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CGM Benefits A1C Levels, Speakers Say

Andrew Keegan

Continuous blood glucose monitoring (CGM) devices could give the next big boost to diabetes patient self-management, according to a number of presentations at the American Diabetes Association's 67th Scientific Sessions, held June 22–26 in Chicago.

The impact of the tools on diabetes care is likely to equal that of such staples as the blood glucose meter and the insulin pump, according to speaker Jay S. Skyler, MD, a professor at University of Miami Miller School of Medicine at Florida. By tapping the interstitial fluid in the fatty tissue just below the skin, CGM devices provide real-time glucose readings, updated every 5 minutes.

The currently available systems—DexCom STS and Medtronic's Guardian REAL-Time CGMS (Note: Medtronic also offers a MiniMed Paradigm System that integrates continuous monitoring with a pump)—offer alarms for glucose highs and lows, and the ability to download data and track trends over time. These features enable patients to easily observe how any given food, exercise, or insulin dose affects them over the course of a few hours. Patients are then free to modify their own behaviors to gain much better control.

Directional arrows are a key aid to control, making users aware when their blood glucose levels are in a state of flux, as well as the direction their blood glucose is heading.

"Knowing the direction and speed that the glucose is heading is the true advantage of CGM," says Howard Zisser, MD, director of clinical research at the Sansum Diabetes Research Institute in Santa Barbara, Calif.

And better control is key to managing glycated hemoglobin (A1C), note Skyler and Zisser. "The biggest improvement occurs in those with the highest A1Cs," Skyler says.

Howard Wolpert, MD, senior physician in the Joslin Clinic Section on Adult Diabetes in Boston, reiterates the benefits of these devices, adding that the early warning of low blood glucose and better control translate to better quality of life for users. But he notes that there is a learning curve for those new to the device, and important differences between this system and the familiar blood glucose monitor.

The biggest difference: Glucose rises and falls more rapidly in blood than in interstitial fluid. So those who use CGM devices must become acquainted with the resulting lag time and learn to treat themselves accordingly.

Those new to the device are also taught not to treat until levels stabilize. Also, these devices have been approved by the Food and Drug Administration for "adjunctive use," not as a replacement for blood glucose meters. Any readings requiring action should be backed up by a standard finger-prick test.

According to Wolpert, the successful use of these devices rests on two major legs: highly motivated patients and comprehensive patient education.

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Keegan, A. Search for Related Content PubMed Articles by Keegan, A. Social Bookmarking                What's this?