Endocrine

, Volume 43, Issue 1, pp 41–50 | Cite as

Continuous glucose monitoring in type 1 diabetes

  • Nelly Mauras
  • Larry Fox
  • Kimberly Englert
  • Roy W. Beck
Review

Abstract

Continuous glucose monitors (CGM), devices that can measure interstitial glucose in “real time,” have become widely available particularly for use in patients with diabetes, and their accuracy and ease of use have greatly improved over the last decade. A number of large and well-controlled clinical trials have firmly established their usefulness in improving metabolic control (as measured by HbA1C) and decreasing time spent in hypoglycemia in adults; however, data have been less robust proving benefit in children and adolescents. Benefits are clearly linked to near-continuous wear. Insulin dosing algorithms based on CGM glucose trends have proven useful in dissecting the large volume of data generated daily by these devices, although these are imperfect tools, particularly in children. The technology is likely to be most useful when integrated with insulin pump delivery systems (sensor augmented). In this review, we concentrate on the analysis of published results of the largest trials in adults and children, including the very young, with diabetes.

Keywords

Continuous glucose sensors Adolescents Children Diabetes control Quality of life 

References

  1. 1.
    S.A. Weinzimer, R.W. Beck, H.P. Chase, L.A. Fox, B.A. Buckingham, W.V. Tamborlane, C. Kollman, J. Coffey, D. Xing, K.J. Ruedy, Diabetes Research in Children Network Study Group, Accuracy of newer-generation home blood glucose meters in a diabetes research in children network (DirecNet) inpatient exercise study. Diabetes Technol. Ther. 7, 675–680 (2005)PubMedCrossRefGoogle Scholar
  2. 2.
    J.C. Pickup, S.C. Freeman, A.J. Sutton, Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ 343, d3805 (2011)PubMedCrossRefGoogle Scholar
  3. 3.
    M. Phillip, T. Danne, S. Shalitin, B. Buckingham, L. Laffel, W. Tamborlane, T. Battelino, for the Consensus Forum Participants, Use of continuous glucose monitoring in children and adolescents. Pediatr. Diabetes 13, 215–228 (2012)PubMedCrossRefGoogle Scholar
  4. 4.
    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. J. Clin. Endocrinol. Metab. 96, 2968–2979 (2011)PubMedCrossRefGoogle Scholar
  5. 5.
    Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, W.V. Tamborlane, R.W. Beck, B.W. Bode, B. Buckingham, H.P. Chase, R. Clemons, R. Fiallo-Scharer, L.A. Fox, L.K. Gilliam, I.B. Hirsch, E.S. Huang, C. Kollman, A.J. Kowalski, L. Laffel, J.M. Lawrence, J. Lee, N. Mauras, M. O’Grady, K.J. Ruedy, M. Tansey, E. Tsalikian, S. Weinzimer, D.M. Wilson, H. Wolpert, T. Wysocki, D. Xing, Continuous glucose monitoring and intensive treatment of type 1 diabetes. N. Engl. J. Med. 359, 1464–1476 (2008)PubMedCrossRefGoogle Scholar
  6. 6.
    Diabetes Research In Children Network (DirecNet) Study Group, B. Buckingham, D. Xing, S. Weinzimer, R. Fiallo-Scharer, C. Kollman, N. Mauras, E. Tsalikian, W. Tamborlane, R. Wysocki, K. Ruedy, R. Beck, Use of the DirecNet applied treatment algorithm (data) for diabetes management with a real-time continuous glucose monitor (the freestyle navigator). Pediatr. Diabetes 9, 142–147 (2008)PubMedCrossRefGoogle Scholar
  7. 7.
    Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, B. Bode, R.W. Beck, D. Xing, L. Gilliam, I. Hirsch, C. Kollman, L. Laffel, K.J. Ruedy, W.V. Tamborlane, S. Weinzimer, H. Wolpert, Sustained benefit of continuous glucose monitoring on A1c, glucose profiles, and hypoglycemia in adults with type 1 diabetes. Diabetes Care 32, 2047–2049 (2009)PubMedCrossRefGoogle Scholar
