Insulin monitor
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Insulin Monitor: Continuous Glucose Monitoring and Insulin Management
Continuous Glucose Monitoring (CGM) in Diabetes Management
Continuous glucose monitoring (CGM) has revolutionized diabetes management by providing real-time glucose readings, which help in adjusting insulin therapy more effectively. CGM systems, such as the Dexcom G6 and G5, have been extensively studied for their efficacy in both type 1 and type 2 diabetes patients.
CGM in Hospitalized Patients
A randomized clinical trial evaluated the use of CGM in hospitalized patients with diabetes. The study found that while there were no significant differences in time in range (TIR) or mean daily glucose levels between CGM-guided and point-of-care (POC) groups, CGM significantly reduced the recurrence of hypoglycemic events among patients who experienced hypoglycemia1. This suggests that CGM can be a valuable tool in preventing recurrent hypoglycemia in a hospital setting.
CGM for Type 1 Diabetes with Hypoglycemia Awareness
The HypoDE study focused on adults with type 1 diabetes who had impaired hypoglycemia awareness or a history of severe hypoglycemia. The study demonstrated that real-time CGM (rtCGM) significantly reduced the incidence and severity of hypoglycemic events compared to self-monitoring of blood glucose (SMBG). Participants using rtCGM experienced a 72% reduction in hypoglycemic events, highlighting the effectiveness of CGM in high-risk individuals2.
CGM in Type 2 Diabetes
For patients with type 2 diabetes on multiple daily insulin injections, CGM has also shown promising results. A randomized trial found that CGM use led to a significant reduction in HbA1c levels over 24 weeks compared to usual care. This indicates that CGM can improve glycemic control in type 2 diabetes patients, supporting its broader adoption in this population3.
Insulin Pump Therapy and CGM
Combining CGM with insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), has been shown to enhance diabetes management. A study involving children and adults with type 1 diabetes found that adding CGM to insulin pump therapy significantly reduced HbA1c levels and the time spent in hypoglycemia. This combination allows for more frequent self-adjustments of insulin therapy, contributing to better overall glucose control5.
Advanced CGM Systems and Insulin Advisory Systems
Recent advancements in CGM technology include the integration of insulin advisory systems. These systems provide automated insulin titration and dosing recommendations based on CGM data. A study involving type 1 diabetes patients demonstrated that using a CGM/insulin informed advisory system reduced glucose variability and hypoglycemia exposure, suggesting that such systems can offer more personalized and effective diabetes management8.
Conclusion
Continuous glucose monitoring has proven to be a valuable tool in managing both type 1 and type 2 diabetes. It helps in reducing hypoglycemic events, improving glycemic control, and enhancing the effectiveness of insulin therapy. The integration of CGM with insulin pumps and advisory systems represents a significant advancement in diabetes care, offering more precise and personalized treatment options. As technology continues to evolve, CGM is likely to become an even more integral part of diabetes management strategies.
Sources and full results
Most relevant research papers on this topic
Continuous Glucose Monitoring-Guided Insulin Administration in Hospitalized Patients With Diabetes: A Randomized Clinical Trial.
Continuous glucose monitoring (CGM) is safe and effective in guiding insulin therapy in hospitalized patients with diabetes, leading to similar improvement in glycemic control and a significant reduction in recurrent hypoglycemic events compared to point-of-care testing.
RCT
Rigorous JournalReal-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial
Real-time continuous glucose monitoring significantly reduces the incidence and severity of hypoglycemia in high-risk individuals with type 1 diabetes treated with multiple daily insulin injections.
RCTRigorous Journal
Highly CitedContinuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial.
Continuous glucose monitoring (CGM) improves glycemic control in adults with type 2 diabetes receiving multiple daily insulin injections compared to usual care.
RCTRigorous JournalHighly CitedDiabetes Technology-Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline.
Continuous subcutaneous insulin infusion and continuous glucose monitoring are effective treatments for adults with diabetes, with limited randomized controlled trials supporting their use for various indications.
Systematic ReviewRigorous JournalHighly CitedThe use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial
Continuous glucose monitoring in type 1 diabetes patients using insulin pump therapy leads to decreased HbA1c levels and less time spent in hypoglycemia, potentially due to more frequent self-adjustments.
RCTRigorous JournalHighly CitedInsulin Pump and Continuous Glucose Monitor Initiation in Hospitalized Patients with Type 2 Diabetes Mellitus.
Insulin pump and CGM initiation during hospitalization are feasible for type 2 diabetes patients, but may not improve glycemic control, but may detect more hypoglycemic episodes.
RCTRigorous JournalElectrochemical Aptamer-Based Sensor for Real-Time Monitoring of Insulin.
The electrochemical aptamer-based sensor provides rapid, specific, and quantitative real-time monitoring of insulin, with a limit of detection of 20 nM and ability to discriminate against glucagon and somatostatin.
Highly CitedContinuous Glucose Monitoring and Insulin Informed Advisory System with Automated Titration and Dosing of Insulin Reduces Glucose Variability in Type 1 Diabetes Mellitus.
The UVA decision support system effectively reduces glucose variability and improves protection against hypoglycemia in type 1 diabetes patients.
RCTRigorous JournalHighly CitedNeedle-type dual microsensor for the simultaneous monitoring of glucose and insulin.
The needle-type dual microsensor offers rapid, linear, and reproducible glucose and insulin monitoring, offering potential for improved diabetes management.
Highly CitedContinuous glucose monitoring‐based time‐in‐range using insulin glargine 300 units/ml versus insulin degludec 100 units/ml in type 1 diabetes: The head‐to‐head randomized controlled InRange trial
Insulin glargine 300 U/ml and insulin degludec 100 U/ml show similar time-in-range results in adults with type 1 diabetes when compared using continuous glucose monitoring.
RCTRigorous Journal