Diabetes Self-Management: There are more tools available for moni-
toring blood glucose levels than ever before. What developments do you see
as most promising, and how do you decide what to recommend to patients?
Clare Jung Eun Lee,
MD, endocrinologist
and assistant profes-
sor of medicine, Johns
Hopkins Medicine:In terms of blood glucose monitor-
ing, we’re able to offer options that
are less painful. Some of the latest
editions of continuous glucose
monitors (CGMs) do not require
that you calibrate their systems with
a fingerstick glucometer. Theoreti-
cally, if your blood sugar is behav-
ing, you shouldn’t have to prick
your fingers at all. And that’s been
a big boon to patients who had
to prick their fingers five to seven
times a day. We’re talking about
quality of life.
Even on the cost front, [tradi-
tional glucometers and CGMs] may
be neck and neck. CGMs are not
necessarily cheap, but test strips are
not cheap, either. And the fact that
you can see not only where your
blood sugar is at the moment but
where it’s going has implications
for how patients can prepare and
maintain their levels. It’s an exciting
development, and these systems are
only going to get better and better.David Matthew
Nathan, MD, endocri-
nologist and director
of Diabetes Center,
Massachusetts
General Hospital:CGM has been the major develop-
ment for Type 1 diabetes and is of
great importance to patients at par-
ticularly high risk for severe hypogly-
cemia. Its benefit in other patients
with Type 1 diabetes is a little less
clear and depends on the individual
patient’s ability and willingness to
adjust their insulin regimen.
Pump-treated patients can
respond to CGM data often and
more easily than [those treated
with] multiple daily injections, but
studies have demonstrated a benefit
for the latter group as well. Individ-
ualizing monitoring remains impor-
tant. CGM is a critical element in
creating true artificial pancreases.
Whether CGM will provide a benefit
for some patients with Type 2 diabe-
tes remains to be established.Adrian Vella, MD,
endocrinologist and
diabetes researcher,
Mayo Clinic:I think the ease of monitoring that
comes with CGMs or flash monitors
is a positive thing, provided it is used
appropriately to motivate patients
towards better glycemic control and
to decrease the risk of hypoglycemia.
If someone is on a regimen that
requires frequent testing—for exam-
ple, more than three times a day—it
is increasingly becoming my practice
to recommend a flash meter, since
the cost is beginning to approach
that of standard self-testing. I tend to
reserve CGMs for patients who are
using an insulin pump. Not every
patient needs this, but from a per-
sonal point of view, if I had Type 1
diabetes, I probably would want the
ability to check my blood sugars as
frequently as necessary.DiabetesSelfManagement.com 23