  8. 8.
    R.M. Bergenstal, W.V. Tamborlane, A. Ahmann, J.B. Buse, G. Dailey, S.N. Davis, C. Joyce, T. Peoples, B.A. Perkins, J.B. Welsh, S.M. Willi, M.A. Wood, STAR 3 Study Group, Effectiveness of sensor augmented insulin pump therapy in type 1 diabetes. N. Engl. J. Med. 363, 311–320 (2010)PubMedCrossRefGoogle Scholar
  9. 9.
    M.L. Misso, K.J. Egberts, M. Page, D. O’Connor, J. Shaw, Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochr. Datab. Syst. Rev. 1, CD005103 (2010)Google Scholar
  10. 10.
    J.C. Pickup, A.J. Sutton, Severe hypoglycaemia and glycaemic control in type 1diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabet. Med. 25, 765–774 (2008)PubMedCrossRefGoogle Scholar
  11. 11.
    T. Battelino, M. Phillip, N. Bratina, R. Nimri, P. Oskarsson, J. Bolinder, Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care 34, 795–800 (2011)PubMedCrossRefGoogle Scholar
  12. 12.
    M.A. O’Connell, S. Donath, D.N. O’Neal, P.G. Colman, G.R. Ambler, T.W. Jones, E.A. Davis, F.J. Cameron, Glycaemic impact of patient-led use of sensor-guided pump therapy in type 1 diabetes: a randomised controlled trial. Diabetologia 52, 1250–1257 (2009)PubMedCrossRefGoogle Scholar
  13. 13.
    C.U. Ludwig-Seibold, M. Holder, B. Rami, K. Raile, B. Heidtmann, R. Holl, Continuous glucose monitoring in children, adolescents, and adults with type 1 diabetes mellitus: analysis from the prospective DPV diabetes documentation and quality management system from Germany and Austria. Pediatr. Diabetes 13, 12–14 (2012)PubMedCrossRefGoogle Scholar
  14. 14.
    R.H. Slowver, J.B. Welsh, A. Criego, S.A. Weinzimer, S.M. Willi, M.A. Wood, W.V. Tamborlane, Effectiveness of sensor-augmented pump therapy in children and adolescents with type 1 diabetes in the STAR 3 study. Pediatr. Diabetes 13, 6–11 (2012)CrossRefGoogle Scholar
  15. 15.
    A.E. Scaramuzza, D. Iafusco, I. Rabbone, R. Bonfanti, F. Lombardo, R. Schiaffini, P. Buono, S. Toni, V. Cherubini, G.V. Zuccotti, Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology, Use of integrated real-time continuous glucose monitoring/insulin pump system in children and adolescents with type 1 diabetes: a 3-year follow-up study. Diabetes Technol. Ther. 13, 99–103 (2011)PubMedCrossRefGoogle Scholar
  16. 16.
    O. Kordonouri, E. Pankowska, B. Rami, T. Kapellen, R. Coutant, R. Hartmann, K. Lange, M. Knip, T. Danne, Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the paediatric onset study (ONSET) after 12 months of treatment. Diabetologia 53, 2487–2495 (2010)PubMedCrossRefGoogle Scholar
  17. 17.
    N. Mauras, R. Beck, D. Xing, B. Buckingham, M. Tansey, N.H. White, S.A. Weinzimer, W. Tamborlane, C. Kollman, Diabetes Research in Children Network (DirecNet) Study Group, A randomized clinical trial to assess the efficacy and safety of real-time continuous glucose monitoring in the management of type 1 diabetes in young children aged 4 to <10 years. Diabetes Care 35, 204–210 (2012)PubMedCrossRefGoogle Scholar
  18. 18.
    Diabetes Research in Children Network (DirecNet) Study Group, Youth and parent satisfaction with clinical use of the GlucoWatch G2 Biographer in the management of pediatric type 1 diabetes. Diabetes Care 28, 1929–1935 (2005)CrossRefGoogle Scholar
  19. 19.
    J. Ludvigsson, R. Hanas, Continuous subcutaneous glucose monitoring improved metabolic control in pediatric patients with type 1 diabetes: a controlled crossover study. Pediatrics 111, 933–938 (2003)PubMedCrossRefGoogle Scholar
  20. 20.
