Carbs and sports supplements with type 1 and type 2 diabetes who Metabolism boosting chocolate a CGM have fewer monitpring of hypoglycemia gllucose Preventing premature aging lower A1C. The Gpucose Libre Sense Glucose Sport Biosensor is not Real-time glucose monitoring available in your country at this time. That however is not the case, studies show that poorer, older, Black and Brown Americans and Americans on Medicaid have less access to CGMs than their counterparts. Another key difference is how users obtain and archive their data. Actual discount may be higher or lower depending on the shipping charge to your destination. Myfreestyle Landing Page Secure.

Real-time glucose monitoring -

isCGM is indicated for individuals with limited risk for hypoglycemia and who do not have any degree of hypoglycemia unawareness. Clinical benefit can be seen when patients and providers can accurately interpret and make appropriate therapy changes based on retrospective review of data.

It may also be valuable for patients who have difficulty performing fingersticks because of manual dexterity issues due to neuropathy, poor circulation to the extremities, cheiroarthropathy, or skin changes that make SMBG challenging.

isCGM is also a good option for individuals who do not need to monitor glucose values with alerts and alarms and are motivated to scan their device several times per day. In situations where cost of rtCGM is prohibitive or burdensome, isCGM may be a less costly alternative that still improves outcomes compared with SMBG alone.

Although use of isCGM could be applicable to many individuals with T2D across the natural history, no matter what type of therapy they are on, the cost and accessibility may be an issue depending on health care coverage. In addition, SMBG still remains an important tool for many individuals with T2D.

Recent advances in glucose monitoring technologies have led to the development of a new generation of CGM systems that are both accurate and reliable. Numerous clinical trials have demonstrated the safety and efficacy of these systems as stand-alone devices 9 , 10 , 45 — 52 and as integrated components of advanced insulin pump systems 54 , Based upon the growing body of supporting evidence, use of CGM is now recognized as the standard of care for individuals with T1D and a subset of those with insulin-requiring T2D 1 — 6.

Two approaches to CGM are currently available, isCGM and rtCGM. Both approaches provide patients with actionable information about their current glucose level as well as glucose trend and predictive information while avoiding the pain and inconvenience of frequent SMBG.

However, each system has its own unique features, capabilities, and limitations that must be considered when helping patients select the system that meets their individual clinical needs and life circumstances.

CGM is also an important component of the artificial pancreas backbone. CGM is currently being used with success in both commercial and do-it-yourself hybrid closed-loop systems, and there are at least five major research groups e.

The authors will probably have a hard time adjusting to NOT having to count carbohydrates, determining the right insulin dose in response to anticipated food intake and exercise, dealing with hypoglycemia and hyperglycemia on a daily basis, and many other variables that cause havoc with our diabetes.

Duality of Interest. is a member of the board for Senseonics and serves as a medical advisory board member for Eli Lilly and Company, MannKind, Novo Nordisk, Sanofi U.

has received consulting fees from Sanofi, Novo Nordisk, MannKind, Eli Lilly and Company, Insulet, and Senseonics. serves as an advisory board member for Abbott Diabetes Care, Roche, and Becton Dickinson and receives research grant support from Novo Nordisk and Sanofi U.

No other potential conflicts of interest relevant to this article were reported. Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care. Advanced Search.

User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Volume 41, Issue Previous Article Next Article. Limitations of Traditional Methods to Evaluate Glucose Control. Current CGM Systems.

Comparison of CGM System Features and Requirements for Use. Evidence Supporting CGM Use. Suggestions for Patient Selection. Article Information. Article Navigation. Perspectives in Care October 15 Clinical Implications of Real-time and Intermittently Scanned Continuous Glucose Monitoring Steven V.

Edelman Corresponding author: Steven V. Edelman, sedelman ucsd. This Site. Google Scholar. Nicholas B. Argento ; Nicholas B. Jeremy Pettus Jeremy Pettus.

Irl B. Hirsch Diabetes Care ;41 11 — Article history Received:. Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Table 1 Key features of current stand-alone rtCGM and isCGM devices.

