SEARCH · PubMed Health

Results for “continuous glucose monitoring”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources

PubMed2006

Value and limitations of the Continuous Glucose Monitoring System in the management of type 1 diabetes.

The CGMS (Continuous Glucose Monitoring System) is a portable device allowing continuous measuring of glucose. It provides recordings of at least 72 h, during which 288 measures/day are performed. Results are visualised in the form of a set of curves, illustrating the variations in blood glucose levels over time. The quality of the records has often been questioned by several authors. Some of the system's physiologically related limitations can be explained by the less than perfect coincidence of variations in glucose levels observed in the interstitial tissue, where CGMS measurings are done, and in the blood, where calibrations are performed. Other limitations, such as defects in accuracy or in reproducibility of tracings or premature curtailments of recordings, are due to technical weaknesses which were considerably improved during the past few years, particularly with regard to the quality of the electrodes providing a more stable signal over time. In clinical practice, CGMS is a tool for investigating the glycaemic patterns of diabetic patients in conjonction with SMBG. It allows the identification of overlooked hyper- or hypoglycaemia. Generally well accepted, it is a usefull tool to analyse the nocturnal period, or any situation where glucose checks are rare. The visual nature of its results provides a facilitating support in the discussion between the patient and the care-provider during consultations or educational sessions. CGMS utilisation was proposed for guiding treatment adjustment. At present, it is still difficult to state with certainty that this tool allows effective improvement in the metabolic control of patients with type 1 diabetes, in view of the paucity of controlled studies showing an impact on HbA1c values or on the frequency of hypoglycaemia, even if such a tendency emerges from most non-controlled intervention trials.

Blood Glucose↗

PubMed2002

Continuous glucose monitoring and haemoglobin A(1c).

BACKGROUND: Measurement of HbA(1c) is the standard test for assessment of glycaemic control in diabetic subjects. Using new glucose sensing technology we re-evaluated the significance of HbA(1c) in terms of the aspects of the blood profile it measures in patients with diabetes. METHODS: In a group of 27 patients with type 1 diabetes, interstitial fluid glucose concentrations were monitored for a mean of 2.6 days using the Continuous Glucose Monitoring System trade mark (MiniMed Inc, CA, USA). Results were correlated with an HBA(1c) measurement taken at the time of sensor insertion. RESULTS: Results were available in 25 subjects, two datasets being lost due to patient error. There was a correlation between mean sensor glucose value, and the HbA(1c) value (r = 0.59, P = 0.002). The correlation with standard deviation of the readings was weaker (r = 0.3, P = 0.15). No other descriptor of the sensor glucose concentration correlated with HbA(1c). CONCLUSION: The mean interstitial glucose concentration recorded with the Continuous Glucose Monitoring System correlates with HbA(1c) level recorded at the time, but with no other marker of glucose control in diabetic subjects. These results have implications for the interpretation of HbA(1c) concentrations in type 1 diabetes.

Adult↗

PubMed2003

First human experiments with a novel non-invasive, non-optical continuous glucose monitoring system.

This paper describes a non-invasive continuous glucose monitoring system based on impedance spectroscopy. Changes in the glucose concentrations can be monitored by varying the frequency in the radio band over a range, optimised to measure the impact of glucose on the impedance pattern. A number of clinical-experimental studies (hyperglycaemic excursions) were performed with healthy subjects in order to prove the applicability of this approach. The sensor used in these experiments is the size of a wristwatch and holds an open resonant circuit coupled to the skin and a circuit, performing an impedance measurement. In most cases, the experiments showed a good correlation between changes in blood glucose and the sensor recordings. A detailed description of the trials is presented. The results of this first series of experiments can be considered as a proof of concept for this novel non-invasive monitoring approach. Nevertheless, partly due to the indirect measurement, a considerable number of questions remain to be clarified.

Blood Glucose↗

PubMed2003

Subcutaneous continuous glucose monitoring and dose adjustment decreases glycosylated hemoglobin in spontaneously diabetic cynomolgus monkeys.