    K. Yates, A. Hasnat Milton, K. Dear, G. Ambler, Continuous glucose monitoring-guided insulin adjustment in children and adolescents on near-physiological insulin regimens: a randomized controlled trial. Diabetes Care 29, 1512–1517 (2006)PubMedCrossRefGoogle Scholar
  21. 21.
    F.R. Kaufman, L.C. Gibson, M. Halvorson, S. Carpenter, L.K. Fisher, P. Pitukcheewanont, A pilot study of the continuous glucose monitoring system: clinical decisions and glycemic control after its use in pediatric type 1 diabetic subjects. Diabetes Care 24, 2030–2034 (2001)PubMedCrossRefGoogle Scholar
  22. 22.
    D.T. Golicki, D. Golicka, L. Groele, E. Pankowska, Continuous glucose monitoring system in children with type 1 diabetes mellitus: a systematic review and meta-analysis. Diabetologia 51, 233–240 (2008)PubMedCrossRefGoogle Scholar
  23. 23.
    W.H. Lagarde, F.P. Barrows, M.L. Davenport, M. Kang, H.A. Guess, A.S. Calikoglu, Continuous subcutaneous glucose monitoring in children with type 1 diabetes mellitus: a single-blind, randomized, controlled trial. Pediatr. Diabetes 7, 159–164 (2006)PubMedCrossRefGoogle Scholar
  24. 24.
    H.P. Chase, L.M. Kim, S.L. Owen, T.A. MacKenzie, G.J. Klingensmith, R. Murtfeldt, S.K. Garg, Continuous glucose monitoring in children with type 1 diabetes. Pediatrics 107, 222–226 (2001)PubMedCrossRefGoogle Scholar
  25. 25.
    Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Prolonged nocturnal hypoglycemia is common during 12 months of continuous glucose monitoring in children and adults with type 1 diabetes. Diabetes Care 33, 1004–1008 (2010)CrossRefGoogle Scholar
  26. 26.
    P. Adolfsson, S. Nilsson, B. Lindblad, Continuous glucose monitoring system during physical exercise in adolescents with type 1 diabetes. Acta Paediatr. 100, 1603–1609 (2011)PubMedCrossRefGoogle Scholar
  27. 27.
    Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, The effect of continuous glucose monitoring in well controlled type 1 diabetes. Diabetes Care 32, 1378–1383 (2009)CrossRefGoogle Scholar
  28. 28.
    Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, R.W. Beck, J.M. Lawrence, L. Laffel, T. Wysocki, D. Xing, E.S. Huang, B. Ives, C. Kollman, J. Lee, K.J. Ruedy, W.V. Tamborlane, Quality-of-life measures in children and adults with type 1 diabetes: juvenile diabetes research foundation continuous glucose monitoring randomized trial. Diabetes Care 33, 2175–2177 (2010)PubMedCrossRefGoogle Scholar
  29. 29.
    JDRF CGM Study Group, JDRF randomized clinical trial to assess the efficacy of real-time continuous glucose monitoring in the management of type 1 diabetes: research design and methods. Diabetes Technol. Ther. 10, 310–321 (2008)CrossRefGoogle Scholar
  30. 30.
    K. McLachlan, A. Jenkins, D. O’Neal, The role of continuous glucose monitoring in clinical decision-making in diabetes in pregnancy. Aust. N. Z. J. Obstet. Gynaecol. 47, 186–190 (2007)PubMedCrossRefGoogle Scholar
  31. 31.
    H.R. Murphy, G. Rayman, K. Duffield, K.S. Lewis, S. Kelly, B. Johal, D. Fowler, R.C. Temple, Changes in the glycemic profiles of women with type 1 and type 2 diabetes during pregnancy. Diabetes Care 30, 2785–2791 (2007)PubMedCrossRefGoogle Scholar
  32. 32.
    E. Stenninger, A. Lindqvist, J. Aman, I. Ostlund, E. Schvarcz, Continuous subcutaneous glucose monitoring system in diabetic mothers during labour and postnatal glucose adaptation of their infants. Diabet. Med. 25, 450–454 (2008)PubMedCrossRefGoogle Scholar
  33. 33.
    M.G. Dalfra, G. Sartore, G. Di Cianni, G. Mello, C. Lencioni, S. Ottanelli, J. Sposato, F. Valgimigli, C. Scuffi, M. Scalese, A. Lapolla, Glucose variability in diabetic pregnancy. Diabetes Technol. Ther. 13, 853–859 (2011)PubMedCrossRefGoogle Scholar
