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The American Diabetes Association has the set the recommendations for health care professionals on what they should be doing, and what should be available for the optimal care of patients with diabetes. Among these recommendations are occasional monitoring of blood glucose either by fingerstick or through a venipuncture (for clinical laboratory testing). Such assessment can be used to supplement the information obtained from the patient's home glucose monitoring, or to verify portable meter testing in the office. Office testing allows the health care professional to see if the patient's results at home are accurate.
Continuous glucose sensors (CGMS)
The Food and Drug Administration has approved clinical use of Continuous Glucose Monitoring Sensors (CGMS). The first generation of these devices functioned like a Holter monitor of the heart. Now, a small cannula is inserted into the superficial tissue of the abdomen (the subcutaneous tissue). The introducing needle is removed, leaving the sensor to be taped in place then connected to an external device about the size of a digital pager. This records glucose values at an interval of roughly 5 minutes over a 72-hour period. At the end of that period, the recorded glucose values are downloaded, and information is reviewed with a health care professional. Patients usually keep a log over the 72-hour period of how they feel, what they eat, and what their fingerstick readings are for comparison with the sensor data. These data are especially helpful for athletes, patients with unpredictably high or low blood sugar levels, and those who cannot find a pattern to their fingerstick glucose readings. The drawback to the original sensors was that the data were not available in a "real time" format. As a result, the patient would have to bring the device into the health care professional's office to download and review the data in conjunction with the logs they were keeping.
CGM systems have improved dramatically in the last few years. They represent useful tools for diabetic patients to gain insight into their patterns of glucose response and to tailor more individual treatment regimens. The newest generation sensors provide a real time glucose value to the patient. The implantable sensor communicates wirelessly with a pager-sized device that has a screen. The device is kept near the sensor to allow for transfer of data; however, it can be a few feet away and still receive transmitted information. Depending on the model, the screen displays the blood glucose reading, a thread of the readings over time, and a potential rate of change in the glucose values. These sensors can be programmed to "beep" if blood sugars are in a range that is selected as too high or too low. Some can provide a warning alert if the drop in blood sugar is occurring too quickly.
Recent developments have produced one new sensor designed to communicate directly with the insulin pump. While the pump does not yet respond directly to information from the sensor, it does "request" a response from the person wearing the sensor if there is a need to adjust insulin, according to the sugar patterns which the sensor has been programmed to detect. The ultimate goal of this technology is to "close the loop" by continuously sensing what the body needs, then responding by providing the appropriate dose of insulin. While this technology needs further development, strides in this direction continue to be significant and encouraging. There is now one sensor that communicates with a pump to have it suspend insulin infusion for 2 hours, if there is a downward trend in blood glucose that could lead to hypoglycemia.