Patients with diabetes face daily challenges in managing their blood glucose levels, and it has been postulated that patients could benefit from a system providing continuous real-time glucose readings. The Endocrine Society has recently released a clinical practice guideline (CPG) providing recommendations on settings where patients are most likely to benefit from continuous glucose monitoring (CGM).
The most common way to self-check blood glucose levels is to prick the skin to get a drop of blood, put the blood on a test strip, and insert it in a glucose meter. CGM, though, measures glucose in the interstitial fluid -- the fluid between body cells just under the skin. People with both type 1 and type 2 diabetes use the results of blood glucose tests to make decisions about food, medicines and exercise.
"There are some caveats to consider before accepting continuous monitoring of glucose as a routine measure to improve glycemic control in diabetes," said David Klonoff, MD, of Mills-Peninsula Health Services in San Mateo, California and chair of the task force that authored the CPG. "There are still concerns about the high costs of CGM and the accuracy of the various systems available. However, the new CPG shows that CGM can be a beneficial tool to help maintain target levels of glycemia and limit the risk of hypoglycemia."
Recommendations from The Endocrine Society's CPG include:
- Use of CGM with currently approved devices in children and adolescents with type 1 diabetes mellitus (T1DM) because it will assist in maintaining target HbA1c levels while limiting the risk of hypoglycemia;
- Use of CGM devices by adult patients with T1DM who have demonstrated they can use these devices on a nearly daily basis; and
- Refrainment from using CGM alone for glucose management in the intensive care unit or operating room until further studies provide sufficient evidence for its accuracy and safety in those settings.
- D. C. Klonoff, B. Buckingham, J. S. Christiansen, V. M. Montori, W. V. Tamborlane, R. A. Vigersky, H. Wolpert. Continuous Glucose Monitoring: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 2011; 96 (10): 2968 DOI: 10.1210/jc.2010-2756
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