Page 250 - Glucose Monitoring Devices

CHAPTER

Low glucose suspend

systems 13

2
1
Viral N. Shah, MD , Amanda Rewers, MD , Satish Garg, MD 3
1
Assistant Professor of Pediatrics and Medicine, Barbara Davis Center for Diabetes Adult Clinic,
2
University of Colorado Anschutz Medical Center, Aurora, CO, United States; Research Assistant,
3
Barbara Davis Center for Diabetes Adult Clinic, Aurora, CO, United States; Professor of
Pediatrics and Medicine, Barbara Davis Center for Diabetes Adult Clinic, University of Colorado
Anschutz Medical Center, Aurora, CO, United States
Introduction
Diabetes is a chronic health disease that affects millions of people worldwide.
According to the International Diabetes Federation (IDF), 451 million people in
the world were expected to have diabetes in 2017; that number is projected to
increase to 693 million by 2045 [1]. Recent data from Centers for Disease Control
and Prevention estimated that 23 million Americans had diagnosed diabetes, 7.2.
Americans had undiagnosed diabetes, and 84.1 million had prediabetes in the
year 2015 [2]. Type 1 diabetes (T1D) is an autoimmune form of diabetes, character-
ized by inadequate insulin production due to near-total b-cell destruction [3].
Patients with T1D require life-long insulin therapy to achieve glycemic control to
prevent long-term acute and chronic diabetes complications [4]. Type 2 diabetes
(T2D) is characterized by inadequate insulin action, initial insulin resistance, later
followed by a decrease in insulin secretion requiring treatment with insulin [5].
Most patients with T2D ultimately need insulin therapy 20e30 years after diagnosis
[4,5]. Thus insulin is a cornerstone of diabetes management. Insulin use in patients
with diabetes is expected to increase from 516$1 million vials per year in 2018 to
633$7 million vials per year in 2030 [6].
In patients with T1D and T2D, intensive diabetes treatment has been shown to
reduce long-term micro- and macrovascular complications [7,8]. However, intensive
therapy is associated with an increased risk for hypoglycemia [9]. Hypoglycemia is
stated by patients, caregivers, and providers as the most feared complication of
intensive insulin therapy.
Incidence rates of hypoglycemia associated with intensive insulin therapy span
from 115 to 320 events per 100 patients with T1D [10]. Recent data from the T1D
Exchange Registry reported a 6% prevalence of severe hypoglycemia defined as
loss of consciousness or seizure among subset of 2561 patients with T1D who
completed the participant questionnaire [11]. Severe hypoglycemia was more than
threefold higher in the intensively treated group of DCCT than in conventionally

Glucose Monitoring Devices. https://doi.org/10.1016/B978-0-12-816714-4.00013-2 257
Copyright © 2020 Elsevier Inc. All rights reserved.