Continuous Glucose Monitoring
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Continuous Continuous Glucose Glucose Monitoring Monitoring Thomas Repas D.O. Thomas Repas D.O. Diabetes, Endocrinology and Nutrition Center, Affinity Diabetes, Endocrinology and Nutrition Center, Affinity Medical Group, Neenah, Wisconsin Medical Group, Neenah, Wisconsin Member, Inpatient Diabetes Management Committee, St. Member, Inpatient Diabetes Management Committee, St. Elizabeth’s Hospital, Appleton, WI Elizabeth’s Hospital, Appleton, WI Member, Diabetes Advisory Group, Wisconsin Diabetes Member, Diabetes Advisory Group, Wisconsin Diabetes Prevention and Control Program Prevention and Control Program Website: www.endocrinology-online.com Website: www.endocrinology-online.com
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Continuous Glucose Monitoring. Thomas Repas D.O. Diabetes, Endocrinology and Nutrition Center, Affinity Medical Group, Neenah, Wisconsin Member, Inpatient Diabetes Management Committee, St. Elizabeth’s Hospital, Appleton, WI - PowerPoint PPT Presentation
Transcript of Continuous Glucose Monitoring
Continuous Glucose Continuous Glucose MonitoringMonitoring
Thomas Repas D.O.Thomas Repas D.O.Diabetes, Endocrinology and Nutrition Center, Affinity Medical Group, Neenah, WisconsinDiabetes, Endocrinology and Nutrition Center, Affinity Medical Group, Neenah, Wisconsin
Member, Inpatient Diabetes Management Committee, St. Elizabeth’s Hospital, Appleton, WIMember, Inpatient Diabetes Management Committee, St. Elizabeth’s Hospital, Appleton, WIMember, Diabetes Advisory Group, Wisconsin Diabetes Prevention and Control Program Member, Diabetes Advisory Group, Wisconsin Diabetes Prevention and Control Program
Website: www.endocrinology-online.comWebsite: www.endocrinology-online.com
MiniMed Continuous Glucose Monitoring MiniMed Continuous Glucose Monitoring System (CGMS)System (CGMS)
Interstitial fluid glucose (G2) is almost always comparable with blood glucose (G1)
Interstitial Fluid Measurement
Continuous Glucose MonitoringContinuous Glucose Monitoring
Midnight Midnight MidnightNoonNoon0
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Meal Meal Meal MealMeal Meal
Type 1
Normal
2-day tracing
•Elevated glycosylated hemoglobin (HbA1c)Elevated glycosylated hemoglobin (HbA1c)•Hypoglycemic episodes and unawarenessHypoglycemic episodes and unawareness•Hyperglycemic episodesHyperglycemic episodes•Diabetic ketoacidosisDiabetic ketoacidosis•Unexplained blood glucose excursionsUnexplained blood glucose excursions•GastroparesisGastroparesis•Gestational diabetes, preconception, pregnancy and nursingGestational diabetes, preconception, pregnancy and nursing•Evaluation of therapeutic changes to medication regimenEvaluation of therapeutic changes to medication regimen•Evaluation of behavioral modifications affecting glycemic controlEvaluation of behavioral modifications affecting glycemic control•Patients undergoing erythropoietin therapy or with hemolytic disorders Patients undergoing erythropoietin therapy or with hemolytic disorders because HbA1c may be unreliable because HbA1c may be unreliable
While the system may be used effectively with all diabetes patients, it may be of particular use in evaluating the following conditions and situations:
CGMS Indications
Snapshot vs. ContinuousSnapshot vs. Continuous
4 times/day
Glucose Sensor Profile: 12-18-99
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12:00 AM 4:00 AM 8:00 AM 12:00 PM 4:00 PM 8:00 PM 12:00 AM
Time
Glu
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Meter Value
Exercise
Snapshot vs. ContinuousSnapshot vs. ContinuousGlucose Sensor Profile: 12-18-99
-50
0
50
100
150
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250
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12:00 AM 4:00 AM 8:00 AM 12:00 PM 4:00 PM 8:00 PM 12:00 AM
Time
Glu
cos
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(m
g/d
L)
Meter Value
Sensor Value
Insulin
Meal
Exercise
Other
288 times/day
CGMS Pilot Study
9.9
8.88.6
7.5
8
8.5
9
9.5
10
Baseline Week 5 Week 10
HbA1c (%)
Bode, et al., Diabetes Research and Clinical Practice, 1999, 46:183-190.
p=0.0006 p=0.021, from BaselineN=9
