Another type of CGM sensor—called an implantable sensor—may be placed inside your body. CGM sensors estimate the glucose level in the fluid between your cells, which is very similar to the glucose level in your blood.

Sensors must be replaced at specific times, such as every few weeks, depending on the type of sensor you have. The second part of the CGM is a transmitter. The transmitter sends the information, without using wires, to the third part, a software program that is stored on a smartphone, on an insulin pump , or on a separate device called a receiver.

Your doctor may recommend that you use a CGM if you need insulin to manage type 1 diabetes , type 2 diabetes , or another form of diabetes. Talk with your doctor about whether using a CGM could help you manage your diabetes. Doctors can prescribe CGMs for adults and children.

Some models can be used for children as young as 2 years old. Your doctor may suggest using a CGM all the time or only for a few days to help adjust your diabetes care.

All CGMs estimate blood glucose levels, but they store and display the information in different ways. Some CGMs send and display information to your smartphone or receiver automatically. But you will need to scan the CGM with a separate receiver or smartphone every few hours to view and store the data.

A third type of CGM collects data about your blood glucose level for your doctor to download and review later. Doctors provide this type of CGM to check on your diabetes care, and you wear it for a limited time.

For some CGM models, you may need to do a finger-stick test with a standard blood glucose monitor to calibrate the system and make sure the CGM readings are correct. Many CGMs work with apps that have special features, such as. For safety, it is important to act quickly if a CGM alarm sounds when your glucose level is too low or too high.

You should get help or follow your treatment plan to bring your glucose level into a healthy range. The CGM will create an alert and might display a graphic that shows whether your glucose level is rising or dropping—and how quickly—so you can choose the best way to reach your target range.

Over time, keeping your glucose levels in the healthy range can help you stay well and prevent diabetes complications. The people who benefit the most from a CGM are those who use it every day or nearly every day. Researchers are working to make CGMs more accurate and easier to use. However, you may experience some issues while using a CGM.

For safety, you may sometimes need to compare your CGM glucose readings with a finger-stick test and a standard blood glucose meter. This could be needed if you doubt the accuracy of your CGM readings, if you are changing your insulin dose, or if your CGM gives a warning alert.

You might have to replace parts of your CGM over time. Disposable CGM sensors should be replaced every 7 to 14 days, depending on the model. Some implantable sensors can last up to days. You may have to replace the transmitters of some CGMs. You may also need to reconnect the CGM, transmitter, and receiver or smartphone if your CGM is not working correctly.

Skin redness or irritation from the sticky patches used to attach the sensor may occur for some people. A CGM costs more than using a standard glucose meter, but it may be covered by your health insurance.

You might be able to get financial help for diabetes care from your health insurance or other resources. Check with your health insurance plan or Medicare to see if the costs will be covered. An artificial pancreas , also called an automated insulin delivery system AID , mimics how a healthy pancreas controls blood glucose in the body.

A CGM, an insulin pump, and a software program that shares information between the CGM and insulin pump make up the artificial pancreas. The CGM estimates glucose levels and wirelessly sends the information to a software program on a smartphone or insulin pump.

The program calculates how much insulin your body needs, and the insulin pump delivers the insulin when glucose levels rise higher than your target range.

On the other hand, if your glucose levels fall lower than your target range, the artificial pancreas can lower or stop the amount of insulin given by the insulin pump. The artificial pancreas is mainly used to help people with type 1 diabetes keep their glucose levels in their target range.

NIDDK has a long-standing commitment to funding research to better understand diabetes and improve the lives of people with the disease. NIDDK-funded research helped scientists learn that glucose levels in the fluid between cells could be used to estimate blood glucose levels. The widespread use of sliding scales for insulin administration for hospitalized patients began during the era of urine glucose testing, and it increased after the introduction of rapid capillary blood glucose testing in the last two to three decades.

However, there are few data to support its benefit and some evidence of potential harm when such treatment is applied in a rote fashion, that is, when all patients receive the same orders and, importantly, when the sole form of insulin administered is rapid-acting insulin every four to six hours without underlying provision of basal insulin.

This was illustrated in an observational study of patients with diabetes who were admitted to a university hospital, of whom 76 percent were placed on a sliding-scale insulin regimen [ 18 ]. Sliding-scale insulin regimens when administered alone were associated with a threefold higher risk of hyperglycemic episodes as compared with no therapy relative risk [RR] 2.

