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Realistic Expectations and Practical Use of Continuous Glucose Monitoring for the Endocrinologist

University of Washington School of Medicine, Seattle, Washington 98105

Address all correspondence and requests for reprints to: Irl B. Hirsch, M.D., University of Washington Medical Center-Roosevelt, 4225 Roosevelt Way NE, Suite 101, Seattle, Washington 98101. E-mail: ihirsch{at}u.washington.edu.

Context: Real-time continuous glucose monitoring (CGM) has been available for type 1 diabetes for several years. This paper is a status report on our early experiences with this next technology.

Evidence Acquisition: The two major sources of data acquisition included PubMed search strategies and personal experience of the author from clinical experience.

Evidence Synthesis: Data assessing CGM accuracy, short-term outcomes (12 wk), and longer term outcomes (6 months) are reported. Potential strategies for successful and efficient use in an office or clinic setting are also discussed. Practical aspects of CGM use (alarm settings, using glycemic trending information) are also reviewed.

Conclusions: Accuracy of this technology has improved in the short amount of time it has been available. Six-month data suggest that patient selection is a key for success. Patients who do not understand or practice the basics of intensive insulin therapy have the greatest challenges. Those who do best watch the receiver frequently, continue with frequent home blood glucose monitoring, use the trending information to make insulin adjustments, and understand the limitations of the technology. With insurance reimbursement improving, CGM is gaining acceptance as an important tool for the management of type 1 diabetes. Like home blood glucose monitoring and insulin pump therapy, this technology by itself is not a panacea for diabetes control. However, it further adds to our ability to improve the lives of people with diabetes. Long-term, the hope is that this technology will pave the way for a "closed-loop" device.

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