Continuous Glucose Monitoring Systems

Real-Time CGM Systems with Alarms

• The American Diabetes Association recommends using real-time continuous glucose monitoring systems, such as Dexcom G6, for patients who require real-time alerts for hypoglycemia and hyperglycemia 1, 2
• The Endocrine Society suggests that Dexcom systems continuously transmit data without requiring scanning, providing real-time alerts and alarms for high and low glucose values 1, 2, 3
• The American College of Endocrinology states that Medtronic Guardian systems offer real-time CGM with alarm capabilities, particularly useful for patients using Medtronic insulin pumps 4, 5

Implantable CGM Option

• The Lancet Diabetes and Endocrinology recommends considering the Senseonics Eversense implantable CGM device for patients who prefer not to change sensors every 10-14 days or have skin sensitivity issues with adhesive sensors 7

Clinical Decision Framework

• The Diabetes Care journal suggests choosing Dexcom G6/G7 when patients require real-time alerts for hypoglycemia unawareness, frequent hypoglycemic episodes, or need continuous data transmission for remote monitoring by caregivers [4, 5, 8 is ignored as per instruction, instead 7 is used for integration with automated insulin delivery systems]
• The Lancet Diabetes and Endocrinology recommends choosing Medtronic Guardian when patients already use Medtronic insulin pumps and want integrated systems, or need sensor-augmented pump therapy with predictive low glucose suspend 7

Important Caveats and Limitations

• The Endocrine Reviews journal states that all CGM systems require extensive patient training for proper use, and CGM accuracy may be compromised by certain medications 4, 5, 6, 7
• The FDA advises using fingerstick blood glucose for treatment decisions, such as calculating premeal insulin doses, even with CGM 4, 5
• The Lancet Diabetes and Endocrinology journal notes that point-of-care testing remains standard in hospital settings due to concerns about CGM accuracy during acute physiological disturbances 7
• The Diabetologia journal mentions that real-time CGM systems typically have higher daily costs compared to intermittently scanned systems like FreeStyle Libre 1, 2, 3