Continuous glucose monitoring in pregnant women with Type 1 diabetes: benefits for mothers, using pumps or pens, and their babies

Aims: To review the current literature on the use of continuous glucose monitoring during pregnancy in women with Type 1 diabetes. Methods: We searched the literature for randomized controlled trials using continuous glucose monitoring during pregnancy in women with Type 1 diabetes. Results: Three randomized trials were found and discussed in this review. One UK study found a reduction in large-for-gestational-age infants; however, only masked continuous glucose monitoring was used in that study. A Danish study used intermittent real-time continuous glucose monitoring and found no differences. The present authors conducted the CONCEPTT trial, in which pregnant women and women planning pregnancy were randomized to receive continuous glucose monitoring or standard care. We found a greater drop in HbA1c, more time spent in the target range, and a reduction in some adverse neonatal outcomes in women using continuous glucose monitoring. Numbers-needed-to-treat to prevent a large-for-gestational-age infant, a neonatal intensive care unit admission for >24 h, and a neonatal hypoglycaemia event were low. These findings were seen in both injection and pump users and across all countries. Possible reasons for differences in study findings are discussed. In addition, several issues need further study. Glycaemic variability and differences in dietary intake may also have played a role. Despite excellent glycaemic control, babies continue to be large. More research is needed to understand the role of glucose targets and the dynamic placental processes involved in fetal growth. Conclusions: The use of continuous glucose monitoring in women with Type 1 diabetes in pregnancy is associated with improved glycaemic control and neonatal outcomes. Further research examining the glycaemic and non-glycaemic variables involved in fetal growth and the cost–benefit of using continuous glucose monitoring in pregnancy is warranted

Oral glucose tolerance test and continuous glucose monitoring for gestational diabetes diagnosis: a survey study of women and health care professionals

Aims: The oral glucose tolerance test (OGTT), used for gestational diabetes mellitus (GDM) diagnosis for over 65 years, has poor acceptability and tolerability. Continuous glucose monitoring is being considered as potential alternative. The aim of our study was to formally assess women’s and health care professionals’ perception of both tests as diagnostic tools for GDM. Methods: Participants in a pilot study on continuous glucose monitoring for GDM diagnosis were invited to fill two questionnaires, each of 6 Likert-scale and one optional open-ended question. A range of healthcare practitioners were also invited to fill a questionnaire of 13 Likert-scale and 7 optional open-ended questions. Results: Sixty women completed the OGTT and 70 the continuous glucose monitoring questionnaire. OGTT was reported as poorly acceptable. Continuous glucose monitoring was described as significantly more tolerable (81% vs 27% 5/5 general acceptability rate, p < 0.001); ninety-three percent of the participants would recommend it for GDM diagnosis. Thirty health care professionals completed the survey. Most of them (73%) had confidence in OGTT as a diagnostic test for GDM with 66% raising some concerns. Doubts on continuous glucose monitoring were raised in terms of costs, accessibility and accuracy for GDM diagnosis due to “lack of evidence”. Conclusions: Continuous glucose monitoring was substantially better tolerated for women than OGTT. Current lack of evidence for diagnostic accuracy for GDM underlines the need for studies on correlation between continuous glucose monitoring parameters and pregnancy outcomes to strengthen evidence for its use as diagnostic test for GDM

The Effect of Continuous Glucose Monitoring on Glucose Control and Re-hospitalizations in Type II Diabetes Mellitus Patients

Purpose: This Program Development and Evaluation project was designed to improve the management of patients with type II diabetes mellitus through the implementation of a combined in-patient discharge protocol and outpatient continuous glucose monitoring protocol follow-up plan in a diabetes clinic following discharge from a rural-based acute facility hospitalization. Method: This quasi-experimental project was based on Rosswurm and Larrabee\u27s Model for Change framework. Outcome measures analyzed type II diabetes mellitus patients to assess the effects of a continuous glucose monitoring discharge protocol on pre- and post-glycemic levels, rehospitalizations, and patient (n=2) and provider knowledge (n=4) obtainment. Results: In a comparison of average pre- and post-glycemic levels, the continuous glucose monitoring group revealed a 14% decrease compared to 4% among the non-continuous glucose monitoring group. There was a 7.3% reduction of rehospitalizations indicated from pre- and post-implementation in a sample size of two, with a rehospitalization rate of 5.5% in the study population. Based on pre- and post-survey Likert scale results, participants showed increased knowledge related to diabetic treatment, monitoring of blood glucose levels, and lifestyle measures in controlling type II diabetes mellitus. Healthcare provider participants showed increased knowledge of continuous glucose monitoring risk factors, benefits, and advantages. Conclusion: Our findings support evidence for the use of continuous glucose monitoring in patients diagnosed with type II diabetes mellitus to improve clinical outcomes and reduce healthcare costs. This project is needed to support the more widespread use of continuous glucose monitoring, which can lead to reducing rehospitalizations, decreasing glycemic index, and improving overall patient satisfaction