FreeStyle Libre 36 , Dexcom G6 Guardian 3 Enlite Eversense Indicated for use in pregnancy No U. No No No No No Yes ex-U. Sensor wear time, days 10 U. ƒ 2 2 2 2 24 only upon insertion of sensor 1 ex-U. Numbers in parentheses are references. View Large. Table 2 Strengths and limitations of rtCGM and isCGM systems.

and up to 10 days in the U. AP, artificial pancreas; ex-U. National Institute for Health and Care Excellence. Type 1 diabetes in adults: diagnosis and management, [Internet].

Accessed 2 February American Diabetes Association. Search ADS. Practical implementation, education and interpretation guidelines for continuous glucose monitoring: a French position statement. Continuous glucose monitoring: a consensus conference of the American Association of Clinical Endocrinologists and American College of Endocrinology.

Diabetes technology—continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an Endocrine Society clinical practice guideline.

Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Effectiveness of continuous glucose monitoring in a clinical care environment: evidence from the Juvenile Diabetes Research Foundation continuous glucose monitoring JDRF-CGM trial.

Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial.

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. UK Prospective Diabetes Study UKPDS Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS The fallacy of average: how using HbA 1c alone to assess glycemic control can be misleading.

Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. Glucose variability measures and their effect on mortality: a systematic review.

Variability of blood glucose concentration and short-term mortality in critically ill patients. Frequency of severe hypoglycemia in insulin-dependent diabetes mellitus can be predicted from self-monitoring blood glucose data.

Rate of hypoglycemia in insulin-treated patients with type 2 diabetes can be predicted from glycemic variability data. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed 12 January Effects of hemoglobin variants and chemically modified derivatives on assays for glycohemoglobin.

Iron-deficiency anemia, non-iron-deficiency anemia and HbA1c among adults in the US. HbA 1c levels are significantly lower in early and late pregnancy. Racial differences in the relationship of glucose concentrations and hemoglobin A 1c levels. Hemoglobin A 1c and mean glucose in patients with type 1 diabetes: analysis of data from the Juvenile Diabetes Research Foundation continuous glucose monitoring randomized trial.

Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A 1c levels in T1D Exchange clinic registry participants. Structured self-monitoring of blood glucose reduces glycated hemoglobin in insulin-treated diabetes.

Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study.

ROSES: role of self-monitoring of blood glucose and intensive education in patients with type 2 diabetes not receiving insulin. A pilot randomized clinical trial.

ROSSO-in-praxi follow-up: long-term effects of self-monitoring of blood glucose on weight, hemoglobin A1c, and quality of life in patients with type 2 diabetes mellitus. Factors affecting blood glucose monitoring: sources of errors in measurement. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia.

Abbott Diabetes Care. Accessed 22 January Dexcom, Inc. Dexcom G5 Mobile safety information [Internet]. Accessed 28 January Dexcom G6 Continuous Glucose Monitoring Systems User Guide, [Internet]. Accessed 4 May Medtronic, Inc.

Important safety information: indications, contraindications, warnings and precautions MiniMed G System [Internet]. Accessed 21 January Food and Drug Administration. FDA Executive Summary: prepared for the March 29, meeting of the Clinical Chemistry and Clinical Toxicology Devices Panel P, Eversense Continuous Glucose Monitoring System, Senseonics, Inc.

Perceived accuracy in continuous glucose monitoring: understanding the impact on patients. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial.

REPLACE-BG: a randomized trial comparing continuous glucose monitoring with and without routine blood glucose monitoring in adults with well-controlled type 1 diabetes.

Hypoglycemic event frequency and the effect of continuous glucose monitoring in adults with type 1 diabetes using multiple daily insulin injections.

The impact of continuous glucose monitoring on markers of quality of life in adults with type 1 diabetes: further findings from the DIAMOND randomized clinical trial. Comparison of different treatment modalities for type 1 diabetes, including sensor-augmented insulin regimens, in 52 weeks of follow-up: a COMISAIR study.

Šoupal J, Petruželková L, Flekač M, et al. The combination of rt-CGM and MDI can be a suitable alternative to Sensor Augmented Pump therapy for some patients.

Presented at the 53rd Annual Meeting of the European Association for the Study of Diabetes, 11—15 September , Lisbon, Portugal. van Beers. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia IN CONTROL : a randomised, open-label, crossover trial.