  34. 34.
    H.R. Murphy, G. Rayman, K. Lewis, S. Kelly, B. Johal, K. Duffield, D. Fowler, P.J. Campbell, R.C. Temple, Effectiveness of continuous glucose monitoring in pregnant women with diabetes: a randomized clinical trial. BMJ 337, a1680 (2008)PubMedCrossRefGoogle Scholar
  35. 35.
    A.L. Secher, A.B. Madsen, L. Ringholm, C. Barfred, E. Stage, H.U. Andersen, P. Damm, E.R. Mathiesen, Patient satisfaction and barriers to initiating real-time continuous glucose monitoring in early pregnancy in women with diabetes. Diabet. Med. 29, 272–277 (2012)PubMedCrossRefGoogle Scholar
  36. 36.
    G. Petrovski, C. Dimitrovski, M. Bogoev, T. Milenkovic, I. Ahmeti, I. Bitovska, Is there a difference in pregnancy and glycemic outcome in patients with type 1 diabetes on insulin pump with constant or intermittent glucose monitoring? A pilot study. Diabetes Technol. Ther. 13, 1109–1113 (2011)PubMedCrossRefGoogle Scholar
  37. 37.
    L. Messer, K. Ruedy, D. Xing, J. Coffey, K. Englert, K. Caswell, B. Ives, for the Diabetes Research in Children Network (DirecNet) Study Group, Educating families on real time continuous glucose monitoring: the DirecNet Navigator pilot study experience. Diabetes Educ. 35, 124–135 (2009)PubMedCrossRefGoogle Scholar
  38. 38.
    M.J. Rice, D.B. Coursin, Continuous measurement of glucose: facts and challenges. Anesthesiology 116, 199–204 (2012)PubMedCrossRefGoogle Scholar
  39. 39.
    G. McGarraugh, R. Brazg, R. Weinstein, Freestyle navigator continuous glucose monitoring system with trustart algorithm, a 1-h warm-up time. J. Diabetes Sci. Technol. 5, 99–106 (2011)Google Scholar
  40. 40.
    Medtronic Diabetes. An inpatient performance evaluation of a new subcutaneous glucose sensor, Clinical Trial NCT01112696. http://clinicaltrials.gov/ct2/show/NCT01112696?term=medtronics±diabetes&rank=1 (2010). Accessed 4 June 2012
  41. 41.
    E. Tsalikian, L. Fox, S. Weinzimer, B. Buckingham, N.H. White, R. Beck, C. Kollman, D. Xing, K. Ruedy, Diabetes Research in Children Network (DirecNet) Study Group. Feasibility of prolonged continuous glucose monitoring in toddlers with type 1 diabetes. Pediatr. Diabetes 13, 294–300 (2012)CrossRefGoogle Scholar
  42. 42.
    P. Choudhary, J. Shin, Y. Wang, M.L. Evans, P.J. Hammond, D. Kerr, J.A. Shaw, J.C. Pickup, S.A. Amiel, Insulin pump therapy with automated insulin suspension in response to hypoglycemia. Diabetes Care 34, 2023–2025 (2011)PubMedCrossRefGoogle Scholar
  43. 43.
    J. Mastrototaro, J. Shin, A. Marcus, G. Sulur, for the STAR 1 Clinical Trial Investigators, The accuracy and efficacy of real-time continuous glucose monitoring sensor in patients with type 1 diabetes. Diabetes Technol. Ther. 10, 385–390 (2008)PubMedCrossRefGoogle Scholar
  44. 44.
    DexCom Seven Plus®: User Guide (2010)Google Scholar
  45. 45.
    Medtronic MiniMed iPro2® CGM: User Guide (2010)Google Scholar
  46. 46.
    Animas® Vibe Insulin Pump and CGM System: User Guide (2011)Google Scholar
  47. 47.
    D.B. Keenan, J.J. Mastrototaro, H. Zisser, K.A. Cooper, G. Raghavendhar, S.W. Lee, J. Yusi, T.S. Bailey, R.L. Brazg, R.V. Shah, Accuracy of the Enlite 6-day glucose sensor with guardian and veo calibration algorithms. Diabetes Technol. Ther. 14, 225–231 (2012)PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Nelly Mauras
    • 1
  • Larry Fox
    • 1
  • Kimberly Englert
    • 1
  • Roy W. Beck
    • 2
  1. 1.Nemours Children’s ClinicJacksonvilleUSA
  2. 2.Jaeb Center for Health ResearchTampaUSA

Personalised recommendations