Thus, in this observational study, the use of sliding-scale insulin alone provided no benefit. Correction insulin — Varying doses of rapid-acting insulin can be added to usual pre-meal rapid-acting insulin in patients on basal-bolus regimens to correct pre-meal glucose excursions.

In this setting, the additional insulin is referred to as "correction insulin" algorithm 1 and algorithm 2 , which differs from a sliding scale because it is added to planned mealtime doses to correct for pre-meal hyperglycemia.

The dose of correction insulin should be individualized based upon relevant patient characteristics, such as previous glycemia, previous insulin requirements, and, if possible, the carbohydrate content of meals.

When administered prior to meals, the type of correction insulin eg, short acting or rapid acting should be the same as the usual pre-meal insulin. Meal-time correction insulin alone is sometimes used in place of a fixed mealtime dose, usually when risk of hypoglycemia is high, dietary intake is uncertain, or other clinical circumstance that warrants a conservative approach to glycemic management.

Correction insulin alone may also be used as initial insulin therapy or as a dose-finding strategy in hyperglycemic patients with type 2 diabetes previously treated at home with diet or non-insulin agents who will not be eating regularly during the hospitalization.

This use of correction insulin is essentially a "sliding scale. Rapid-acting insulin analogs can also be used but may require more frequent dosing up to every four hours and do not have clear advantage over regular insulin in fasting patients.

Insulin infusion — Most patients with type 1 or type 2 diabetes admitted to the general medical wards can be treated with subcutaneous insulin. There are little data showing that intravenous insulin is superior to subcutaneous insulin.

The key point is that the patient should have at least a small amount of insulin circulating at all times, which will significantly increase the likelihood of successfully managing blood glucose levels during illness.

In addition, the safe implementation of insulin infusion protocols requires frequent monitoring of blood glucose, which is not typically available on a general medical ward. Practical considerations including skill and availability of the nursing staff may impact the choice of delivery; complex intravenous regimens may be dangerous where nurses are short staffed or inexperienced.

Thus, insulin infusions are typically used in critically ill intensive care unit ICU patients, rather than in patients on the general medical wards of the hospital. There is a lack of consensus on how to best deliver intravenous insulin infusions, and individual patients may require different strategies.

The best protocols take into account not only the prevailing blood glucose, but also its rate of change and the current insulin infusion rate. Several published insulin infusion protocols appear to be both safe and effective, with low rates of hypoglycemia, although most have been validated only in the ICU setting, where the nurse-to-patient ratio is higher than on the general medical and surgical wards [ 13,19,20 ].

There are few published reports on such protocols outside of the critical care setting. In the course of giving an intravenous regular insulin infusion, we recommend starting with approximately half the patient's usual total daily insulin dose, divided into hourly increments until the trend of blood glucose values is known, and then adjusting the dose accordingly.

A reasonable regimen usually involves a continuous insulin infusion at a rate of 1 to 5 units of regular insulin per hour; within this range, the dose of insulin is increased or decreased based on frequently measured glucose concentrations, ideally through the use of an approved protocol.

In patients who are not eating, concomitant glucose infusion is necessary to provide some calories, reduce protein loss, and decrease the risk of hypoglycemia; separate infusions allow for more flexible management.

When the patient receiving intravenous insulin is more stable and the intercurrent event has passed, the prior insulin regimen can be resumed, assuming that it was effective in achieving glycemic goals.

Because of the short half-life of intravenous regular insulin , the first dose of subcutaneous insulin must be given before discontinuation of the intravenous insulin infusion. If intermediate- or long-acting insulin is used, it should be given two to three hours prior to discontinuation, whereas short- or rapid-acting insulin should be given one to two hours prior to stopping the infusion.

Patients with type 2 diabetes — The treatment of patients with type 2 diabetes depends upon previous therapy and the prevailing blood glucose concentrations. Any patient who takes insulin before hospitalization should receive insulin throughout the admission algorithm 1 and algorithm 2 [ 13 ]. If the patient is unable to eat normally, oral agents or injectable GLPbased therapies should be discontinued.

In patients who are eating and who do not have contraindications to their oral agent, oral agents or injectable GLPbased therapies may be cautiously continued if they are on the hospital's formulary see 'Patients treated with oral agents or injectable GLPbased therapies' below.