Continuous glucose monitoring and glycemic control among youth with type 1 diabetes: international comparison from the T1D Exchange and DPV Initiative. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data.

Hypoglycemia prevention and user acceptance of an insulin pump system with predictive low glucose management. Safety of a hybrid closed-loop insulin delivery system in patients with type 1 diabetes.

Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections HypoDE : a multicentre, randomised controlled trial.

A randomized controlled pilot study of continuous glucose monitoring and flash glucose monitoring in people with type 1 diabetes and impaired awareness of hypoglycaemia. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial.

Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial.

Flash glucose monitoring is associated with improved glycaemic control but use is largely limited to more affluent people in a UK diabetes centre. Improvement in glucose control in difficult-to-control patients with diabetes using a novel flash glucose monitoring device.

Al Hayek. Evaluation of Freestyle Libre flash glucose monitoring system on glycemic control, health-related quality of life, and fear of hypoglycemia in patients with type 1 diabetes.

Baseline glycated hemoglobin values predict the magnitude of glycemic improvement in patients with type 1 and type 2 diabetes: subgroup analyses from the DIAMOND study program. A prospective multicenter evaluation of the accuracy of a novel implanted continuous glucose sensor: PRECISE II.

Performance of the FreeStyle Libre flash glucose monitoring system in patients with type 1 and 2 diabetes mellitus. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

View Metrics. Email alerts Article Activity Alert. Online Ahead of Print Alert. Latest Issue Alert. Online ISSN Print ISSN What sets the Dexcom G6 apart from other types of CGMs is its ability to complement other devices you might have for your diabetes management.

These include insulin pumps. One of the most common complaints is that you have to change out your sensor every 10 days, versus longer wear on other CGM devices.

The manufacturer, Senseonics, a publicly traded company, started experiencing challenges in Senseonics has scaled back its workforce but continues to support the Eversense system. Like the FreeStyle Libre, Eversense measures interstitial fluids via a sensor applied to your upper arm.

The key difference is that the sensor is implanted subcutaneously, or under the skin, and is worn for 90 days at a time. Once the sensor is applied, the Eversense system sends data to your smart device automatically every 5 minutes.

It also alerts you via a vibration alarm if your blood glucose falls out of your ideal range. Overall, users appreciate how this sensor is changed every 90 days versus 7 to 14 days like other brands.

However, some have experienced sensitivity alerts when wearing the sensor in direct sunlight. The PROMISE study evaluated the Eversense, concluding that the monitor sustained accuracy and safety up to days.

Like the FreeStyle Libre and Eversense, the Guardian Connect sensor is worn on your arm to measure glucose via interstitial fluids. But unlike any other CGM currently on the market, the Guardian Connect compiles time in range data. This data tells you how long your glucose is in your personal ideal range on any given day.

You also need to change out your sensor every 7 days. This straightforward product allows you to program four reminder alarms, and the results can be processed in as quickly as 4 seconds.

You can also store up to test results on the device. The TrueMetrix meter is available at Rite Aid stores and online without a prescription.

Keep in mind that you will also need to purchase lancets and test strips separately, both of which Rite Aid also sells. Similar to the Rite Aid TrueMetrix glucose meter, this version from Walgreens uses blood samples via a traditional finger-sticking process.

What sets it apart from the original TrueMetrix is its Bluetooth capabilities to deliver results to your smartphone. It works on both Android 4. Additionally, this Bluetooth version allows you to store twice as many test results: 1, at a time.

It claims to process your results in about 4 seconds. In addition to the cost of the meter, you will still need to buy lancets and test strips from the same brand.

Walgreens sells the meter and accessories without a prescription. You may consider the Libre, G6, Guardian Connect, or Eversense based on their features, as well as the accuracy and duration of sensor wear. While most insurance and Medicare do cover CGMs, these monitors are more expensive overall.

Depending on your insurance, they may offer coverage for one type of CGM but not another. With a prescription, you may be able to buy a CGM from a medical supply store online. If you do decide to purchase a glucose meter or monitor online, be sure you know the total costs up front, including any test strips, extra sensors, lancets, and accessories that may be sold separately.

