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Use of Continuous Glucose Monitoring Can Address Patient Fears and Facilitate Improved Glycaemic Management

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Published Online: Nov 18th 2011 European Endocrinology, 2011;7(2):88-91 DOI:
Authors: Jeff Unger, Christopher G Parkin
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Effective diabetes management can delay or prevent many of the complications of diabetes. Achieving optimal glycaemic control, however, often requires intensive insulin treatment, which is associated with an increased risk of severe hypoglycaemia. Many intensively managed patients are reluctant to follow and/or adjust their insulin regimens as needed because of fear of hypoglycaemia. This lack of adherence can result in exposure to chronic hyperglycaemia, oxidative stress and long-term complications. Severe hypoglycaemia can be prevented through vigilance in identifying patients at risk, using appropriate medications and medication regimens, and effective glucose monitoring strategies and technologies. This article reviews some evidence relevant to hypoglycaemia in intensively managed patients and discusses how tools such as continuous glucose monitoring (CGM) can help patients overcome their fear of hypoglycaemia and safely achieve optimal glycaemic control


Hypoglycaemia, type 1 diabetes, type 2 diabetes, continuous glucose monitoring (CGM), self-monitoring of blood glucose (SMBG), intensive insulin management, multiple daily injections (MDI)


Glycaemic Control is a Challenge in Diabetes

Large controlled clinical trials have demonstrated that intensive management of glycaemia and other diabetes risk factors can significantly decrease the development and/or progression of macrovascular and microvascular disease.1–4 Achieving optimal glycaemic control requires a high level of daily self-management.

Glycaemic Control is a Challenge in Diabetes

Large controlled clinical trials have demonstrated that intensive management of glycaemia and other diabetes risk factors can significantly decrease the development and/or progression of macrovascular and microvascular disease.1–4 Achieving optimal glycaemic control requires a high level of daily self-management. For patients with type 1 diabetes, this often includes intensive insulin therapy with dose adjustment (based upon carbohydrate intake and activity) and frequent glucose monitoring.1,5 Despite the proven benefits of effective diabetes management, many people with diabetes are reluctant or unable to follow and/or adjust their insulin regimens as needed, due to concerns about hypoglycaemia.6–8

Impact of Hypoglycaemia on Diabetes Management

Hypoglycaemia occurs when blood glucose concentrations drop below the level necessary to properly maintain the body’s requirement for energy and stability.9 Plasma glucose ≤70 mg/dl (3.9 mmol/l) is generally considered the cut-off point for hypoglycaemia; however, severe hypoglycaemia is usually defined as having plasma glucose <50 mg/dl (2.8 mmol/l), seizure, coma and/or requiring the assistance of another person.1,10

Retrospective studies of severe hypoglycaemia in type 1 diabetes have reported the incidence to be 1.3 (n=1,076) to 1.5 (n=195) episodes per patient-year; the percentage of patients affected ranged from 36.7 % to 40.5 %, respectively.11,12 Although the reported incidence rates in type 2 diabetes are more varied, depending on the treatment, duration of the disease and the cut-off points used to define severe hypoglycaemia,13–20 the frequency of severe hypoglycaemia in type 2 diabetes, including episodes that require emergency medical treatment, is similar to that seen in type 1 diabetes when matched for duration of insulin therapy.21–23 Patients affected by hypoglycaemia unawareness – a condition that occurs when a person with diabetes no longer experiences the symptoms of impending hypoglycaemia – have a three- to sixfold increased risk of severe hypoglycaemia because they are no longer alerted to take action (ingest carbohydrates) to prevent it.24–26

Patients treated with insulin or insulin secretagogues experience severe hypoglycaemia more frequently when glucose control is intensified.27–29 In the Action to control cardiovascular risk in diabetes (ACCORD) trial, Gerstein et al. found that intensive therapy to target normal glycated haemoglobin (HbA1c) levels significantly increased the occurrence of hypoglycaemia requiring assistance compared with standard care: 538 (10.5 %) versus 179 (3.5 %), respectively, p<0.001.28 At one year, stable median HbA1c levels of 6.4 % and 7.5 % were achieved in the intensive-therapy group and the standard-therapy group, respectively; however, higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up.
Numerous studies have shown significant differences between continuous subcutaneous insulin infusion (CSII) therapy and multiple daily injection (MDI) treatment in the occurrence of severe hypoglycaemia.30–34 A meta-analysis by Pickup and Sutton looked at 22 studies, involving 1,414 type 1 diabetes subjects and found both improved HbA1c levels and reductions in severe hypoglycaemia in CSII-treated subjects compared with those treated by MDI.34 Although differences in hypoglycaemia reduction in type 2 diabetes studies are not as apparent, studies have shown that use of CSII in this population significantly reduces HbA1c without increasing severe hypoglycaemia when compared with MDI therapy.33,35,36