The Effect of Continuous Glucose Monitoring on Glucose Control and Re-hospitalizations in Type II Diabetes Mellitus Patients

Purpose: This Program Development and Evaluation project was designed to improve the management of patients with type II diabetes mellitus through the implementation of a combined in-patient discharge protocol and outpatient continuous glucose monitoring protocol follow-up plan in a diabetes clinic following discharge from a rural-based acute facility hospitalization. Method: This quasi-experimental project was based on Rosswurm and Larrabee\u27s Model for Change framework. Outcome measures analyzed type II diabetes mellitus patients to assess the effects of a continuous glucose monitoring discharge protocol on pre- and post-glycemic levels, rehospitalizations, and patient (n=2) and provider knowledge (n=4) obtainment. Results: In a comparison of average pre- and post-glycemic levels, the continuous glucose monitoring group revealed a 14% decrease compared to 4% among the non-continuous glucose monitoring group. There was a 7.3% reduction of rehospitalizations indicated from pre- and post-implementation in a sample size of two, with a rehospitalization rate of 5.5% in the study population. Based on pre- and post-survey Likert scale results, participants showed increased knowledge related to diabetic treatment, monitoring of blood glucose levels, and lifestyle measures in controlling type II diabetes mellitus. Healthcare provider participants showed increased knowledge of continuous glucose monitoring risk factors, benefits, and advantages. Conclusion: Our findings support evidence for the use of continuous glucose monitoring in patients diagnosed with type II diabetes mellitus to improve clinical outcomes and reduce healthcare costs. This project is needed to support the more widespread use of continuous glucose monitoring, which can lead to reducing rehospitalizations, decreasing glycemic index, and improving overall patient satisfaction

Continuous glucose monitoring sensors: Past, present and future algorithmic challenges

Continuous glucose monitoring (CGM) sensors are portable devices that allow measuring and visualizing the glucose concentration in real time almost continuously for several days and are provided with hypo/hyperglycemic alerts and glucose trend information. CGM sensors have revolutionized Type 1 diabetes (T1D) management, improving glucose control when used adjunctively to self-monitoring blood glucose systems. Furthermore, CGM devices have stimulated the development of applications that were impossible to create without a continuous-time glucose signal, e.g., real-time predictive alerts of hypo/hyperglycemic episodes based on the prediction of future glucose concentration, automatic basal insulin attenuation methods for hypoglycemia prevention, and the artificial pancreas. However, CGM sensors’ lack of accuracy and reliability limited their usability in the clinical practice, calling upon the academic community for the development of suitable signal processing methods to improve CGM performance. The aim of this paper is to review the past and present algorithmic challenges of CGM sensors, to show how they have been tackled by our research group, and to identify the possible future ones

Accuracy of a CGM Sensor in Pediatric Subjects With Type 1 Diabetes. Comparison of Three Insertion Sites: Arm, Abdomen, and Gluteus

Patients with diabetes, especially pediatric ones, sometimes use continuous glucose monitoring (CGM) sensor in different positions from the approved ones. Here we compare the accuracy of Dexcom\uae G5 CGM sensor in three different sites: abdomen, gluteus (both approved) and arm (off-label)

Artificial neural network algorithm for online glucose prediction from continuous glucose monitoring.

Background and Aims: Continuous glucose monitoring (CGM) devices could be useful for real-time management of diabetes therapy. In particular, CGM information could be used in real time to predict future glucose levels in order to prevent hypo-/hyperglycemic events. This article proposes a new online method for predicting future glucose concentration levels from CGM data. Methods: The predictor is implemented with an artificial neural network model (NNM). The inputs of the NNM are the values provided by the CGM sensor during the preceding 20 min, while the output is the prediction of glucose concentration at the chosen prediction horizon (PH) time. The method performance is assessed using datasets from two different CGM systems (nine subjects using the Medtronic [Northridge, CA] Guardian® and six subjects using the Abbott [Abbott Park, IL] Navigator®). Three different PHs are used: 15, 30, and 45 min. The NNM accuracy has been estimated by using the root mean square error (RMSE) and prediction delay. Results: The RMSE is around 10, 18, and 27 mg/dL for 15, 30, and 45 min of PH, respectively. The prediction delay is around 4, 9, and 14 min for upward trends and 5, 15, and 26 min for downward trends, respectively. A comparison with a previously published technique, based on an autoregressive model (ARM), has been performed. The comparison shows that the proposed NNM is more accurate than the ARM, with no significant deterioration in the prediction delay