Therapy should be returned to the patient's previous regimen assuming that it had been effective as soon as possible after the acute episode, usually as soon as the patient has resumed eating his or her usual diet.

In those with elevated A1C upon admission, the discharge regimen should be modified to improve glycemic management, or at the very least, the patient should be evaluated by the clinician managing his or her diabetes soon within several weeks after discharge. Diet-treated patients — Patients with type 2 diabetes treated by diet alone who are to have minor surgery or an imaging procedure, or who have a noncritical acute illness that is expected to be short lived, will typically need no specific antihyperglycemic therapy.

Nevertheless, regular blood glucose monitoring is warranted to identify serious hyperglycemia, especially if steroid therapy is administered. The measurement system used should be standardized to ensure reasonable accuracy and precision. See 'Blood glucose monitoring' above.

Correction insulin with rapid-acting analogs can also be used, but the dosing frequency may need to be every four hours, so the more cost-effective regular insulin is preferred. If substantial doses are required, adding basal insulin will improve glycemia and allow reduced the doses of regular insulin.

Insulin requirements can be estimated based upon a patient's body weight algorithm 1. Alternatively, requirements can be based upon the total number of units of correction insulin administered over the course of a hospital day.

Approximately 50 percent of the total daily dose can be given as basal insulin, and the remaining approximately 50 percent can be given in equally divided doses prior to meals one-third prior to each meal. Patients treated with oral agents or injectable GLPbased therapies — In general, insulin is the preferred treatment for hyperglycemia in hospitalized patients previously treated with oral agents or injectable glucagon-like peptide 1 [GLP-1]-based therapies.

This approach stems from the fact that insulin doses can be rapidly adjusted and, therefore, can quickly correct worsening hyperglycemia. In addition, noninsulin diabetes therapies have not been widely tested in the hospital setting.

However, there are some circumstances where insulin may not be necessary. As an example, in patients who are well managed on their outpatient regimen, who are eating, and in whom no change in their medical condition or nutritional intake is anticipated, oral agents may be continued, as long as new contraindications are neither present nor anticipated during the hospital admission, and as long as the medications or similar brands are on the hospital formulary.

Of note, injectable GLPbased therapies are expensive and often not on hospital formularies; their use in the hospital setting is therefore uncommon. If a patient was previously eating but is unable to eat after the evening meal in preparation for a procedure the next morning, oral antihyperglycemic drugs should be omitted on the day of a procedure surgical or diagnostic.

If procedures are arranged as early in the day as possible, antihyperglycemic therapy and food intake can simply then be shifted to later in the day. If the illness requiring admission is more severe eg, an infection requiring hospitalization , hyperglycemia is more likely, even when there is decreased food intake, and most acutely ill patients will need insulin.

In this setting, oral agents should be discontinued. If eating, rapid-acting insulin is preferred, administered before meals. However, a more formal and comprehensive insulin regimen, including some form of basal insulin, is usually preferred when hyperglycemia persists algorithm 1 and algorithm 2.

Oral agents should generally not be administered to patients who are not eating. In addition, many oral agents have specific contraindications that may emerge in hospitalized patients:. Examples include patients with acute cardiac or pulmonary decompensation, acute kidney injury, dehydration, sepsis, urinary obstruction, or in those undergoing surgery or radiocontrast studies.

Given the typical case mix in most acute care hospitals, metformin should probably be discontinued at least temporarily in most patients. See "Metformin in the treatment of adults with type 2 diabetes mellitus", section on 'Contraindications'. As a result, they have an uncertain role in patients who are not eating.

DPP-4 inhibitors have not been used or studied extensively in the acute care setting [ 23 ]. Two studies suggested that they may be reasonably effective in mildly hyperglycemic patients with type 2 diabetes who are eating [ 23,24 ].

We tend to continue them as they may modestly reduce hyperglycemia and decrease the need for insulin injections. They also have few contraindications or safety concerns, and DPP-4 inhibitors do not increase the risk of hypoglycemia. All DPP-4 inhibitors except linagliptin require dose reduction in the setting of impaired kidney function.

See "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Dosing'. Although they may be continued during the hospitalization in stable patients who are expected to eat regularly, unexpected alterations in meal intake will increase the risk for hypoglycemia.

On balance, sulfonylureas should usually be discontinued, at least temporarily, in the hospitalized patient. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects'.