Severe Hypoglycaemia and Adverse Clinical Events

Severe hypoglycaemia has been the suspected cause of the higher mortality in the ACCORD trial; however, a causal relationship between hypoglycaemia and cardiovascular events has not yet been shown. A recent study by Zoungas et al.37 examined the relationship between severe hypoglycaemia and subsequent risks of vascular complications and death among the 11,140 subjects with type 2 diabetes who participated in the Action in diabetes and vascular disease (ADVANCE) trial.28 During a median follow-up period of five years, 231 subjects (2.1 %) had at least one episode of severe hypoglycaemia: 150 (2.7 %) in the intensive group and 81 (1.5 %) in the control group. Within both groups, severe hypoglycaemia was associated with a significant (p<0.001) increase in the adjusted risks of major macrovascular events, major microvascular events, death from a cardiovascular cause and death from any cause. Although these findings demonstrated a strong link between severe hypoglycaemia and adverse clinical events, the analysis indicated that hypoglycaemia is just as likely to be a marker of vulnerability to such events as it is to be the cause. The relationship between severe hypoglycaemia and macrovascular events remains unclear, yet the inevitable consequences of untreated severe hypoglycaemia are significant, including morbidity or even death.38,39 One of the most significant consequences of severe hypoglycaemia, however, is fear,40–43 which often becomes a key obstacle to intensifying therapy and/or adhering to prescribed insulin regimens.9,38,44 This, in turn, can lead to poor metabolic control and subsequent health outcomes.45 A large study by Anderbro et al. identified frequency of severe hypoglycaemia as the most significant factor associated with fear of hypoglycaemia in adults with type 1 diabetes.40

Prevention of Severe Hypoglycaemia

Several strategies have been proposed for the prevention of severe hypoglycaemia, which include adjusting glycaemic goals, using insulin analogues whenever possible and switching patients from MDI therapy to insulin pumps.46

The cornerstone of hypoglycaemia prevention, however, is glucose monitoring, using self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM). Frequent glucose monitoring enables patients to detect glycaemic excursions, identify current or impending hypoglycaemia, monitor resolution of hypoglycaemia, identify recurring patterns of hypoglycaemia and obtain valuable feedback about the effect of medication (dosages, timing), meals and activity on their glycaemic control.47 This, in turn, enables them to make appropriate changes in their treatment regimen, insulin and lifestyle. It also provides valuable information that allows clinicians to make more informed decisions about changes in therapy.

Self-monitoring of Blood Glucose

When using SMBG, testing should occur at or before the peak insulin effect throughout the day to assess glycaemic patterns and periodically during the night to detect night-time and/or early morning hypoglycaemia. SMBG should be matched to the specific therapy. Although use of seven-point glucose profiles can help identify asymptomatic hypoglycaemia or high-risk patterns,48 some peaks and troughs may be missed.

Continuous Glucose Monitoring

CGM systems provide 24-hour coverage, measuring glucose levels in interstitial fluid at one-minute or five-minute intervals, depending on the system (see Figure 1). Currently, only three manufacturers offer CGM systems that are approved by the US Food and Drug Administration (FDA): Abbott, DexCom and Medtronic. These systems are available by prescription49 and are often covered by insurance in the US, especially in poorly controlled patients or those with problematic hypoglycaemia. However, reimbursement for CGM in Europe is sparse. CGM devices are made up of three main components:

1) a disposable sensor that measures glucose levels;
2) a transmitter that is attached to the sensor; and
3) a receiver that displays and stores glucose data.

Patients, using an insertion device, place a thin plastic sensor just under the skin. The transmitter sends an electrical signal to the receiver where it is processed into a glucose value and adjusted based on periodic calibration using capillary blood glucose. Realtime glucose values and glucose trends are then presented in the display. The data can also be downloaded to a computer for review and analysis.

