Individualizing Care for the Many

Abstract

PURPOSE: A generation of individuals with diabetes has come of age since the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study, providing demonstrable evidence that optimal glycemic control, achieved early with intensive therapy, yields a durable beneficial effect. Yet realizing the full potential of intensive therapy requires more frequent glucose monitoring and accurate interpretation of data. Because patients typically check no more than 3 or 4 times per day and rarely during the night, glucose variability, including glycemic spikes and asymptomatic hypoglycemia, may be missed. Short-term use of a professional continuous glucose monitoring (CGM) device, worn by patients without access to real-time data, reveals patterns of high and low blood glucose undetectable by self-monitoring of blood glucose (SMBG) alone. Clinicians interpret the continuous profile retrospectively to identify and adjust components of the insulin regimen responsible for nocturnal hypoglycemia, postprandial hyperglycemia, and other glucose excursions. This supplement discusses how professional CGM, used as an adjunct to SMBG, can help patients understand the effects of their behavior on glycemic control and consider the potential utility of diabetes technology in transforming knowledge to action. CONCLUSION: Strategic implementation of professional CGM may improve the time- and cost-effectiveness of diabetes care while advancing more personalized treatment in the course of everyday practice.