Spontaneously diabetic cynomolgus monkeys (Macaca fascicularis) exhibit a condition similar to human type 2 diabetes. These monkeys have been maintained by treatment with insulin therapy based on fasting blood glucose levels and glycosylated hemoglobin (HbA1c) values, which are determined periodically by blood sampling. Instead we sought to determine whether the MiniMed Continuous Glucose Monitoring System (CGMS, MiniMed Inc., Sylmer, Calif.), which takes glucose measurements continually over 24 h, would facilitate monitoring and treatment in diabetic cynomolgus monkeys. We attached the CGMS to five diabetic monkeys and obtained their blood glucose profiles. The performance of the CGMS was evaluated against blood glucose values obtained using a palm-sized blood glucose meter. The CGMS accurately measured the animals' blood glucose levels, with a median correlation of 0.95 and a mean absolute difference of 8.2% +/- 4.7% in comparison to the hand-held blood glucose meter. The diabetic monkeys were monitored two or three times during the 3-month study period. Throughout the study, the feeding time, dosage, and insulin administration time were changed in three of the five monkeys in light of the monitoring results. HbA1c levels were measured before and at 1 and 3 months after insulin adjustment. Although the adjusted dosage was not significantly different from the preceding one, HbA1c levels decreased from 7.6% +/- 1.3% to 6.5% +/- 1.1% (P < 0.05) by the end of the study. We concluded that the values from the CGMS closely correlated with those obtained with the hand-held blood glucose meter. Using the CGMS to determine blood glucose profiles allows the blood glucose levels of the monkeys to be monitored during the night as well as the day. Therefore, such continuous monitoring is useful in preventing nocturnal hypoglycemia and hypoglycemic seizures and may facilitate successful management of diabetes.

Animals↗

PubMed2004

Day-to-day glucose variability during pregnancy in women with Type 1 diabetes mellitus: glucose profiles measured with the Continuous Glucose Monitoring System.

OBJECTIVE: To observe day-to-day variability in glucose levels in pregnant women with Type 1 diabetes using the Continuous Glucose Monitoring System (CGMS) and to assess the usefulness of continuous glucose measurements for adjustment of insulin treatment. DESIGN: A prospective observational study. SETTING: The obstetrical outpatient clinic of the University Medical Centre Utrecht. POPULATION: Pregnant women with Type 1 diabetes mellitus. METHODS: Thirty-one pregnant women with Type 1 diabetes used the CGMS for two consecutive days. Patients were classified in two groups (high vs low day-to-day variability) based on visual inspection of the glucose excursions. The relationship between day-to-day variability and the variables HbA(1c), maternal age and body mass index (BMI), duration of diabetes, number of self-monitored blood glucose levels, number of insulin injections, gestational age, nutrition, physical activity, White classification, living with children and method of insulin administration was determined. The two days of the first 20 CGMS measurements were separated and four physicians were asked to give recommendations on treatment adjustment for each separate day. MAIN OUTCOME MEASURES: Mean absolute difference (MAD) was calculated for each patient as measure of day-to-day variability. RESULTS: Seventeen patients (55%) were classified as having low (MAD 0.92-2.33 mmol/L) and 14 (45%) as having high day-to-day variability (MAD 2.41-6.12 mmol/L). Of the variables measured, only the relation between MAD and HbA(1c) was significant (r= 0.58, P= 0.001). The difference in recommendation on treatment adjustment between the days of the CGMS measurement ranged from 29% to 48%. This percentage was significantly higher in the high day-to-day variability group (48 vs 33%, P= 0.01). CONCLUSION: Day-to-day glucose variability is high and the treatment of pregnant women with Type 1 diabetes is a problem. Fine-tuning of insulin regimens based on two-day measurements with the CGMS is not advisable.

Adult↗

PubMed2006

Intensive insulin therapy in the intensive care unit: assessment by continuous glucose monitoring.