An important feature of the CGM devices is an audible or vibratory alarm that is triggered if glucose rises above or falls below a defined threshold or changes rapidly, thus predicting an impending hyperglycaemic or hypoglycaemic event. Arrows in the display indicate both the direction and rate of glucose change (see Figure 2).
Several studies have shown realtime CGM use to be effective in helping type 1 and type 2 diabetes patients achieve good glycaemic control with a reduced risk of hypoglycaemia.50–55 In a recent randomised controlled multicentre study, 120 intensively managed type 1 diabetes children and adults were randomly assigned to conventional home monitoring with a blood glucose metre and wearing a masked continuous glucose monitor every second week for five days, or to a group with realtime CGM.56 At 26 weeks, the time per day spent in hypoglycaemia (interstitial glucose concentration <63 mg/dl [<3.5 mmol/l]) was significantly shorter in the continuous monitoring group than in the control group: mean (standard deviation [SD]) hours per day, 0.48 (0.57) versus 0.97 (1.55), respectively (p=0.03). Time spent in normoglycaemia (70–180 mg/dl [3.9–10 mmol/l]) was significantly longer in the CGM group compared with the control group: mean (SD) hours per day, 17.6 (3.2) versus 16.0 (3.4), respectively (p=0.009). At study end, HbA1c in the CGM group was significantly lower than in the control group: 6.69 % versus 6.95 %, respectively (p=0.008).

An earlier study by Garg et al. reported findings from a randomised controlled trial that looked at the accuracy, safety and clinical effectiveness of CGM use in 91 insulin-requiring subjects with type 1 diabetes (n=75) and type 2 diabetes (n=16).54 Subjects were randomised to control (CGM with no data provided) for three consecutive 72-hour periods and experimental (realtime CGM with data masked during the first period but available for periods two and three). When compared with control subjects, the experimental group spent 21 % less time hypoglycaemic (<55 mg/dl [<3.1 mmol/l]), 23 % less time hyperglycaemic (≥240 mg/dl [>13.3 mmol/l]) and 26 % more time within the target glucose range (81–140 mg/dl [4.5–7.8 mmol/l]) (p<0.001). Nocturnal hypoglycaemia was also reduced by 38 % in experimental subjects compared with control subjects (p<0.001). Other trials have demonstrated that CGM is beneficial for type 1 diabetes patients who have already achieved excellent control (HbA1c <7.0%),56–58 and that safe and efficacious CGM use in children and adults can be sustained over time.59,60 In a recent study, paediatric patients and their caregivers identified prevention of hypoglycaemia and decreased anxiety about hypoglycaemic events as the most common perceived benefit of CGM use.61

Professional Use of Continuous Glucose Monitoring – Masked Data

Use of masked data is one option for intensive monitoring. Short-term periodic use of CGM devices over three to seven days, without patient access to data, often reveals patterns of previously undetected hyperglycaemia and hypoglycaemia.62 This option allows clinicians to interpret data retrospectively, identify issues and then adjust the insulin regimen accordingly. Reviewing the CGM data with patients also creates opportunities for more meaningful discussions, enhancing patient understanding and encouraging adherence to treatment. There are limitations, however, to professional CGM use. For example, it does not empower patients with immediate feedback that would allow them to make treatment changes (insulin and/or lifestyle). Furthermore, if patients know they are being monitored, they may alter their behaviour. Another factor to consider is the duration of CGM use; three to seven days of monitoring may be inadequate to detect important glycaemic patterns.

Patient Use – Realtime Data

Use of realtime CGM provides the ability to view realtime glucose values, analyse graphs of recent glucose trends and receive alarms/alerts for impending hypoglycaemia or hyperglycaemia. This allows patients to immediately identify acute or impending episodes of previously undetected hypoglycaemia63 and then take appropriate action to resolve or prevent the hypoglycaemia.64


Severe hypoglycaemia is a significant health risk of insulin-treated diabetes, particularly in those treated with MDI therapy.31,35,65 Given its associated morbidity and mortality, many patients are reluctant to follow their prescribed insulin regimens,9,38,44 thereby increasing their risk of developing the microvascular and macrovascular complications of hyperglycaemia.1–4 Given the evidence in support of glycaemic control, clinicians have an obligation to recommend and use the most effective treatments and technologies that will enable patients to safely manage their diabetes. A key challenge is helping patients obtain reimbursement for tools such as CGM; some payers (public and private) only allow CGM in patients who are using CSII or who already have documented hypoglycaemia. This automatically excludes many patients on MDI therapy who would potentially benefit from this technology. Appropriate use of medication and CGM technology will enable clinicians to initiate treatment regimens that will help patients safely achieve optimal glycaemic control and overcome their fear of hypoglycaemia.