As a result, these prandial-administered drugs may have a theoretical advantage in hospitalized patients but should also be used cautiously, including in those with acute ischemic heart disease events. Further limiting their inpatient use, meglitinides are typically not on hospital formularies.

See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus". As a result, their use should generally be avoided in the acute setting.

They are also not usually included on most hospital formularies, in part due to high cost. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Introduction'. They increase calorie losses as well as risk of dehydration, volume contraction, and genitourinary tract infections.

In addition, euglycemic diabetic ketoacidosis has been reported in patients with both type 1 during off-label use and, more rarely, type 2 diabetes who were taking SGLT2 inhibitors. These drugs should therefore generally not be used in the inpatient setting, particularly when patients are acutely ill, although they may be started just prior to discharge if compelling indications are present.

For example, these agents may be used by cardiologists and especially heart failure specialists for the benefit of SGLT2 inhibitors in the setting of heart failure.

See "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Adverse effects' and "Primary pharmacologic therapy for heart failure with reduced ejection fraction", section on 'Sodium-glucose co-transporter 2 inhibitors' and "Treatment and prognosis of heart failure with preserved ejection fraction", section on 'Sodium-glucose co-transporter 2 inhibitors'.

If the question of ventricular dysfunction is raised during a hospitalization, thiazolidinediones should be held until the situation is clarified. The antihyperglycemic effect of this drug class extends for several weeks after discontinuation as does the fluid-retaining effect , so that temporary interruption of therapy should have little effect on glycemia.

See "Thiazolidinediones in the treatment of type 2 diabetes mellitus". Moreover, these inhibitors of intestinal carbohydrate absorption are only effective in patients who are eating and therefore have a limited role in this setting.

See "Alpha-glucosidase inhibitors for treatment of diabetes mellitus". Patients treated with insulin — Insulin therapy should be continued in all patients already taking it to maintain a reasonably constant basal level of circulating insulin.

Failing this, severe hyperglycemia or even ketoacidosis can occur, even in patients labeled as having type 2 diabetes but who have become significantly insulin deficient over a prolonged disease course.

If the glucose was well managed with the outpatient insulin regimen, we typically reduce the dose by 25 to 50 percent because, in the more controlled environment of the hospital where the amount of food consumed may be less than at home and blood glucose levels are checked regularly , patients may need considerably less insulin than they were taking in the outpatient setting.

However, clinicians should be ready to rapidly advance the dose if this reduction results in inadequate glycemic management.

Different basal-bolus regimens are similarly effective in reducing A1C concentrations when insulin doses are titrated to achieve glycemic goals. In some studies, treatment with such a basal-bolus insulin regimen was associated with better glycemic outcomes than sliding-scale insulin [ ].

As an example, in one open-label, randomized trial of insulin glargine supplemented with preprandial glulisine versus sliding-scale insulin, a greater proportion of patients treated with the basal-bolus regimen achieved target glucose values 66 versus 38 percent, respectively [ 26 ].

However, in this study, the mean daily dose of insulin was more than threefold higher in the basal-bolus-treated patients than in those assigned to sliding scale, likely reflecting a failure to titrate the doses of sliding-scale insulin. Because the high concentration of insulin delays absorption, the pharmacologic profile of U regular insulin is most similar to that of NPH [ 30 ].

Thus, if U is not available, U NPH insulin twice daily should be substituted again, with a 50 percent dose reduction. We would also caution that errors are common with U administration, and clear communication among patient, clinician, nursing staff, and pharmacy is imperative to ensure proper dosing.

Although in the past U insulin was dispensed using standard U insulin or Tuberculin syringes, a dedicated U insulin syringe is available and U insulin should be dispensed with the U insulin syringe, if possible [ 31 ].

The syringe contains scale markings from 25 to units in 5-unit increments total volume 0. The insulin dose should be expressed in units, rather than in volumetric terms as was the convention with the Tuberculin or U syringes. U insulin syringes are not available with a safety needle and, therefore, may not be allowed in some facilities.

In such cases, the U insulin pen device may be used. The pen dosing window shows the number of units of U to be injected, and the pen delivers the volume that corresponds to the selected dose.

If neither dedicated U insulin syringes nor the U insulin pen device is available, U insulin can be dispensed using a Tuberculin syringe, rather than a U insulin syringe, to emphasize that it is different from U regular insulin. With the Tuberculin syringe, every 0.