OBJECTIVE: Hyperglycemia occurs in most critically ill patients. Using continuous glucose monitoring (CGM), we investigated whether intensive insulin therapy based on discontinuous glucose monitoring can achieve normoglycemia (80-110 mg/dl) in a medical intensive care unit (MICU). RESEARCH DESIGN AND METHODS: Fifty adults (men/women 31/19, age 62 +/- 16 years, nondiabetic/diabetic 30/20, intravenous/subcutaneous insulin 22/28, and Acute Physiology and Chronic Health Evaluation II score 22 +/- 7) were prospectively recruited. Forty-eight-hour CGM was performed using a subcutaneous glucose sensor (GlucoDay) and compared with arterial glycemia. Main outcome measures were percent of time in normoglycemia and accuracy/applicability of CGM. RESULTS: During 48-h CGM, glycemia reached target (80-110 mg/dl) in only 22 +/- 18%, was >140 mg/dl in 39 +/- 27%, and was <60 mg/dl in 5 +/- 10% of the time. Patients on subcutaneous versus intravenous insulin had more glycemia readings >110 mg/dl (P = 0.016). Glycemia was higher in diabetic patients (170 +/- 77 vs. 129 +/- 35 mg/dl, P = 0.013). BMI was an independent determinant for bad glycemic control (beta = 0.73, P < 0.0001). Diabetic state (beta = 0.47, P < 0.0001), septic shock (beta = 0.22, P = 0.045), sequential organ failure assessment score (beta = 0.40, P = 0.001), and use of corticoids (beta = 0.28, P = 0.014) and inotropics (beta = -0.24, P = 0.035) were independent determinants of insulin dose. GlucoDay values and arterial glycemia correlated well (r = 0.85, P < 0.0001, n = 555 after six-point calibration), with 97% of data falling in regions A and B of error grid analysis. There were no adverse events using GlucoDay. CONCLUSIONS: GlucoDay, a well-tolerated 48-h CGM system, revealed that normoglycemia was only achieved 22% of the time in MICU patients. Further studies should investigate whether application of CGM to titrate insulin therapy can improve patient outcome.

Blood Glucose↗

PubMed2006

Toward continuous glucose monitoring with planar modified biosensors and microdialysis. Study of temperature, oxygen dependence and in vivo experiment.

Glucose biosensors based on the use of planar screen-printed electrodes modified with an electrochemical mediator and with glucose oxidase have been optimised for their application in the continuous glucose monitoring in diabetic patients. A full study of their operative stability and temperature dependence has been accomplished, thus giving useful information for in vivo applications. The effect of dissolved oxygen concentration in the working solution was also studied in order to evaluate its effect on the linearity of the sensors. Glucose monitoring performed with serum samples was performed to evaluate the effect of matrix components on operative stability and demonstrated an efficient behaviour for 72 h of continuous monitoring. Finally, these studies led to a sensor capable of detecting glucose at concentrations as low as 0.04 mM and with a good linearity up to 2.0 mM (at 37 degrees C) with an operative stability of ca. 72 h, thus demonstrating the possible application of these sensors for continuous glucose monitoring in conjunction with a microdialysis probe. Moreover, preliminary in vivo experiments for ca. 20 h have demonstrated the feasibility of this system.

Animals↗

PubMed2003

Analysis of continuous glucose monitoring data from non-diabetic and diabetic children: a tale of two algorithms.

Use of the Medtronic MiniMed Continuous Glucose Monitoring System (CGMS) in non-diabetic children has revealed many low and high sensor glucose (SG) values, suggesting that the original analytical algorithm (Solutions 2.0) might be overreading glycemic excursions. A revised algorithm (Solutions 3.0) was introduced in 2001. Our aim was to compare analyses of the same sensor profiles using both programs. Twenty-five lean, non-diabetic subjects (mean age 14 +/- 4 years) underwent continuous glucose monitoring with CGMS for up to 72 h. Sensor tracings were analyzed with both algorithms and compared. Separate analyses were performed for nocturnal readings (12-6 a.m.). Mean SG values were similar (103 +/- 24 mg/dL for version 2.0 vs. 100 +/- 14 for version 3.0), but the distribution was significantly different: 13.8% of total SG were <70 mg/dL by version 2.0 versus 8.2% by version 3.0 (p < 0.001), and 7.7% of total SG were >150 mg/dL by version 2.0 versus 4.7% by version 3.0 (p = 0.02). Of nocturnal SG values, 25.8% were <70 mg/dL by version 2.0 compared with 17.9% by version 3.0, and 9.4% were >150 mg/dL by version 2.0 compared with 4.0% by version 3.0. In lean non-diabetic children, Solutions 2.0 identified significantly more hypoglycemia and hyperglycemia than Solutions 3.0. Similar analyses in 40 children with type 1 diabetes revealed no significant differences. Solutions 3.0 may be a more useful algorithm for preventing over-reading of low and high SG readings in non-diabetic children, whereas both algorithms give similar results in children with diabetes.

Adolescent↗

PubMed2006

Psychological aspects of continuous glucose monitoring in pediatric type 1 diabetes.

