Role of Continuous Glucose Monitoring in Diabetes Treatment最新文献

{"title":"Continuous Glucose Monitoring Data as an Adjunct to A1C","authors":"R. Bergenstal","doi":"10.2337/DB20181-19","DOIUrl":"https://doi.org/10.2337/DB20181-19","url":null,"abstract":"The health care improvement goal of excellent quality and patient experience at reasonable cost is further shifting emphasis away from A1C as the reigning standard of care toward minimizing the daily burdens of living with diabetes.","PeriodicalId":364202,"journal":{"name":"Role of Continuous Glucose Monitoring in Diabetes Treatment","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125311906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future of Continuous Glucose Monitoring","authors":"T. Battelino","doi":"10.2337/DB20181-24","DOIUrl":"https://doi.org/10.2337/DB20181-24","url":null,"abstract":"The historical vision for continuous glucose monitoring (CGM) is becoming reality in day-to-day diabetes management, with the prospect of rapid growth in the foreseeable future. The latest U.S. Food and Drug Administration (FDA) approval of the first factorycalibrated CGM sensor will strengthen the path toward total elimination of cumbersome manual CGM calibrations.","PeriodicalId":364202,"journal":{"name":"Role of Continuous Glucose Monitoring in Diabetes Treatment","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133179560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Selection for Continuous Glucose Monitoring","authors":"James Chamberlain","doi":"10.2337/db20181-11","DOIUrl":"https://doi.org/10.2337/db20181-11","url":null,"abstract":"Identifying appropriate patients for continuous glucose monitoring (CGM) use is a vital component of therapy success. Potential candidates come from a diverse group of individuals with diabetes.","PeriodicalId":364202,"journal":{"name":"Role of Continuous Glucose Monitoring in Diabetes Treatment","volume":"265 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122751119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction: History of Glucose Monitoring","authors":"I. Hirsch","doi":"10.2337/DB20181-1","DOIUrl":"https://doi.org/10.2337/DB20181-1","url":null,"abstract":"","PeriodicalId":364202,"journal":{"name":"Role of Continuous Glucose Monitoring in Diabetes Treatment","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128852470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring Systems: Categories and Features","authors":"James Chamberlain","doi":"10.2337/db20181-4","DOIUrl":"https://doi.org/10.2337/db20181-4","url":null,"abstract":"","PeriodicalId":364202,"journal":{"name":"Role of Continuous Glucose Monitoring in Diabetes Treatment","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128444521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approaches for Successful Outcomes with Continuous Glucose Monitoring","authors":"G. Aleppo","doi":"10.2337/DB20181-6","DOIUrl":"https://doi.org/10.2337/DB20181-6","url":null,"abstract":"Individuals who perform SMBG typically focus on pre-meal or bedtime glucose levels, obtaining only a static snapshot of points in time. In the past two decades, continuous glucose monitoring (CGM), using subcutaneous sensors to measure interstitial glucose levels, has emerged to provide a better understanding of glucose trends and patterns.","PeriodicalId":364202,"journal":{"name":"Role of Continuous Glucose Monitoring in Diabetes Treatment","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133157126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evidence Base for Continuous Glucose Monitoring","authors":"A. Peters","doi":"10.2337/DB20181-3","DOIUrl":"https://doi.org/10.2337/DB20181-3","url":null,"abstract":"Twenty-seven published randomized controlled trials (RCTs) assessing outcomes of continuous glucose monitoring (CGM), involving a total of 3,826 patients, have been published to date. Although the number of patients in each study has been small compared to drug trials, cumulative evidence indicates a benefit of CGM for patients treated with either continuous subcutaneous insulin infusion (CSII) or a multiple daily injection (MDI) insulin regimen. Additionally, some data suggest that CGM may benefit people with type 2 diabetes who do not use insulin therapy. Overall, RCTs have shown improved glucose control in patients with higher initial A1Cs (often in the range of 7.8– 8.8%) using CGM compared to self-monitoring of blood glucose (SMBG). People who wear their CGM device most consistently derive the most benefit. Time spent in the designated hypoglycemia range (usually <70 mg/dL) was reduced in some studies, particularly in those with patients selected for having a higher risk of hypoglycemia. These patients tended to have lower baseline A1Cs (in the range of 6.5–7.5%). Rates of severe hypoglycemia generally have not differed between CGM and non-CGM groups, and these rates have been low across all studies. Studies fall into a few basic categories: adults with type 1 diabetes (8 trials, 698 patients), adults with type 2 diabetes (4 trials, 547 patients), children with type 1 diabetes (2 trials, 227 patients), adults plus children with type 1 diabetes (7 trials, 1,084 patients), adults with type 1 or type 2 