time in glycemic range, and hypoglycemia.
Discrete access to automated glucose monitoring, digestible retrospective glucose
analysis, and a reduction in fingerprick glucose testing are among the practical ben-
efits offered to users. The inclusion of high and low glucose alert features helps
address previously unidentified glucose fluctuations and supports a population of
individuals vulnerable to the deleterious impact of hypoglycemia unawareness. As
a research tool, access to continuous glucose data has proven to be insightful and
remains pivotal in establishing the clinical significance of glycemic variability
and other metrics of glucose control beyond HbA1c.
In acknowledging the many benefits of CGM, users and healthcare providers
must not lose sight of the proven efficacy of CGM as an adjunct and not a replace-
ment for capillary glucose testing. Furthermore, evidence suggests CGM to be more
effective when applied as a real-time interventional tool among adults willing to
comply with frequent use. Appreciation of these variables and the provision of
appropriate educational support must be considered when selecting individuals
that would reap the benefits of CGM. Ongoing dialogue to ensure that the limitations
and operational requirements are understood is crucial to retain compliance and
manage user expectations. Although lacking a glucose alert feature, the arrival of
flash glucose monitoring provides an unobtrusive means of glucose monitoring in
individuals unable to improve glycemia despite the intensive escalation of therapy.
In our aspiration to replicate physiological glucose control, CGM technology is
currently the most effective means of providing frequent efferent glucose data to aid
human or algorithmic insulin pump directed intervention. Sensor-augmented insulin
pumps with integrated low glucose suspend capabilities have proven successful in
improving glycemic control and reducing hypoglycemia. With the growing presence
of hybrid closed-loop systems on the scene, CGM continues to maintain its position
at the forefront of innovative diabetes care.

References
[1] Diabetes Control and Complications Trial Research Group, et al. The effect of inten-
sive treatment of diabetes on the development and progression of long-term complica-
tions in insulin-dependent diabetes mellitus. The New England Journal of Medicine
1993;329:977e86.
[2] Stratton IM, et al. Association of glycaemia with macrovascular and microvascular
complications of type 2 diabetes (UKPDS 35): prospective observational study.
BMJ 2000;321:405e12.
[3] Zoungas S, et al. Association of HbA1c levels with vascular complications and death
in patients with type 2 diabetes: evidence of glycaemic thresholds. Diabetologia 2012;
55:636e43.
[4] Duckworth W, et al. Glucose control and vascular complications in veterans with type
2 diabetes. The New England Journal of Medicine 2009;360:129e39.
[5] Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study.
Journal of the American Medical Association 1979;241:2035e8.