A folyamatos szubkután glükózmonitorizálás szerepe az intenzív terápiában

A kritikus állapotú betegek stressz-hyperglykaemiájának értékelése az elmúlt évtizedben jelentősen megváltozott. A vércukor szoros kontrolljának mortalitást csökkentő hatását igazolta több jelentős vizsgálat, ugyanakkor az ezt célzó inzulinkezelés megnöveli a hypoglykaemia kockázatát, amely független mortalitási tényező lehet. A hypoglykaemia szempontjából kiemelt jelentőségű a gyermekpopuláció, a fejlődő idegrendszer miatt. Ezek alapján joggal merül fel a vércukorváltozások intenzív osztályos monitorizálásának igénye, különösen gyermek betegeknél. A hagyományos, vérmintából történő vércukor-meghatározások nem tesznek lehetővé kellően szoros monitorizálást. A cukorbetegek számára kifejlesztett, a szövet közti glükóz meghatározásán alapuló módszerek (continuous glucose monitoring) jó alternatívát jelenthetnek az intenzív osztályos monitorizálásra, amennyiben felmérjük a rendszer korlátait. A mérés a szövet közti folyadékban történik, így a szöveti perfúzió változásai zavarhatják a pontosságát. A folyamatos glükózmonitoring módszer intenzív osztályos alkalmazását jelenleg még nem javasolják, amíg a rendszer megbízhatóságáról nem áll rendelkezésre elegendő adat. Összefoglaló közleményükben a szerzők a magyar klinikai gyakorlatban elterjedt Medtronic folyamatos szubkután glükózmonitorizáló rendszert értékelik, részben saját eredményeik alapján. Orv. Hetil., 2013, 154, 1043–1048. | Critical care associated with stress hyperglycaemia has gained a new view in the last decade since the demonstration of the beneficial effects of strong glycaemic control on the mortality in intensive care units. Strong glycaemic control may, however, induce hypoglycaemia, resulting in increased mortality, too. Pediatric population has an increased risk of hypoglycaemia because of the developing central nervous system. In this view there is a strong need for close monitoring of glucose levels in intensive care units. The subcutaneous continuous glucose monitoring developed for diabetes care is an alternative for this purpose instead of regular blood glucose measurements. It is important to know the limitations of subcutaneous continuous glucose monitoring in intensive care. Decreased tissue perfusion may disturb the results of subcutaneous continuous glucose monitoring, because the measurement occurs in interstitial fluid. The routine use of subcutaneous continuous glucose monitoring in intensive care units is not recommended yet until sufficient data on the reliability of the system are available. The Medtronic subcutaneous continuous glucose monitoring system is evaluated in the review partly based on the authors own results. Orv. Hetil., 2013, 154, 1043–1048

Enhancing Diabetic Patient Continuous Glucose Monitoring Access

Problem: Diabetic patients utilize treatments that require frequent monitoring and medication changes based on their blood sugar results. Continuous Glucose Monitoring (CGM) is more commonly used for diabetes management as time in range is becoming more prevalent to measure diabetes outcomes. Many diabetic patients find CGM use more accessible than finger sticks and glucometers. In contrast, others utilize the technology to closely monitor their blood sugars for interventions throughout the day. However, older adults have difficulty facilitating new CGM technology and may require further reinforcement using additional education methods such as teach-back. Context: The endocrinology clinic serves a patient population, primarily diabetic patients who utilize treatments that require frequent monitoring and medication changes based on their blood sugar results. This clinic has deficits in patient care related to the initiation of patient continuous glucose monitoring devices (CGM). The current process delays patient care and impedes healthcare providers\u27 work processes within the endocrinology and diabetes education clinics by limiting time dedicated to patient care. Interventions: This problem was mitigated by creating a foundational baseline for the CGM process from the point of prescription to the point of use or evaluation, reviewing the standardized CGM process using the teach-back method with patients, and educating the clinic staff on the standardized process. Measures: The measures utilized to monitor the study are the percentage of reduced clinic visit time dedicated to CGM set-up with providers and Diabetes Education Clinic, the reduction in time dedicated per provider per patient for CGM set-up in Endocrinology and Diabetes Education Clinic, and the clinic staff feedback with a detailed log of time dedicated for CGM device download and set-up time during clinic visits. An additional measure used is the evaluation of provider knowledge about the process, all through surveys throughout the quality improvement process. Results: At the conclusion of the project, time dedicated to education during visits was reduced from 1.4 minutes to 1 minute on average, the percentage of office visit time lost was reduced from 6.5% to 1%, and the average number of correct answers for CGM access knowledge test increased from 2.9 to 3.8 out of 5, and overall percentage correct on the knowledge tests increased from 57% to 76%. Conclusions: This intervention successfully met the expected goals by decreasing the percentage of office visit time dedicated to CGM education and increasing the overall staff knowledge of the CGM process. After the conclusion of this project, it is expected to continue in the clinic for use by healthcare providers and potentially expand to other primary care and hospital-based clinics