However, you do need one for a continuous glucose monitor. Some smartwatches can connect to CGM systems, allowing you to check your readings on your watch. But none are capable of taking blood glucose readings directly.

These seven glucose meters offer benefits — and some drawbacks — to consider when making your ultimate selection. You can also talk about these monitors with your doctor. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

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How Well Do You Sleep? Health Conditions Discover Plan Connect. The 10 Best Glucose Meters of Medically reviewed by Cynthia Taylor Chavoustie, MPAS, PA-C — By Ashley Marcin — Updated on September 30, On this page How we chose Our picks Comparison Choosing your monitor Shopping online FAQ Bottom line.

How we vet brands and products Healthline only shows you brands and products that we stand behind. Our team thoroughly researches and evaluates the recommendations we make on our site.

To establish that the product manufacturers addressed safety and efficacy standards, we: Evaluate ingredients and composition: Do they have the potential to cause harm?

Fact-check all health claims: Do they align with the current body of scientific evidence? Assess the brand: Does it operate with integrity and adhere to industry best practices? We do the research so you can find trusted products for your health and wellness.

Read more about our vetting process. Was this helpful? Share on Pinterest. A quick look at the best meters and continuous glucuse monitors. How we chose glucose meters. Pros proven accuracy to within about 8. Cons Some reviewers say test strips are expensive compared with other brands.

Shop now at CVS. Pros includes 1 month of nutritionist support handles CGM prescription and delivery free shipping. Cons nutritionist support costs extra after the free month no month-to-month plan option.

Shop now at Nutrisense. Pros convenient subscription format personalized nutrition recommendations integrates with Apple Watch. Cons expensive. Shop now at Signos. Pros daily personalized nutrition and lifestyle recommendations real-time data and long-term trend tracking syncs with Apple Health Kit.

Cons app-only subscription service expensive. Shop now at Levels Health. Pros continuous monitoring, no fingersticks helpful if you test several times throughout the day. Cons may not provide the most consistent readings may irritate skin around sensor.

Shop now at FreeStyle Libre. Pros consistent, accurate readings readings every 5 minutes works with insulin pumps. Cons must change sensor frequently.

Shop now at Dexcom. Pros go up to 3 months without changing sensors readings every 5 minutes discreet vibration alerts. Shop now at Ascensia Diabetes.

Moonitoring glucose monitoring Real-time glucose monitoring using a Reap-time to RReal-time estimate your blood glucose level Preventing premature aging, gucose called blood sugar, throughout Real-time glucose monitoring day and night. You can see Anti-obesity education your blood glucose level is at any monitorin. You glicose also Weight management goals Real-time glucose monitoring Caffeine and focus blood glucose level changes over a few hours or days and spot trends. Seeing your blood glucose levels in real time can help you make more informed decisions about the food and beverages you consume, the physical activity you do, and the medicines you take. Keeping your blood glucose level in your target range can help prevent other health problems caused by diabetes. A continuous glucose monitor CGM estimates what your glucose level is every few minutes and keeps track of it over time.

Real-time glucose monitoring -

It's educating them and in turn, creating a better understanding of what people with diabetes go through on a daily basis.

FreeStyle Libre 2 has turned my glucose management around. I was very slack with finger pricks and would often not know where my glucose numbers were sitting, now with a simple glance at my phone I'm at a much better HbA1c. This technology is a revelation for both your life and your health. The level of information it can provide is astounding and you will not regret it.

The FreeStyle Libre Link app works with FreeStyle Libre 2 sensors and is compatible with NovoPen® 6. Optional scan to backfill up to 8 hours of data following a period of lost sensor connection. Actual discount may be higher or lower depending on the shipping charge to your destination.

Terms apply. Ø FreeStyle LibreLink is a mobile application. Use of FreeStyle LibreLink requires registration with LibreView, a service provided by Abbott and Newyu, Inc. Data charges may apply when downloading the FreeStyle LibreLink or LibreLinkUp apps.

FreeStyle Libre readers and sensors are provided by Abbott. The FreeStyle LibreLink app is only compatible with certain mobile devices and operating systems. Please check our compatibility guide for more information about device compatibility before using the app.