Clinical use of near-continuous glucose monitors (CGMs) could have substantial impact on family management of pediatric type 1 diabetes and could generate both beneficial and adverse psychological reactions. In addition to glycemic benefits, CGM could possibly yield educational and motivational benefits. Conversely, CGM may also lead to information overload and increased treatment burden. Further, patients and families with certain affective, behavioral, and cognitive characteristics might derive greater benefit from CGM use. As information about these processes could facilitate optimal clinical use of CGM, the Diabetes Research in Children Network (DirecNet) included measurement of selected psychological variables in a recent randomized trial of the GlucoWatch G2 Biographer (GW2B, Cyngus, Inc., Redwood City, CA, USA). A multicenter sample of 200 youths with type 1 diabetes was randomized to 6 months of either continued usual care (UC) using a conventional home glucose meter for diabetes or supplementation of standard care with use of the GW2B. Diabetes treatment adherence, diabetes-specific quality of life, and diabetes-related anxiety were measured at baseline and at the end of the study. Satisfaction with use of the GW2B was measured at the end of the study. The results indicated neither adverse nor beneficial psychological effects of CGM use. More frequent GW2B use over the 6-month study was found among youths whose parents reported higher scores for treatment adherence and diabetes-related quality of life at baseline. The study illustrates the empiric assessment of the psychological context of CGM use and establishes methods that are applicable to new CGM devices as they emerge.

Adolescent↗

PubMed2003

Continuous glucose monitoring by means of the microdialysis technique: underlying fundamental aspects.

The microdialysis technique allows extraction of substances (e.g., glucose) from fluids in the human body for quantitative measurements ex vivo. The microdialysis catheter can be inserted in many different tissues; for continuous glucose monitoring it is most often implanted in the subcutaneous fat tissue in the abdominal region. Perfusion of the thin catheter with an isotonic solution without glucose leads to a diffusion of glucose available in the interstitial fluid along the concentration gradient across the semipermeable membrane into the catheter. The glucose levels in the dialysate are measured quantitatively outside the body by means of specific sensors. A number of factors have a profound impact on the amount of glucose extracted (i.e., the glucose levels in the dialysate can be considerably lower than that in the interstitial fluid). However, as long as this proportion remains constant (independent of the prevailing glucose level), the sensor signal, which is related to the glucose level in the interstitial fluid, can be calibrated to the blood glucose level by means of a conventional blood glucose measurement. The microdialysis systems that are commercially available or in clinical development allow (after a run-in phase of some hours) continuous glucose monitoring with a good reliability over several days. Insertion of the microdialysis catheters cannot be performed by the patients themselves but requires professional help. From a technological point of view the microdialysis technique is demanding; consequently the costs of continuous glucose monitoring using this approach are considerable. However, further developments probably will allow development of cheaper patient self-care systems that can be used for longer periods of time.

Biosensing Techniques↗

PubMed2003

The SCGM1 System: subcutaneous continuous glucose monitoring based on microdialysis technique.

The SCGM1 System is designed to allow continuous glucose monitoring in the subcutaneous interstitial fluid for up to 120 h. The system is based on the microdialysis technique and is composed of three components: (1) a disposable Cassette, which contains the microdialysis catheter (with the necessary tubes), an electrochemical flow-through sensor for glucose measurement, and the fluid reservoirs for both the microdialysis perfusate and a reagent solution containing glucose oxidase; (2) the Sensor Unit, which houses the Cassette and is worn by the patient using a belt pack; and (3) the Data Manager, with an integrated blood glucose meter for the calibration of the glucose signal. The Data Manager also has the option of displaying the continuous glucose signal. The Sensor Unit and Data Manager exchange glucose data and calibration data by radio transmission. In vitro precision was assessed by measurements of two standard glucose solutions (90 mg/dL, 3.4%; 360 mg/dL, 2.4%) over a time course of 4 days. The mean difference (+/- SD) between SCGM1 System devices (n = 11) and 15 glucose standard solutions with different concentrations was 1.4 +/- 3.5 mg/dL. The mean relative difference and the mean absolute relative difference ranged from - 0.6% to 3.7% and from 0.2% to 3.8%, respectively. The inherent physical lag time was 31 +/- 2 min (n = 10). The interference on the glucose signal of ascorbic acid, acetaminophen, and uric acid at the highest physiological concentrations was below 4%. The SCGM1 System showed a reliable and precise performance under in vitro conditions.

Blood Glucose↗

PubMed2004

The public health impact of the MiniMed Continuous Glucose Monitoring System (CGMS)-an assessment of the literature.

