Continuous Glucose Monitoring

The talks on continuous glucose monitoring, or CGM, were some of the most heavily attended at ADA this year. Clearly, the attendees of the ADA saw CGM as an important topic for the future, and we hope that this is a promising sign for the growth of CGM. There were also several talks on progress with "closing the loop" by integrating CGM with an insulin or insulin/glucagon pump pump. Based on what we've seen, there's still a way to go before we have a fully integrated system, but there has been steady progress towards this eventual goal.

  • One-year results from a JDRF clinical trial of CGM showed that the technology reduces the rates of severe hypoglycemia in children with A1cs <7.0% and significantly lowered the A1cs of children and adults with A1cs <7.0%. Hopefully, the accumulation of data showing glycemic benefits with CGM will encourage insurance companies to reimburse it for more people.
  • David Rodbard, MD (Hahnemann Medical College and Hospital) presented results from a study in which patients wore a CGM for one week without seeing their readings, and then for two weeks where they were allowed to check their readings. When patients could see their CGM measurements, rates of hyperglycemia and glucose variability fell dramatically.
  • Steven Russell, MD (Boston University, Boston, MA) performed a trial of bi-hormonal closed loop system, in which CGM readings were used to determine injection levels of both insulin lispro (a fast acting insulin, marketed as Humalog) and glucagon (a hormone that raises blood sugar). The expected benefit of such a system is that hypoglycemia can be treated with glucagon if too large a dose of insulin is by the system. The bi-hormonal system maintained more stable glucose levels between meals than a single hormone system, with a mean blood glucose level of 143 mg/dl (8.5 mmol/l). Patients in whom insulin lispro had a longer than normal half life experienced more hypoglycemia, reminding us how important it is to develop a faster rapid-acting insulin for the development of closed-loop systems.
  • Weinstein et al presented data on the Abbott Navigator "TruStart" algorithm, which drastically reduces the startup time associated with Navigator CGM systems. Currently, the Navigator takes 10 hours to initialize, as opposed to two hours with the DexCom SEVEN PLUS and the MedTronic Paradigm. This new algorithm brings that down to one hour, which makes the Navigator a much more attractive option.

So, all in all, a positive year for diabetes: new and promising therapies are developing, existing but important therapies (read: continuous glucose monitoring) are gaining popularity, and at least two cardiovascular scares were debunked. It seems that we're on the tipping point of big and wonderful changes in the world of diabetes. We'll certainly have a whole lot more to talk about at next year's ADA Scientific Sessions.


Nick Wilkie, editor of diaTribe (diaTribe.us), also contributed to this article. diaTribe is a free online newsletter for patients who looking for more information on products and research.

Reprinted with permission by Close Concerns

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

 

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Last Modified Date: April 01, 2014

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