Article Information:

Jeff Unger has no conflicts of interest to declare. Chris Parkin has provided consulting services to DexCom and Roche Diagnostics.


Jeff Unger, Director of Metabolic Studies, Catalina Research Institute, 14,726 Ramona Avenue, Suite 110, Chino, CA 91710, US. E:




  1. The Diabetes Control and Complications Trial Research Group, The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus, N Engl J Med, 1993;329(14):977–86.
  2. 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 33), Lancet, 1998;352(9131):837–53.
  3. Holman RR, Paul SK, Bethel MA, et al., 10-Year follow-up of intensive glucose control in type 2 diabetes, N Engl J Med, 2008;359(15):1577–89.
  4. Gaede P, Lund-Andersen H, Parving HH, Pedersen O, Effect of a multifactorial intervention on mortality in type 2 diabetes, N Engl J Med, 2008;358(6):580–91.
  5. Evans JM, Newton RW, Ruta DA, et al., Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database, BMJ, 1999;319(7202):83–6.
  6. Di Battista AM, Hart TA, Greco L, Gloizer J, Type 1 diabetes among adolescents: reduced diabetes self-care caused by social fear and fear of hypoglycemia, Diabetes Educ, 2009;35(3):465–75.
  7. Morris AD, Boyle DI, McMahon AD, et al., Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit, Lancet, 1997;350(9090):1505–10.
  8. Smith CB, Choudhary P, Pernet A, et al., Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit, Diabetes Care, 2009;32(7):1196–8.
  9. Cryer PE, Diverse causes of hypoglycemia-associated autonomic failure in diabetes, N Engl J Med, 2004;350(22):2272–9.
  10. Buse JB, Bigger JT, Byington RP, et al., Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods, Am J Cardiol, 2007;99(12A):21i–33i.
  11. Pedersen-Bjergaard U, Pramming S, Heller SR, et al., Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection, Diabetes Metab Res Rev, 2004;20(6):479–86.
  12. ter Braak EW, Appelman AM, van de Laak M, et al., Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia, Diabetes Care, 2000;23(10):1467–71.
  13. Abraira C, Colwell JA, Nuttall FQ, et al., Veterans Affairs Cooperative Study on glycemic control and complications in type II diabetes (VA CSDM). Results of the feasibility trial. Veterans Affairs Cooperative Study in Type II Diabetes, Diabetes Care, 1995;18(8):1113–23.
  14. Gurlek A, Erbas T, Gedik O, Frequency of severe hypoglycaemia in type 1 and type 2 diabetes during conventional insulin therapy, Exp Clin Endocrinol Diabetes, 1999;107(3):220–4.
  15. Henderson JN, Allen KV, Deary IJ, Frier BM, Hypoglycaemia in insulin-treated type 2 diabetes: frequency, symptoms and impaired awareness, Diabet Med, 2003;20(12):1016–21.
  16. Macleod KM, Hepburn DA, Frier BM, Frequency and morbidity of severe hypoglycaemia in insulin-treated diabetic patients, Diabet Med, 1993;10(3):238–45.
  17. Murata GH, Duckworth WC, Shah JH, et al., Hypoglycemia in stable, insulin-treated veterans with type 2 diabetes, J Diabetes Complications, 2005;1:10–7.
  18. Ohkubo Y, Kishikawa H, Araki E, et al., Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulindependent diabetes mellitus: a randomized prospective 6-year study, Diabetes Res Clin Pract, 1995;28(2):103–17.
  19. Saudek CD, Duckworth WC, Giobbie-Hurder A, et al., Implantable insulin pump vs multiple-dose insulin for noninsulin- dependent diabetes mellitus: a randomized clinical trial. Department of Veterans Affairs Implantable Insulin Pump Study Group, JAMA, 1996;276(16):1322–7.
  20. Yki-Jarvinen H, Ryysy L, Nikkila K, et al., Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus. A randomized, controlled trial, Ann Intern Med, 1999;130(5):389–96.
  21. Hepburn DA, Macleod KM, Pell AC, et al., Frequency and symptoms of hypoglycaemia experienced by patients with type 2 diabetes treated with insulin, Diabet Med, 1993;10(3):231–7.
  22. Holstein A, Plaschke A, Egberts EH, Clinical characterisation of severe hypoglycaemia—a prospective population-based study, Exp Clin Endocrinol Diabetes, 2003;111(6):364–9.