The obvious concern when using U insulin with a Tuberculin syringe is the potential for confusion of volume and units. For institutions using Tuberculin syringes to deliver U insulin, therefore, U insulin should be dispensed directly from the hospital pharmacy, in individually labelled Tuberculin syringes.

See 'Patients with type 1 diabetes' below. Automated insulin delivery AID systems are typically used in the outpatient setting, more often in patients with type 1 diabetes. Whether the modest improvement in glycemia in noncritical hospitalized patients improves outcomes and warrants the potential increased cost is uncertain.

See "Continuous subcutaneous insulin infusion insulin pump ", section on 'Types of insulin pumps'. If an episode is clearly short lived eg, a procedure done in the early morning , subcutaneous insulin usual dose of short acting and intermediate or long acting and breakfast can simply be delayed until after the episode.

The adjustment of insulin doses in preparation for surgery or other procedures is reviewed in more detail separately. See "Perioperative management of blood glucose in adults with diabetes mellitus", section on 'Insulin injection'.

Once the patient is taking a normal diet, the usual at-home regimen can be restarted, as long as glycemic goals were being met. If altered nutritional intake is present, reduced doses of insulin will be required, starting with doses similar to those administered in the preprocedure setting.

Patients with type 1 diabetes — Patients with type 1 diabetes have an absolute requirement for insulin at all times , whether or not they are eating, to prevent ketosis.

The doses of insulin needed are usually lower than in patients with type 2 diabetes since most of the former do not have insulin resistance. However, their blood glucose concentrations tend to fluctuate more during the course of the illness or procedure.

It is important to avoid hypoglycemia, even if the consequence is a temporary modest rise in the blood glucose concentration.

Insulin can be given either subcutaneously or intravenously. Algorithms for glycemic management of nonfasting and fasting patients with type 1 diabetes who are not critically ill are shown for subcutaneous dosing regimens algorithm 1 and algorithm 2 [ 13 ].

If the patient is receiving nothing by mouth, the administration of basal insulin is still required. As examples:. No boluses would be administered until the patient is able to eat.

Since nursing staff are not always familiar or comfortable with the use of insulin pumps, patients should be alert enough to manage their pump therapy and possess sufficient vision and dexterity to safely use the device.

In addition, vigilance regarding pump catheter placement is necessary. Catheters may inadvertently be dislodged during transfers in the operating room or in bed, and if the patient is not alert enough to provide self-care, the health care providers should consider changing to conventional injection therapy until the patient is able to manage pump therapy again.

In patients with tightly managed glycemia, an alternative approach is to reduce the dose of glargine by 10 to 20 percent eg, give 16 to 18 units to minimize the risk of hypoglycemia that might require oral ingestion of calories and thereby delay the planned procedure.

Short-acting insulin should not be given, unless significant hyperglycemia is noted, as described above. Blood glucose should be measured every two to three hours until the first meal is eaten. Intravenous glucose at approximately 3.

See "Cases illustrating intensive insulin therapy in special situations". Patients receiving enteral or parenteral feedings — Patients with diabetes who are receiving total parenteral nutrition TPN or tube feeds bolus or continuous require special consideration.

TPN — In patients receiving total parenteral nutrition TPN , insulin may be administered as part of the nutritional solution, if allowed by the hospital pharmacy. To determine the correct dose of insulin to add to the TPN fluid, a separate infusion of regular insulin can be used initially.

When glucoses have reached goal, the total daily dose of regular insulin provided by the insulin drip is calculated; 80 percent of this amount is added to the TPN fluid as regular insulin to be delivered over 24 hours.

For example, if the intravenous insulin infusion at steady state was set at 1 unit per hour or 24 units per day , around 80 percent of this amount 20 units should be added to the TPN solution by the pharmacy to be given over the course of the day. The amount of insulin can then be titrated every one to two days, based upon glucose monitoring.

Since more frequent adjustments are impractical and costly, the concurrent use of rapid- or short-acting insulin as correction every six hours will help to fine-tune glycemic management. See 'Correction insulin' above. If TPN is interrupted, most patients with type 2 diabetes can be followed with careful glucose monitoring.