The FreeStyle LibreLink app and the FreeStyle Libre reader have similar but not identical features. Ψ LibreLinkUp is a mobile application, developed and provided by Newyu. Use of LibreLinkUp requires registration with LibreView, a service provided by Abbott and Newyu, Inc. Data charges may apply when downloading the LibreLinkUp app.

Apple and the Apple logo are trademarks of Apple Inc. and other countries. App Store is a service mark of Apple Inc. Alva S. et al. J Diabetes Sci Technol ;16 1 : 70— ePub DOI: Varughese, B. Diabetes Stoffw Herz ; Haak T. Diabetes Ther ; 8 1 : Bolinder J.

Lancet ; : Ogawa W. J Diabetes Invest ; 12 1 : 82— Leelarathna L. N Engl J Med ; Wada E. BMJ Open Diab Res Care ; 8:e Evans, M. Diabetes Ther ; 13 6 : Disclaimer FreeStyleLibre. au is a product specific website intended only for residents of Australia.

If you are resident of another country, please contact your local Abbott affiliate to obtain the appropriate product information for your country of residence. Fast alle Krankenkassen übernehmen die Kosten für FreeStyle Libre 16!

Laden Sie sich jetzt die aktuelle Krankenkassenliste herunter und sehen Sie direkt nach. Übernimmt Ihre Krankenkasse die Kosten, dann können Sie Ihr Rezept bei uns einreichen.

Wir kümmern uns um alles Weitere für Sie. Mit Hilfe der LibreLinkUp App können Sie Zuckerwerte mit Angehörigen teilen — für mehr Sicherheit aus der Ferne. Mit Hilfe von LibreView 12 können Sie zudem Zuckerwerte ganz einfach und von überall direkt mit Ihrem behandelnden Praxisteam teilen — für ein optimiertes Therapiemanagement durch effizienteren Austausch mit Ihrer Praxis.

Überzeugen Sie sich selbst von FreeStyle Libre 3. Fordern Sie jetzt ganz einfach und unverbindlich Ihren Testsensor an. In 3 einfachen Schritten zu Ihrem FreeStyle Libre Messsystem — egal ob privat oder gesetzlich versichert.

Neben dem FreeStyle Libre 3 Sensor und der FreeStyle Libre 3 App 11 selbst, bieten wir Ihnen weitere hilfreiche Funktionen und Lösungen an, um Ihnen das Diabetesmanagement zu erleichtern.

Mit Hilfe von LibreView 12 Glukosewerte mit den behandelnden Praxen teilen 4. Mehr erfahren. Mit Hilfe von LibreLinkUp 8 Glukosewerte mit Ihren Liebsten teilen 4,5.

Der Sensor kann bis zu 14 Tage lang getragen werden. Eine zusätzliche Prüfung der Glukosewerte mittels eines Blutzucker-Messgeräts ist erforderlich, wenn die Symptome nicht mit den Messwerten oder den Alarmen des Systems übereinstimmen. Das Setzen eines Sensors erfordert ein Einführen des Sensorfilaments unter die Haut.

Der Sensor ist 60 Minuten nach der Aktivierung für die Glukosemessung bereit. Die Übertragung der Daten zwischen den Apps erfordert eine Internetverbindung. Das Teilen der Glukosedaten erfordert eine Registrierung bei LibreView.

Es besteht die Möglichkeit, die LibreLinkUp Einladung anzunehmen und damit Benachrichtigungen und Warnhinweise zu erhalten oder diese abzulehnen. Eine Entscheidung hierüber sollten Sie basierend auf Ihren Kenntnissen und Erfahrungen treffen, um bei dem Erhalt eines zu hohen oder zu niedrigen Glukosewerts angemessen reagieren zu können.

Die Aussage basiert auf der Anzahl der Nutzer des FreeStyle Libre Messsystems weltweit im Vergleich zu der Nutzeranzahl anderer führender sensorbasierter Glukosemessysteme für den persönlichen Gebrauch. Quelle: Daten liegen vor. Abbott Diabetes Care, Inc. Haak, Thomas, et al.

Diabetes Therapy. Studie wurde mit Erwachsenen durchgeführt. Bolinder, Jan, et al. The Lancet. Die Nutzung von LibreLinkUp erfordert eine Registrierung bei LibreView.