  23. Leese GP, Wang J, Broomhall J, et al., Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use, Diabetes Care, 2003;26(4):1176–80.
  24. Bolli GB, Hypoglycaemia unawareness, Diabetes Metab, 1997;23(Suppl. 3):29–35.
  25. Gold AE, Macleod KM, Frier BM, Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia, Diabetes Care, 1994;17(7):697–703.
  26. Choudhary P, Geddes J, Freeman JV, et al., Frequency of biochemical hypoglycaemia in adults with type 1 diabetes with and without impaired awareness of hypoglycaemia: no identifiable differences using continuous glucose monitoring, Diabet Med, 2010;27(6):666–72.
  27. Duckworth W, Abraira C, Moritz T, et al., Glucose control and vascular complications in veterans with type 2 diabetes, N Engl J Med, 2009;360(2):129–39.
  28. Gerstein HC, Miller ME, Byington RP, et al., Effects of intensive glucose lowering in type 2 diabetes, N Engl J Med, 2008;358(24):2545–59.
  29. Patel A, MacMahon S, Chalmers J, et al., Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes, N Engl J Med, 2008;358(24):2560–72.
  30. Bode BW, Steed RD, Davidson PC, Reduction in severe hypoglycemia with long-term continuous subcutaneous insulin infusion in type I diabetes, Diabetes Care, 1996;19(4):324–7.
  31. Boland EA, Grey M, Oesterle A, et al., Continuous subcutaneous insulin infusion. A new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes, Diabetes Care, 1999;22(11):1779–84.
  32. Jeha GS, Karaviti LP, Anderson B, et al., Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia, Diabetes Technol Ther, 2005;7(6):876–84.
  33. Berthe E, Lireux B, Coffin C, et al., Effectiveness of intensive insulin therapy by multiple daily injections and continuous subcutaneous infusion: a comparison study in type 2 diabetes with conventional insulin regimen failure, Horm Metab Res, 2007;39(3):224–9.
  34. Pickup JC, Sutton AJ, Severe hypoglycaemia and glycaemic control in type 1 diabetes: meta analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion, Diabet Med, 2008;25(7):765–74.
  35. Herman WH, Ilag LL, Johnson SL, et al., A clinical trial of continuous subcutaneous insulin infusion versus multiple daily injections in older adults with type 2 diabetes, Diabetes Care, 2005;28(7):1568–73.
  36. Wainstein J, Metzger M, Boaz M, et al., Insulin pump therapy vs. multiple daily injections in obese type 2 diabetic patients, Diabet Med, 2005;22(8):1037–46.
  37. Zoungas S, Patel A, Chalmers J, et al., Severe hypoglycaemia and risks of vascular events and death, N Engl J Med, 2010;363(15):1410–8.
  38. Cryer PE, Hypoglycemia: still the limiting factor in the glycemic management of diabetes, Endocr Pract, 2008;14(6):750–6.
  39. Gill GV, Woodward A, Casson IF, Weston PJ, Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes—the ‘dead in bed’ syndrome revisited, Diabetologia, 2009;52(1):42–5.
  40. Anderbro T, Amsberg S, Adamson U, et al., Fear of hypoglycaemia in adults with type 1 diabetes, Diabet Med, 2010;27(10):1151–8.
  41. Cox DJ, Irvine A, Gonder-Frederick L, et al., Fear of hypoglycemia: quantification, validation, and utilization, Diabetes Care, 1987;10(5):617–21.
  42. Irvine AA, Cox D, Gonder-Frederick L, Fear of hypoglycemia: relationship to physical and psychological symptoms in patients with insulin-dependent diabetes mellitus, Health Psychol, 1992;11(2):135–8.
  43. Polonsky WH, Davis CL, Jacobson AM, Anderson BJ, Hyperglycaemia, hypoglycaemia, and blood glucose control in diabetes: symptom perceptions and treatment strategies, Diabet Med, 1992;9(2):120–5.
  44. Riddle MC, The underuse of insulin therapy in North America, Diabetes Metab Res Rev, 2002;18(Suppl. 3):S42–9.
  45. Wild D, von Maltzahn R, Brohan E, et al., A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education, Patient Educ Couns, 2007;68(1):10–5.