Insulin should be administered if hyperglycemia occurs. In patients with type 1 diabetes, hyperglycemia will occur and can result in ketosis if all insulin is withheld. Thus, patients with type 1 diabetes require insulin when the TPN is interrupted.

The amount and type of insulin depend upon the anticipated duration of the interruption. Because of the potential for inadvertent discontinuation of insulin therapy if TPN is interrupted, some clinicians recommend giving a portion of the basal insulin as an injection eg, 50 percent in patients with type 1 diabetes.

In the example above patient receiving 24 units of regular insulin a day, 80 percent of this amount [19 units] added to the TPN solution , approximately 10 units of regular insulin can be added to the TPN solution and 9 units of NPH, glargine, or detemir administered as a basal injection.

This approach can also be used in insulin-requiring patients with type 2 diabetes. Enteral feedings — In patients receiving continuous enteral feeds, the total daily dose of insulin could be administered as basal insulin alone once-daily glargine, detemir, or degludec, or twice-daily detemir or NPH.

However, if the enteral feeds are unexpectedly discontinued, hypoglycemia may occur. Thus, a safer approach may be to administer approximately 50 percent of the total daily insulin dose as basal insulin and 50 percent as prandial short- or rapid-acting insulin, which is given every four rapid-acting insulin to six short-acting insulin hours [ 33 ].

A similar ratio of basal-to-prandial insulin can be used for patients receiving bolus feeds, for whom the prandial insulin would be divided equally before each bolus feed. Correction rapid- or short-acting insulin can then be administered, as needed, with the prandial insulin same type.

In those receiving cycled enteral feeding eg, 8 to 10 hours overnight , the ideal insulin may be NPH, which has an activity profile similar to this duration, its effect waning when the feeds are stopped. Again, correction rapid- or short-acting insulin can then be administered as needed to optimize glycemic management.

Another approach is to use short-acting insulin alone. This approach is supported by the findings of a randomized trial of sliding-scale, regular insulin every four to six hours alone or in combination with insulin glargine in 50 noncritically ill patients with diabetes receiving enteral nutrition [ 34 ].

There were no differences in any glycemic measures mean study glucose, mean peak or nadir glucose, hypoglycemia events, or total daily insulin dose between the two groups.

However, NPH insulin was required in 48 percent of subjects randomly assigned to sliding-scale, regular insulin. Thus, when sliding-scale, regular insulin alone is chosen as the initial management strategy for patients receiving enteral feeds, the addition of basal insulin is often required to maintain adequate glycemic management.

Consultation — Most of the time, the treatment of hyperglycemia in patients with diabetes in these stressful circumstances can be done by the patient's internist, generalist, or hospitalist. However, each clinician needs to decide whether or not the patient would benefit from additional advice; consultation with a diabetes specialist or endocrinologist may help, particularly if accompanied by a team including personnel who can provide patient education and nutritional advice.

This team approach can decrease the patient's length of stay as well as decrease the total cost of care [ 35,36 ]. Using the hospitalization to enhance the patient's knowledge about the disease and to improve self-management is encouraged.

Evaluation of overall care — A brief hospitalization is an excellent opportunity to assess or reassess overall care in patients with diabetes. If appropriate, attention should be paid to preventive measures such as smoking cessation, hypertension management, treatment of dyslipidemia, and appropriate vaccinations [ 37 ], glycemic management, assessment of possible complications of diabetes, and overall patient education.

This assessment should lead to the formulation of a plan for future treatment after the patient is discharged. See "Overview of general medical care in nonpregnant adults with diabetes mellitus". In type 2 diabetes, an insulin regimen may not be necessary after the illness requiring hospitalization has resolved.

In addition, even when such a regimen is considered to be the ideal outpatient therapy upon discharge, the patient may not be able to comply safely with the prescribed insulin program, which requires a degree of education, commitment, and self-discipline not exhibited by all.

Thus, it is important to determine both the insulin needs as well as the self-care capacities of each patient prior to discharge. Optimal regimens should be individualized for each patient.

Patients may require a significant dose adjustment after discharge from the hospital, which is why clear communication between the clinician dealing with the acute illness and the clinician who will follow the patient's diabetes care after discharge is so important. Patients found to be newly hyperglycemic during times of illness may actually have undiagnosed diabetes.