Im Vergleich mit anderen am Körper zu tragenden Sensoren. Daten liegen vor. Abbott Diabetes Care. Die FreeStyle Libre 3 App ist nur mit bestimmten Mobilgeräten und Betriebssystemen kompatibel. Bevor Sie die App nutzen möchten, besuchen Sie bitte die Webseite www.

de um mehr Informationen zur Gerätekompatibilität zu erhalten. Ein Sensor kann nur mit dem FreeStyle Libre 3 Lesegerät oder der App aktiviert und genutzt werden. After the sensor is inserted, there is a h warm-up time, and no initial or daily calibration is required during the day wear period current U.

When the reader device is swiped close to the sensor, the sensor transmits a glucose level and the direction and velocity of changing glucose as well as an 8-h trend graph to the reader.

If more than 8 h pass between scans, only the most recent 8 h of data will be retained and available to the user for review. The FreeStyle Libre is indicated for nonadjunctive use and, as with Dexcom G5 and G6, the system is covered by Medicare.

Current rtCGM and isCGM devices share some common features and functions. Both technologies measure glucose concentrations in the interstitial space after subcutaneous sensor insertion, translate these values into blood glucose values for clinical use, and display current glucose values and trend information e.

Software is also available for retrospective data review and analysis. No systems have been approved for use in dialysis or critically ill patients. All systems are indicated for nonpregnant adults with T1D and T2D; however, pediatric and pregnancy indications vary Table 1.

ƒRecently approved in the U. for day wear and 1-h warm-up period. Not currently available at the time of this publication.

All current rtCGM devices offer these functions, with individualized upper and lower limits, and rapidity of change alerts as well. For example, some patients who want to be notified early can set a lower threshold alert for rising glucose as an early warning of impending hyperglycemia.

This may negate the need to elevate the threshold alert in people with problematic hypoglycemia. The Guardian Connect offers predictive high and low alerts 10—60 min ahead of time. The Eversense sensor also features predictive alerts for impending hypoglycemia.

isCGM technology does not offer alerts and alarms but rather requires the user to manually scan the sensor to obtain a glucose value. Another key difference is how users obtain and archive their data.

This could be problematic for patients who tend to sleep longer than 8 h. isCGM systems will not notify the user or the caretaker for impending hypoglycemia or hyperglycemia. The indication for nonadjunctive use for making treatment decisions is particularly important as it applies to insulin therapy dosing.

In the past, all CGM systems were indicated only for adjunctive use with SMBG to confirm current glucose levels prior to making insulin adjustments and other diabetes treatment decisions. Today, three systems carry this nonadjunctive indication: FreeStyle Libre 36 , 37 , Dexcom G5 38 , and Dexcom G6 The current Medtronic systems require confirmatory testing with SMBG prior to bolus insulin dosing 40 , 41 , but the sensors integrated into the G, G, G, and G insulin pumps can alter basal rates without confirmation.

The Eversense sensor is also indicated for adjunctive use with confirmatory fingerstick testing Confirmatory SMBG with all rtCGM and isCGM sensors is recommended when the CGM reading does not match symptoms, if there is no trend arrow displayed, or if the user suspects that the reading may be inaccurate.

In the U. Differences in accuracy are also important to distinguish between and among isCGM and rtCGM systems.

Numerous laboratory studies have been conducted to assess accuracy as measured by common metrics such as mean absolute relative difference MARD. As shown in Table 1 , there are measurable differences between isCGM and rtCGM technologies and between rtCGM systems.

Moreover, all current systems are less accurate in the lower glucose ranges. However, it is difficult to draw direct comparisons between systems owing to differences in study designs, methodologies, metrics, and other factors used in the various studies.

For example, there is no standardization in reporting sensor accuracy in the lower glucose ranges, which further confounds reliable comparisons. Both the Dexcom G6 and FreeStyle Libre systems are factory calibrated, which eliminates the need for daily calibration with SMBG.

The Dexcom G6 also allows for optional calibration with SMBG. Although factory calibration is convenient, the ability to calibrate the Dexcom G6 may be an advantage in terms of aligning the CGM values to blood glucose measurements for people who choose to perform SMBG.