diabetes (3 trials, 655 patients), and women during pregnancy with either type 1 diabetes or gestational diabetes mellitus (GDM) (3 trials, 585 patients). Table 1 lists general findings from all of these trials. It is important to note that some trials used A1C or time in range as the primary endpoint, whereas others used time in a hypoglycemic range as the primary outcome. Readers should also be aware that Table 1 is not a meta-analysis per se, but rather includes studies identified through a literature search of PubMed and Ovid MEDLINE, as well as all prior reviews and studies in their reference lists. Only RCT data are included; observational studies and extension phases of RCTs also have been performed but are not represented here. The first trials, from the early 2000s, used intermittent CGM. Some used “professional” CGM, in which patients were blinded to the CGM data (see the article on p. 8 of this compendium), and others followed an intermittent use schedule. As time progressed, the trials reflected evolving use of CGM to the current day. That is, earlier studies began to suggest that CGM could improve outcomes, but lack of access to real-time data limited benefit. More recent studies of real-time CGM, in which around-the-clock data are available, have shown more benefit in terms of reduction in both A1C and time spent in a hypoglycemic range. A major impediment to interpreting CGM studies is that no uniform standard has been employed for","PeriodicalId":364202,"journal":{"name":"Role of Continuous Glucose Monitoring in Diabetes Treatment","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128332359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Continuous Glucose Monitoring Data","authors":"R. Bergenstal","doi":"10.2337/DB20181-20","DOIUrl":"https://doi.org/10.2337/DB20181-20","url":null,"abstract":"Continuous glucose monitoring (CGM) systems are able to transmit glucose readings every 1–15 minutes to a receiver, insulin pump, phone(s), or watch, and eventually the glucose data may be uploaded to a computer, electronic medical record (EMR) system, and/or the Cloud.","PeriodicalId":364202,"journal":{"name":"Role of Continuous Glucose Monitoring in Diabetes Treatment","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129925037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring Comes of Age","authors":"T. Battelino","doi":"10.2337/DB20181-2","DOIUrl":"https://doi.org/10.2337/DB20181-2","url":null,"abstract":"Current iterations of continuous glucose monitoring (CGM) evolved from enzyme-based electrochemical glucose sensors developed in the 1960s at Cincinnati Children’s Hospital in Ohio, USA. Glucose oxidase (GOx) placed on a platinum electrode catalyzed the oxidation of glucose to gluconolactone in the presence of oxygen, producing hydrogen peroxide and water as by-products. In the 1980s, oxygen was replaced with a synthetic redox electron acceptor, improving the accuracy of secondgeneration biosensors. Proprietary technical improvements resulted in an array of GOx CGM systems obtaining regulatory approval for routine use. Despite considerable initial reluctance from many leading diabetologists to include CGM in diabetes management, clinical evidence has accumulated from research encompassing adult and pediatric populations with diabetes (1,2), hypoglycemia (3), use with sensor-augmented pumps (4,5), stand-alone use with multiple daily injections (6), outcomes during pregnancy (7), utility in type 1 and type 2 diabetes (8,9), and effects in real-life clinical settings (10). The article on p. 3 of this compendium offers a detailed discussion of published randomized clinical trials to date. A recently introduced factory-calibrated intermittently scanned interstitial glucose monitoring system, also known as flash CGM (FCGM), is also based on GOx CGM technology and represents a new option with clinical benefit comparable to real-time CGM (11). FCGM received regulatory approval as a substitute for blood glucose testing and could conceivably replace traditional self-monitoring of blood glucose in diabetes management for people with diabetes who test multiple times per day (Figure 1). The maturation of CGM technology and research is not only facilitating imminent development of closed-loop insulin delivery (12), but also substantiating the collection and analysis of continuous data as a routine treatment modality in major clinical guidelines (13,14). CGMderived metrics such as time in range and coefficient of variation are now regarded as viable parameters for everyday diabetes management, as well as for clinical research (15). As newer CGM systems with patient-centered features (see the article on p. 8 of this compendium) become a clinical reality for individuals with type 1 or type 2 diabetes, appropriate educational and technical support for both people with diabetes and health care providers will be needed to solidify the emerging status of continuous glucose data as a standard of care for daily diabetes management.","PeriodicalId":364202,"journal":{"name":"Role of Continuous Glucose Monitoring in Diabetes Treatment","volume":"171 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116496301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}