Continuous glucose sensors have the potential to revolutionize diabetes care by offering, for the first time, a minute-by-minute window into glucose levels and to alarm when glucose levels exceed safe thresholds. Parents of kids with diabetes and adults with diabetes will be able to sleep through the night, knowing that an unexpected low blood sugar will be detected and an alarm will sound. (See citations below about nocturnal hypoglycemia.) Everyone will be able to see the immediate effects of food on their glucose levels, and will be able to make changes in their diets to improve glucose control.

Continuous sensing is not equivalent to blood glucose however. Continuous sensors measure glucose in the interstitial space, not the blood. While the two values correlate well when the blood glucose is stable, there is a difference during periods of rapid change, such as immediately after a meal. This does not mean that continuous sensors are not accurate, or even that they are less accurate. They just measure something different. Everyone involved in diabetes — the patients, the diabetes team members, the scientific community, and industry — are learning how to make the best sense of this new data. And along the way, the nature of treating diabetes is changing.


References:

  1. Effect of Sensor-Augmented Insulin Pump Therapy and Automated Insulin Suspension vs Standard Insulin Pump Therapy on Hypoglycemia in Patients With Type 1 Diabetes. See also Low-Glucose-Suspension Feature Cuts Severe Hypoglycemia (Free Medscape membership required).
  2. Hypoglycemia in Patients with Type 1 Diabetes: Epidemiology, Pathogenesis, and Prevention.
  3. Detection and treatment efficacy of hypoglycemic events in the everyday life of children younger than 7 yr.
  4. Hypoglycaemia, fear of hypoglycaemia and quality of life in children with Type 1 diabetes and their parents.
  5. Review: Continuous glucose monitoring reduces HbA1c more than self-monitoring in type 1 diabetes.
  6. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial.
  7. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes.
  8. How continuous monitoring changes the interaction of patients with a mobile telemedicine system.
  9. Use of Continuous Glucose Monitoring in Subjects With Type 1 Diabetes on Multiple Daily Injections Versus Continuous Subcutaneous Insulin Infusion Therapy.
  10. Continuous glucose monitoring reduces both hypoglycaemia and HbA(1c) in hypoglycaemia-prone type 1 diabetic patients treated with a portable pump.
  11. Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment.
  12. Quality of Life Measures in Children and Adults with Type 1 Diabetes: The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Randomized Trial.
  13. Use of a real-time continuous glucose monitoring system in children and young adults on insulin pump therapy: patients’ and caregivers’ perception of benefit.
  14. Effectiveness of Continuous Glucose Monitoring in a Clinical Care Environment: Evidence from the JDRF-CGM Trial.
  15. Use of continuous glucose monitoring system in the management of severe hypoglycemia.
  16. Reducing glycaemic variability in type 1 diabetes self-management with a continuous glucose monitoring system based on wired enzyme technology.
  17. Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes – The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
  18. Sensor-Augmented Insulin Pump Therapy: Results of the First Randomized Treat-to-Target Study.
  19. The Accuracy and Efficacy of Real-Time Continuous Glucose Monitoring Sensor in Patients with Type 1 Diabetes.
  20. Sensor-augmented pump therapy in type 1 diabetes.
  21. Oscillating glucose is more deleterious on endothelial function and oxidative stress than mean glucose in normals and type 2 diabetic patients.
  22. Accuracy of the 5-Day FreeStyle Navigator Continuous Glucose Monitoring System. Free full text available in HTML and PDF formats.
  23. Hypoglycemia during sleep impairs consolidation of declarative memory in type 1 diabetic and healthy humans.
  24. Evaluating the Clinical Accuracy of Two Continuous Glucose Sensors Using Continuous Glucose Error Grid Analysis (Diabetes Care 28:2412-2417, 2005)
  25. Improvement in Glycemic Excursions With a Transcutaneous, Real-Time Continuous Glucose Sensor (Diabetes Care 29:44-50, 2006)
  26. Awakening and Counterregulatory Response to Hypoglycemia During Early and Late Sleep.
  27. Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1 Diabetes Mellitus. Free full text available in PDF format.
  28. Awakening from Sleep and Hypoglycemia in Type 1 Diabetes Mellitus. Free full text available in PDF format.
  29. Impaired overnight counterregulatory hormone responses to spontaneous hypoglycemia in children with type 1 diabetes.
  30. Nocturnal hypoglycaemia in Type 1 diabetic patients, assessed with continuous glucose monitoring: frequency, duration and associations.
  31. Use of Continuous Glucose Monitoring in the Detection and Prevention of Hypoglycemia.
  32. Impact of Real-Time Continuous Glucose Monitoring on Children and Their Families.
  33. Extended use of a new continuous glucose monitoring system with wireless data transmission in children with type 1 diabetes mellitus (Diabetes Technol Ther. 2006 Apr;8(2):139-45)
  34. Evaluation of CGMS® During Rapid Blood Glucose Changes in Patients with Type 1 Diabetes (Diabetes Technol Ther. 2006 Apr;8(2):146-55)
  35. Continuous subcutaneous glucose monitoring in children with type 1 diabetes mellitus: a single-blind, randomized, controlled trial (Pediatr Diabetes. 2006 Jun;7(3):159-64)
  36. Subcutaneous glucose sensor values closely parallel blood glucose during insulin-induced hypoglycaemia.
  37. Unrecognised hypoglycaemia in children and adolescents with type 1 diabetes using the continuous glucose monitoring system: Prevalence and contributors. (J Paediatr Child Health. 2006 Dec;42(12):758-63)
  38. Nocturnal hypoglycaemia in Type 1 diabetic patients, assessed with continuous glucose monitoring: frequency, duration and associations.
  39. Continuous glucose monitoring versus self-monitoring of blood glucose in the treatment of gestational diabetes mellitus.
  40. The role of continuous glucose monitoring in clinical decision-making in diabetes in pregnancy.
  41. The Medtronic MiniMed Gold Continuous Glucose Monitoring System: An Effective Means to Discover Hypo- and Hyperglycemia in Children Under 7 Years of Age.
  42. Continuous Subcutaneous Glucose Monitoring System in diabetic mothers during labour and postnatal glucose adaptation of their infants.