  46. Unger JP, Parkin C, Hypoglycemia in insulin-treated diabetes: a case for increased vigilance, Postgrad Med, 2011;123(4):81–91.
  47. Dailey G, Assessing glycemic control with self-monitoring of blood glucose and hemoglobin A(1c) measurements, Mayo Clin Proc, 2007;82(2):229–35.
  48. Polonsky WH, Fisher L, Schikman CH, et al., 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, Diabetes Care, 2011;34(2):262–7.
  49. US Department of Health and Human Services. National Diabetes Information Clearinghouse (NDIC): Continuous Glucose Monitoring. Available at: (accessed May 30, 2011).
  50. Chico A, Vidal-Rios P, Subira M, Novials A, The continuous glucose monitoring system is useful for detecting unrecognized hypoglycemias in patients with type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control, Diabetes Care, 2003;26(4):1153–7.
  51. Ryan EA, Germsheid J, Use of continuous glucose monitoring system in the management of severe hypoglycemia, Diabetes Technol Ther, 2009;11(10):635–9.
  52. Geiger MC, Ferreira JV, Hafiz MM, et al., Evaluation of metabolic control using a continuous subcutaneous glucose monitoring system in patients with type 1 diabetes mellitus who achieved insulin independence after islet cell transplantation, Cell Transplant, 2005;14(2–3):77–84.
  53. Bailey TS, Zisser HC, Garg SK, Reduction in hemoglobin A1C with real-time continuous glucose monitoring: results from a 12-week observational study, Diabetes Technol Ther, 2007;9(3):203–10.
  54. Garg S, Jovanovic L, Relationship of fasting and hourly blood glucose levels to HbA1c values: safety, accuracy, and improvements in glucose profiles obtained using a 7-day continuous glucose sensor, Diabetes Care, 2006;29(12):2644–9.
  55. Garg S, Zisser H, Schwartz S, et al., Improvement in glycemic excursions with a transcutaneous, real-time continuous glucose sensor: a randomized controlled trial, Diabetes Care, 2006;29(1):44–50.
  56. Battelino T, Phillip M, Bratina N, et al., Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes, Diabetes Care, 2011;34(4):795–800.
  57. Beck RW, Hirsch IB, Laffel L, et al., Juvenile Diabetes Research Federation Continuous Glucose Monitoring Study G. The effect of continuous glucose monitoring in wellcontrolled type 1 diabetes, Diabetes Care, 2009;32(8):1378–83.
  58. Bode B, Beck RW, Xing D, et al., Sustained benefit of continuous glucose monitoring on A1C, glucose profiles, and hypoglycemia in adults with type 1 diabetes, Diabetes Care, 2009;32(11):2047–9.
  59. Deiss D, Bolinder J, Riveline JP, et al., Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring, Diabetes Care, 2006;29(12):2730–2.
  60. Hirsch IB, Abelseth J, Bode BW, et al., Sensor-augmented insulin pump therapy: results of the first randomized treat-totarget study, Diabetes Technol Ther, 2008;10(5):377–83.
  61. Cemeroglu AP, Stone R, Kleis L, et al., Use of a real-time continuous glucose monitoring system in children and young adults on insulin pump therapy: patients’ and caregivers’perception of benefit, Pediatr Diabetes, 2010;11(3):182–7.
  62. Nardacci EA, Bode BW, Hirsch IB, Individualizing care for the many: the evolving role of professional continuous glucose monitoring systems in clinical practice, Diabetes Educ, 2010;36(Suppl. 1):4S–19S.
  63. Boland E, Monsod T, Delucia M, et al., Limitations of conventional methods of self-monitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes, Diabetes Care, 2001;24(11):1858–62.
  64. Guerci B, Floriot M, Bohme P, et al., Clinical performance of CGMS in type 1 diabetic patients treated by continuous subcutaneous insulin infusion using insulin analogs, Diabetes Care, 2003;26(3):582–9.
  65. Hirsch IB, Bode BW, Garg S, et al., Continuous subcutaneous insulin infusion (CSII) of insulin aspart versus multiple daily injection of insulin aspart/insulin glargine in type 1 diabetic patients previously treated with CSII, Diabetes Care, 2005;28(3):533–8.

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