A glycohemoglobin test A1C can help discriminate between acute, stress-related hyperglycemia and preexistent diabetes. At a minimum, these individuals should be retested as outpatients upon full recovery. Adequate patient education, discharge planning, and the important transition to the outpatient arena should be facilitated by the personnel dedicated to diabetes care at each institution.

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. See "Society guideline links: Diabetes mellitus in adults" and "Society guideline links: Diabetes mellitus in children".

See 'Goals in the hospital setting' above. See 'Noncritically ill' above.

Although the sample size was planned to be , recruitment was stopped prior to reaching when it was evident that the study completion rate was higher than projected and that achieving participants completing the 8-month visit would require a smaller number randomized.

A decision was made on September 25, , by the study sponsor in conjunction with the coordinating center director to discontinue recruitment at the end of October 31, Between July 30, , and October 30, , adults with type 2 diabetes were screened, of whom 61 did not proceed to the randomized trial eFigure 1 in Supplement 2 and 1 with subsequently diagnosed type 1 diabetes was randomized but excluded from analyses.

Of the remaining randomized participants, were assigned to the CGM group and 59 to the BGM group. The mean baseline HbA 1c level was 9. Participant characteristics according to treatment group are shown in Table 1. Follow-up was completed on July 7, In the CGM group, the median CGM use was 6.

No participant in the BGM group initiated CGM use prior to the primary outcome. The mean number of blood glucose self-monitoring was 1. The mean HbA 1c level, which was 9. Results of the per-protocol analysis and 2 sensitivity analyses with different methods for handling missing data are provided in eTable 7 in Supplement 2.

Among participants with baseline HbA 1c levels of 8. In exploratory subgroup analyses, there was no statistically significant interaction assessing the treatment effect on 8-month HbA 1c levels according to levels of baseline factors eTable 9 in Supplement 2.

There was not statistically significant interaction of the effect of CGM on the 3 key secondary glycemic outcomes comparing daytime and nighttime eTable 10 in Supplement 2. In an exploratory analysis, there were no statistically significant differences between groups in the total daily insulin dose, nor were there significant differences in the addition or reduction of diabetes medications in post hoc analyses eTables 11, 12, and 13 in Supplement 2.

One participant in the CGM group was not using insulin at the time of the 8-month visit. There were no statistically significant differences between groups in change in body weight, blood pressure, or non—high-density lipoprotein cholesterol in exploratory analyses eTable 14 in Supplement 2.

There was 1 occurrence of diabetic ketoacidosis in the CGM group Table 3. A complete listing of reported adverse events is provided in eTable 15 in Supplement 2. In the CGM group, the mean score on the CGM satisfaction scale was 4. In this randomized trial of patients with type 2 diabetes and poor glycemic control mean HbA 1c level, 9.

Exploratory subgroup analyses based on baseline participant characteristics suggested that a HbA 1c level difference favoring the CGM group was present across the age range of 33 to 79 years and the baseline HbA 1c range of 7.

HbA 1c level improvement was achieved while reducing the frequency of CGM-measured hypoglycemia. The high rate of persistent CGM use over 8 months and the high scores on the CGM satisfaction scale are similar to the findings of a randomized trial evaluating CGM in patients with type 2 diabetes using basal insulin plus prandial insulin.

The strengths of this study included a racially and socioeconomically diverse study population, with most participants being non-White, with less than a college degree, and without private insurance.

The study assessed the benefit of CGM vs optimized care for the BGM group, which was reflected in improvement in HbA 1c level in the BGM group. Because type 2 diabetes is primarily managed in the primary care setting and not by endocrinologists, the study was designed to recruit patients from primary care practices.

However, the involvement of the diabetes specialists in this study as advisors to primary care clinicians is not currently standard practice in many clinical settings and thus limits the generalizability of the study findings.

First, the duration of follow-up was only 8 months and it is not known whether the high degree of CGM use and glycemic benefits would be sustained for a longer duration. A 6-month extension phase of the study may provide some insights in this regard.

Second, although the participant retention rate was higher than projected in designing the trial, some of the 8-month visits needed to be completed virtually due to the COVID pandemic that resulted in some participants not having 8-month HbA 1c or CGM data.

Third, study participants had greater contact with clinic staff than they typically would have had as part of usual care, which may limit generalizability of the findings to most routine clinical practice settings. Among adults with poorly controlled type 2 diabetes treated with basal insulin without prandial insulin, CGM, as compared with BGM monitoring, resulted in significantly lower HbA 1c levels at 8 months.