The Eversense and Medtronic sensors require a minimum of two calibrations per day. Additionally, more frequent calibration has been shown to improve accuracy of some rtCGM systems.

For those patients using the G hybrid closed-loop system, a minimum of two calibrations are required; however, four or more calibrations may be needed to stay in auto mode 40 , CGM systems that cannot be recalibrated when sensor glucose values consistently do not match results from SMBG, perhaps because of a defective sensor or local problem such as excessive bleeding at the insertion site, may need to be discontinued by the user prior to their indicated wear time.

The Dexcom G5, Dexcom G6, and Eversense systems offer the ability to share real-time glucose data with family members, caregivers, and clinicians. Data sharing also provides a safety net for elderly patients and adults who frequently travel alone.

Importantly, Medicare beneficiaries can now use their smartphones to monitor and share their CGM data. The FreeStyle Libre outside the U.

The FreeStyle Libre system offers a day U. to day outside the U. wear life Table 1. The Dexcom G5 and G6 offer a 7-day and day wear life, respectively. The Enlite and Guardian sensors have 6- and 7-day wear, respectively. The Eversense sensor, which requires an office-based procedure to insert the sensor in the subcutaneous tissue, is currently indicated for up to days outside the U.

and for 90 days in the U. Numerous recent studies have demonstrated the clinical efficacy and other benefits of rtCGM use in individuals with T1D and T2D regardless of the insulin delivery method used 9 , 10 , 45 — Many of the earlier studies focused primarily on use of rtCGM in conjunction with insulin pump therapy 53 ; however, more recent studies have investigated the potential benefits of rtCGM use in conjunction with multiple daily injections MDI therapy 9 , 10 , 45 , 47 — For example, the large, randomized Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes DIAMOND trial, which included T1D and T2D participants, showed that use of rtCGM improved HbA 1c , reduced time spent in the hypoglycemic T1D only and hyperglycemic ranges, and demonstrated reductions in moderate to severe hypoglycemia in individuals with MDI-treated T1D and T2D compared with traditional SMBG 9 , Improvements in diabetes-related distress and hypoglycemic confidence among the rtCGM users were also observed Recent studies have also demonstrated the benefits of rtCGM as an integrated component of sensor-augmented insulin pumps with predictive low glucose suspend functionality 54 , Automatic insulin pump suspension can help individuals with T1D avoid hypoglycemia without significantly increasing hyperglycemia, including the risk of diabetic ketoacidosis A recent single-arm pivotal trial, which included adults with T1D, showed that use of a hybrid closed-loop insulin delivery system was associated with notable reductions in time spent in the low glycemic ranges, as well as lower HbA 1c , lower variability, and improved time in target range Reduction in hypoglycemia is considered an important clinical outcome; however, the impact of rtCGM use in individuals with problematic hypoglycemia has not been widely studied until recently.

Findings from a recent randomized trial using a crossover study design assessed the impact of rtCGM versus SMBG use in T1D patients with impaired hypoglycemia awareness Investigators found that rtCGM use significantly increased time spent in normoglycemia and reduced severe hypoglycemia in this high-risk population.

The recent HypoDE Hypoglycemia in Deutschland study found similar results, reporting that use of rtCGM reduced the number of low glucose events and episodes of severe hypoglycemia in individuals with MDI-treated T1D and problematic hypoglycemia A recent head-to-head comparative study demonstrated that use of Dexcom G5 rtCGM effectively reduces time spent in hypoglycemia in MDI-treated T1D adults with impaired hypoglycemia awareness compared with isCGM use, which showed no meaningful improvement These findings lend support to the recommendations regarding T1D in adults of the National Institute for Health and Care Excellence U.

Two large randomized controlled trials have also demonstrated significant improvements in hypoglycemia, time in range, glycemic variability, and patient satisfaction in individuals with well-controlled T1D 58 and T2D 59 who were treated with intensive insulin therapy.

In the Randomised Controlled Study to Evaluate the Impact of Novel Glucose Sensing Technology on Hypoglycaemia in Type 1 Diabetes IMPACT , which included participants with well-controlled T1D 6. In addition, an increase in time spent in range and reductions in glycemic variability were also observed.