The Medtronic MiniMed (Northridge, CA) Continuous Glucose Monitoring System (CGMS) was approved by the U. S. Food and Drug Administration in 1999, for the continuous tracking of glucose concentration. The rationale for the use of this device is that frequent glucose measurements allow a more precise understanding of daily glucose fluctuations, without the inconvenience of frequent needle sticks. A review of the medical literature was undertaken to assess the public health impact of this device. Glucose readings from the MiniMed CGMS were found to correlate well with blood glucose (r = 0.73-0.92) and with hemoglobin A(1c) (HBA(1c)) (r = 0.53-0.59). Most important from a public health standpoint is the ability of the MiniMed device to detect episodes of asymptomatic hypoglycemia, and to lower HBA(1c) (absolute decline of 0.3%), as compared with controls. If these findings hold, the use of the MiniMed CGMS could result in a substantial reduction of morbidity and mortality associated with diabetes. The limitations of this analysis, most importantly the paucity of controlled studies that assess the ability of this device to result in improved control of diabetes over long periods of time, are discussed.

Blood Glucose↗

PubMed2004

Does continuous glucose monitoring have clinical utility in contemporary management of diabetes?

Continuous, automated and non-invasive blood glucose monitoring systems have long been a goal to assist management of diabetes mellitus. The first continuous, albeit invasive, device available in Australia is the Medtronic MiniMed Continuous Glucose Monitoring System (CGMS), which is available for physician-supervised use to give a continuous blood glucose profile (5-minutely readings, viewable only after download by the physician) for periods of 72 h. With the availability of this technology, there is a need to assess the accuracy, reproducibility and ability to detect significant clinical events (particularly hypoglycaemia) and blood glucose patterns. The question of whether this technique allows long-term improvement of metabolic control also arises. We present four case studies to illustrate the use of CGMS in clinical practice and have reviewed the rapidly emerging literature. We conclude that CGMS is a useful clinical tool in the management of diabetes mellitus, provided that it is appropriately applied and the limitations are understood.

Adolescent↗

PubMed2003

[Continuous glucose monitoring: different systems, different ambitions].

This paper describes the current approaches towards the development of continuous glucose monitoring system, in which glucose is measured either in blood or in the subcutaneous tissue. These systems may be used as a glycemic holter, or to display continuously the changes in glucose level, to trigger an alarm in case of hypoglycemia, or of risk of hypoglycemia, or finally to pave the way to the development of an artificial beta cell.

Blood Chemical Analysis↗

PubMed2005

Evaluation of a continuous glucose monitoring system for use in veterinary medicine.

BACKGROUND: With the emergence of continuous glucose monitoring systems being used to provide a detailed glucose picture in humans, a commercially available system (CGMS(R), Medtronic Minimed, Northridge, CA) was examined for use in veterinary species. METHODS: Adult, clinically normal horses (n = 7), cats (n = 3), dogs (n = 4), and cows (n = 5) were studied. Cats (n = 4), dogs (n = 5), and one horse with diabetes were included in the study. Several of the normal horses, including the horse with diabetes, and one cow were subjected to an intravenous glucose tolerance test. The CGMS was attached to each animal, and the recorded interstitial glucose concentrations were compared with whole blood glucose concentrations as determined by a point-of-care glucose meter. Events such as insulin administration, feeding, travel, or administration of intravenous glucose were all noted and compared with results from the CGMS. RESULTS: There was a positive correlation between interstitial and whole blood glucose concentrations for all the clinically normal species, those with diabetes mellitus, and those receiving intravenous glucose. Events such as feeding, glucose or insulin administration, and transport to the clinic were noted by the owner or clinician and could be identified on the graph and correlated with time of occurrence. CONCLUSIONS: Our data indicate that the use of the CGMS is valid for use in the species examined. Use of this system alleviated the need for multiple blood samples and the stress associated with obtaining those samples. This system may provide greater monitoring capabilities in patients with diabetes and promote the diagnostic and research potential of serial glucose monitoring in veterinary species.

Animals↗

PubMed2004

The use of a continuous glucose monitoring system in hypoglycemic disorders.

