Continuous Glucose Monitoring Is Here
- Technology that will change the lives of people with diabetes
The goals for glycemic control have changed dramatically since the results of
the Diabetes Control and Complications Trial (DCCT) were announced in
1993. Since that time, caregivers have stressed that getting glucose values to as
close to normal as possible is urgently needed to avoid blindness, nerve disease,
amputations and dialysis-those dreaded complications all of us with diabetes
and our loved ones fear. However, this puts people with diabetes at serious risk
for hypoglycemia. This is especially true as the goals for glycemic control
become tighter and tighter with the ultimate goal of
normalizing the A1c to below 6.5%.
People with diabetes are living longer. But unfortunately,
the ability to detect hypoglycemia, or low blood sugar,
declines the longer people live with the disease. Hypoglycemia
unawareness and fear of hypoglycemia are major
problems and obstacles in achieving tight glycemic control.
Hypoglycemia commonly leads to not only a reduced quality
of life, but also work related absenteeism and on-the-job
accidents, automobile accidents with personal injury and
property damage, expensive paramedic and emergency room
visits and hospitalizations, coma and not uncommonly death.
Recently, I went to a memorial
service for a friend, patient and
TCOYD volunteer who passed away
from severe hypoglycemia. She had
hypoglycemia unawareness, meaning
that the symptoms of low blood sugar
many people experience, such as
shakiness and sweating, did not occur
to warn her of her dropping blood
glucose level. She was determined
not to become blind or lose a leg or
go on dialysis. But by keeping such
tight control, she was at risk for hypoglycemia.
Any suggestion to relax her
glycemic control was contrary to her
goal of avoiding the complications she
fought against. Unfortunately this is not
an uncommon scenario. There is no
question in my mind that a continuous
glucose monitor (CGM) with an alarm
set at 80 or 90mg/dl would have saved
her life.
People living with
diabetes have many
day-to-day struggles
and this is especially
true with type 1 and
insulin requiring type
2 diabetes. There are
so many factors that go into insulin
dose decisions several times each day,
7 days a week, 12 months a year, year
after year. Some of these factors include
type and amount of food to be ingested,
prior type and intensity of exercise,
anticipated type and intensity of
exercise, other illnesses and stresses,
the blood sugar level at that time,
AND the trend of blood sugar levels
preceding the current test (important
information that too few people
currently have). In addition, the way
we give insulin is not physiologic;
subcutaneous insulin delivery can be
inconsistent and lead to unpredictable
blood sugar results.
Home glucose monitoring has been
one of the most important advances
in diabetes care but it does have limitations.
There are 1,440 minutes in a
day and even when people are testing
frequently they see only a partial
snapshot of what is happening. We do
not lack knowledge about how to treat
the disease, but rather, we lack constant
information about what our blood sugar
levels are doing in order to effectively
respond. CGM can now fill those wide
and potentially
dangerous gaps.
Like millions of
Americans living
with diabetes, for the
past 36 years, I have
struggled to control my blood sugar
levels as best I could while avoiding the
lows. I personally have avoided unconsciousness
from hypoglycemia but at
a price. I have diabetic retinopathy,
kidney dysfunction and neuropathy.
The best way to describe how I felt
when I used CGM technology for the
first time was like finally being able to
see clearly after 36 years of partial
blindness.
CGM devices include the Dexcom
Short Term Sensor (www.Dexcom.com)
which is available now. The Abbott
Navigator (www.abbottdiabetescare
.com) is currently in development
and may be approved this year, and
the Medtronic Minimed Guardian
RT (www.Minimed.com) is available
in limited markets.
The challenge now is to get this
technology into the hands of the
people who could benefit the most.
This will take a conserted effort
to educate the people living with
diabetes, the professional community
and the insurers.
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