The updated ADA guidelines contain discussions on using continuous glucose monitoring (CGM) technology to improve glycemic control for diabetic management in adults with diabetes and youth with type 1 or type 2 diabetes.
CGM devices use subcutaneous glucose sensors to automatically track blood glucose levels 24 hours a day. Most devices have alarms for hypoglycemic and hyperglycemic alerts. These systems alert users to changes in blood glucose levels which can assist them in making informed decisions about nutrition, physical activity, and medication. Typically, two main types of CGM systems are used:
- Real-time continuous glucose monitoring
- Intermittently scanned continuous glucose monitoring devices
CGMs can be extremely helpful and convenient for patients who require close tracking of their glucose levels in real-time without the need to perform a fingerstick each time a blood glucose level is needed. Typically, most CGMs check blood glucose levels every 5–15 minutes and can also monitor levels overnight.
There are various monitors commercially available at varying costs. While CGM systems have been around for several years, the newest versions have greatly improved in accuracy and features. There are 3 commonly used CGM systems currently on the market in the U.S.:7
- Dexcom G6 - FDA-approved for ages 2 and up
- Freestyle Libre system from Abbott - FDA-approved for ages 4 and up
- Medtronic’s Guardian Sensor 3 - FDA-approved for ages 3 and up
The ADA guidelines contain the following recommendations on the use of CGMs for diabetes management:
- Real-time continuous glucose monitoring or intermittently scanned continuous glucose monitoring should be offered for diabetes management in adults with diabetes on multiple daily injections or continuous subcutaneous insulin infusion who are capable of using devices safely (either by themselves or with a caregiver). The choice of device should be made based on patient circumstances, desires, and needs. Real-time continuous glucose monitoring or intermittently scanned continuous glucose monitoring should also be offered for diabetes management in youth with type 1 diabetes or type 2 diabetes.
- In patients on multiple daily injections and continuous subcutaneous insulin infusion, real-time continuous glucose monitoring devices should be used as close to daily as possible for maximum benefit. Intermittently scanned continuous glucose monitoring devices should be scanned frequently, at a minimum once every 8 hours.
- In addition, continuous glucose monitoring can help to achieve A1C targets in diabetes and pregnancy.
- Skin reactions, either due to irritation or allergy, should be assessed and addressed to aid in the successful use of devices.
