May 29, 2009
Continuous Glucose Monitoring Technology
Critical appraisal of continuous glucose monitoring technology is focus of Diabetes Technology & Therapeutics supplement
Continuous Glucose Monitoring (CGM) devices represent a critical step toward achieving automated glucose measurement, offering people with diabetes a promising new tool for maintaining optimal glucose control. A comprehensive review of this rapidly changing field, featuring the most recent research findings and critical analysis, is the focus of a special supplement of Diabetes Technology & Therapeutics, a peer-reviewed journal published by Mary Ann Liebert, Inc. (www.liebertpub.com). The supplement is available free online at www.liebertonline.com/dia
"CGM is still in its infancy, yet this technology is already becoming the standard of care," writes Satish K. Garg, MD, Editor-in-Chief of Diabetes Technology & Therapeutics, and Professor of Medicine and Pediatrics from the University of Colorado Denver, in an editorial introducing the supplement. Over the past decade, "The annual healthcare costs related to diabetes care in the United States have increased significantly by 32%...to $174 billion," despite improvements in glucose control, Garg notes. Better methods are needed to prevent the long- and short-term complications associated with diabetes.
This in-depth supplement provides a detailed presentation of the need for better glucose monitoring techniques, describes state-of-the-art CGM technology, and looks to the future and the ultimate goal of integrating CGM with an artificial pancreas to simulate normal blood glucose control systems in the body. Several articles focus on the challenges that CGM must still overcome, whether technical, practical, or economic. In the editorial, "Do We Really Need Continuous Glucose Monitoring?" Anne Peters, MD, from the University of Southern California Keck School of Medicine (Los Angeles), points out some of the drawbacks of current CGM technology: for example, the devices are "finicky and require care and calibration leading patients to use them infrequently"; "few physicians know how to interpret the data"; and "CGM devices have not been shown to reduce rates of severe hypoglycemia."
Associate Editor Jay S. Skyler, MD, from the University of Miami Miller School of Medicine (Florida), reviews the history of CGM in an editorial entitled, "Continuous Glucose Monitoring: An Overview of Its Development." Eric Orzeck, MD, from Endocrinology Associates (Houston, TX), describes the need for better documentation, coding, and appeal procedures for use of CGM to improve insurance coverage, in the article, "Maximizing Reimbursement through Correct Coding Initiatives."
In the commentary entitled, "Continuous Glucose Monitoring: Understanding Our Current Culture," Irl Hirsch, MD, from the University of Washington School of Medicine (Seattle), concludes that CGM, "is only a tool to help patients make better decisions about insulin and food. Until we have a closed-loop system or islet cell transplant, human behavior will continue to dictate the success of a patient with his or her diabetes control."