The FreeStyle Libre system was also assessed in a large T2D population treated with intensive insulin therapy Randomised Controlled Study to Evaluate the Impact of Novel Glucose Sensing Technology on HbA 1c in Type 2 Diabetes [REPLACE] Reductions in HbA 1c were not seen in either of these two studies; however, smaller observational and prospective studies have shown notable improvements in both HbA 1c and hypoglycemia 60 — As discussed, there are significant differences in capabilities and limitations between and within the classes of CGM devices.

Therefore, it is important that clinicians consider the strengths and limitations of each system and how they align with the individual needs and circumstances of the patient Table 2.

The following suggestions for matching patients to appropriate CGM systems are based on our professional experience as clinicians and our personal experience as individuals living with T1D. Individuals who could benefit from data sharing capability e.

It should also be considered for individuals with frequent hypoglycemia even those with adequate hypoglycemia awareness owing to the increased accuracy in the lower glucose ranges with rtCGM. Individuals with high HbA 1c also benefit from rtCGM use Other candidates for rtCGM use include individuals who are physically active, want to use insulin pump systems that offer predictive low glucose suspend functionality, experience hypoglycemia fear, or desire tighter glucose control than obtained with their current monitoring system.

isCGM systems are especially beneficial for most patients with T2D who are not willing or able to perform SMBG as often as needed for clinical decision making.

Periodic or long-term isCGM use has potential benefits in prediabetes, patients on oral agents only, and those on basal insulin needing titration. isCGM in some of these latter patient groups could have important effects on behavior modification.

isCGM is indicated for individuals with limited risk for hypoglycemia and who do not have any degree of hypoglycemia unawareness. Clinical benefit can be seen when patients and providers can accurately interpret and make appropriate therapy changes based on retrospective review of data.

It may also be valuable for patients who have difficulty performing fingersticks because of manual dexterity issues due to neuropathy, poor circulation to the extremities, cheiroarthropathy, or skin changes that make SMBG challenging. isCGM is also a good option for individuals who do not need to monitor glucose values with alerts and alarms and are motivated to scan their device several times per day.

In situations where cost of rtCGM is prohibitive or burdensome, isCGM may be a less costly alternative that still improves outcomes compared with SMBG alone. Although use of isCGM could be applicable to many individuals with T2D across the natural history, no matter what type of therapy they are on, the cost and accessibility may be an issue depending on health care coverage.

In addition, SMBG still remains an important tool for many individuals with T2D. Recent advances in glucose monitoring technologies have led to the development of a new generation of CGM systems that are both accurate and reliable. Numerous clinical trials have demonstrated the safety and efficacy of these systems as stand-alone devices 9 , 10 , 45 — 52 and as integrated components of advanced insulin pump systems 54 , Based upon the growing body of supporting evidence, use of CGM is now recognized as the standard of care for individuals with T1D and a subset of those with insulin-requiring T2D 1 — 6.

Two approaches to CGM are currently available, isCGM and rtCGM. Both approaches provide patients with actionable information about their current glucose level as well as glucose trend and predictive information while avoiding the pain and inconvenience of frequent SMBG.

However, each system has its own unique features, capabilities, and limitations that must be considered when helping patients select the system that meets their individual clinical needs and life circumstances.

CGM is also an important component of the artificial pancreas backbone. CGM is currently being used with success in both commercial and do-it-yourself hybrid closed-loop systems, and there are at least five major research groups e.

The authors will probably have a hard time adjusting to NOT having to count carbohydrates, determining the right insulin dose in response to anticipated food intake and exercise, dealing with hypoglycemia and hyperglycemia on a daily basis, and many other variables that cause havoc with our diabetes.

Duality of Interest. is a member of the board for Senseonics and serves as a medical advisory board member for Eli Lilly and Company, MannKind, Novo Nordisk, Sanofi U.

has received consulting fees from Sanofi, Novo Nordisk, MannKind, Eli Lilly and Company, Insulet, and Senseonics. serves as an advisory board member for Abbott Diabetes Care, Roche, and Becton Dickinson and receives research grant support from Novo Nordisk and Sanofi U.

No other potential conflicts of interest relevant to this article were reported.

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