OBJECTIVE: To evaluate the use of a continuous glucose monitoring system (CGMS) in the evaluation and treatment of infants and children with hypoglycemic disorders. METHODS: Patients with hypoglycemic disorders wore the CGMS device in the Pediatric Clinic Research Center during their evaluation and treatment. Capillary blood glucose (CBG) values were obtained at least 3 times each day and entered into the device for calibration purposes. We evaluated the number of hypoglycemic episodes below 3.3 mmol/l (60 mg/dl) detected by CGMS compared to CBG values and characterized episodes by their duration and intensity. RESULTS: Five patients with hypoglycemic disorders were included in the study. There were a total of 13,369 sensor points, 343 paired sensor and CBG data points, and 57 days included. A total of 180 episodes of hypoglycemia occurred in these five patients, with an average duration of 55 +/- 13 minutes. Using a cut-off of 3.3 mmol/l (60 mg/dl) for hypoglycemia, the sensor had a sensitivity of 65.4%, specificity of 90.6%, and false positive rate of 42.9%. The positive and negative predictive values were 57.1% and 93.2%, respectively. CONCLUSION: CGMS is a useful adjunct in the diagnosis and evaluation of hypoglycemia, and for documentation of euglycemia in these patients following therapy.

Adolescent↗

PubMed2003

Continuous glucose monitoring with glucose sensors: calibration and assessment criteria.

Continuous glucose monitoring (CM) by means of minimally invasive or noninvasive glucose sensors can help to further optimize metabolic control in patients with diabetes without need for frequent capillary blood glucose measurements. Most glucose sensors measure glucose concentration in the interstitial fluid (ISF). Because of the varying conditions in this compartment, a general in vitro calibration ( = factory calibration) by the manufacturer appears not to be possible. Therefore, calibration of the sensor signal must be performed by the patient himself repeatedly. The calibration procedure can be performed by means of conventional capillary blood glucose measurements in order to transform the sensor signals obtained from the specific compartment (e.g., ISF) into "blood" glucose values. A number of aspects can influence the validity of this procedure. The relationship between changes in blood glucose and in ISF glucose, in both time and concentration dimensions, is not well understood, especially during dynamic changes. The physical lag time, which critically depends on the glucose sensor technology used, can also introduce a systematic calibration error. After the first calibration, usually performed some hours after the application of a given glucose sensor, recalibration at certain intervals is necessary. Therefore, patients should critically assess the values displayed by a CM system. In the case of implausible glucose values they should verify the results by means of a conventional capillary glucose measurement. Up to now there is no consensus on assessment criteria to be used for evaluation of CM system performance and calibration quality. Existing methods of displaying CM values against corresponding reference values, including linear regression analysis and error grid analysis, as well as numeric criteria such as System Error, Predicted Error Sum of Squares (in %), and Mean Absolute Deviation are not generally applicable to CM. It appears as if they do not allow sufficient description of data obtained with CM systems. There is a pressing need to develop novel adequate assessment criteria enabling a better characterization of CM system performance. If these were used uniformly by all manufacturers and scientists assessing CM systems, this would allow a fair comparison of the performance of different systems.

Blood Glucose↗

PubMed2006

Unrecognised hypoglycaemia in children and adolescents with type 1 diabetes using the continuous glucose monitoring system: prevalence and contributors.

AIM: To determine prevalence of hypoglycaemia, and contributing factors, in children with type 1 diabetes, using the Medtronic MiniMed continuous glucose monitoring system (CGMS). METHODS: Fifty-one children and adolescents with diabetes were studied with the CGMS. The studies were analysed for frequency and duration of hypoglycaemia (below 3.5 and 2.5 mmol/L). Contributing clinical factors were determined. Occurrence of nocturnal hypoglycaemia was related to bedtime and fasting home glucose recording. RESULTS: Hypoglycaemia was common, with 1 (0-4.2) (median (range)) episode per patient per 24 hours, and 0.33 (0-2) episodes per patient per night. Nocturnal episodes were longer than daytime episodes [97.5 (5-720) versus 35 (5-295) minutes for episodes below 3.5 mmol/L, P < 0.001; and 75 (10-640) versus 25 (5-200) minutes for episodes below 2.5 mmol/L, P < 0.001], and less likely to be recognised by the subject (P < 0.001 for episodes below both 3.5 and 2.5 mmol/L). Nocturnal hypoglycaemia was more common with a bedtime glucose recording <6 mmol/L, but also occurred frequently in subjects with glucose recordings >10 mmol/L. No bedtime glucose value reduced the risk of nocturnal hypoglycaemia to <10%. CONCLUSION: Hypoglycaemia, assessed using the CGMS, is common in children with type 1 diabetes and can be prolonged (although is predominantly mild). Bedtime home glucose recordings are poorly predictive of hypoglycaemia during the following night. Continuous glucose monitoring has proven very useful in management of individual patients, particularly adolescents experiencing difficulties with adherence to diabetes management.

Adolescent↗