Corresponding Author: Roy W. Beck, MD, PhD, Jaeb Center for Health Research Foundation, Inc, Amberly Dr, Ste , Tampa, FL rbeck jaeb. Published Online: June 2, Author Contributions: Dr Beck had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Beck, Ruedy, Peters, Pop-Busui, Philis-Tsimikas, Umpierrez, Kruger, Young, Aleppo, Polonsky, Price, Bergenstal. Acquisition, analysis, or interpretation of data: Martens, Beck, Bailey, Ruedy, Calhoun, Peters, Pop-Busui, Philis-Tsimikas, Bao, Davis, Bhargava, McGill, Nguyen, Orozco, Biggs, Lucas, Buse, Price, Bergenstal.

Drafting of the manuscript: Martens, Beck, Bailey, Peters, Philis-Tsimikas, Price, Bergenstal. Critical revision of the manuscript for important intellectual content: All authors. Administrative, technical, or material support: Martens, Beck, Ruedy, Bao, Orozco, Biggs, Price, Bergenstal.

Conflict of Interest Disclosures: All authors received grant funding from Dexcom to their institution for the conduct of the submitted study. Dr Beck reported his institution receiving grant funding and study supplies from Tandem Diabetes Care and Beta Bionics; study supplies from Medtronic, Ascencia, and Roche; consulting fees and study supplies from Eli Lilly and Novo Nordisk; and consulting fees from Insulet, Bigfoot Biomedical, vTv Therapeutics, and Diasome.

Ms Ruedy reported receiving grants to her institution from Tandem Diabetes Care and Beta Bionics and study supplies from Novo Nordisk and Eli Lilly outside the submitted work. Dr Calhoun reported being a former employee of Dexcom Inc and his current employer receiving consulting payments on his behalf from vTv Therapeutics, Beta Bionics, and Diasome.

Dr Peters reported serving on advisory boards for Abbott Diabetes Care, Eli Lilly, Medscape, Novo Nordisk, and Zealand; receiving nonfinancial study supplies from Abbott Diabetes Care; and owning stock options for Omada Health and Teladoc.

Dr Pop-Busui reported receiving personal fees from Averitas, Nevro, Novo Nordisk, Boehringer Ingelheim, and Bayer and grants from AstraZeneca outside the submitted work.

Dr Bao reported receiving research funding, paid to her institution, from Novo Nordisk, Mylan, AstraZeneca, and Bristol Myers Squibb. Dr Umpierrez reported research funding paid to his institution from Novo Nordisk and AstraZeneca.

Dr Davis reported grants paid to her institution from Insulet and the National Institutes of Health outside the submitted work. Ms Kruger reported receiving consulting and research funds from Abbott Diabetes, consulting and speaking fees from Eli Lilly, consulting fees from Sanofi Aventis, speaker fees from Xeris Pharmaceuticals, and speaking, consulting, and research funding from Novo Nordisk.

Dr Young reported grants to her institution from Eli Lily, vTv Therapeutics, Novo Nordisk, Boehringer Ingelheim Pharmaceuticals Inc, Sanofi, Tolerion, and Bayer outside the submitted work. Dr McGill reported her institution received grants from the National Institutes of Health and Beta Bionics and that she received advisory board fees from Bayer, Eli Lilly, Metavant, and Salix; personal fees from Aegerion, Bayer, Boehringer Ingelheim, Dexcom, Eli Lilly, Janssen, MannKind, Metavant, Novo Nordisk, and Valeritas; consultancy fees from Boehringer Ingelheim; and grants, paid to her employer, from Medtronic and Novo Nordisk.

Dr Aleppo reported grants paid to her institution from AstraZeneca, Eli Lilly, Insulet, and Novo Nordisk and personal fees from Insulet outside the submitted work.

Dr Nguyen reported receiving clinical trial fees from Las Vegas Endocrinology and that his employer has received funds on his behalf for research support, consulting, or serving on the scientific advisory boards for AstraZeneca, Sanofi Aventis, Novo Nordisk, Eli Lilly, Boehringer Ingelheim, and MannKind.

Dr Polonsky reported receiving grants from Dexcom, Abbott Diabetes Care, Sanofi Aventis, Eli Lilly, Novo Nordisk, Boehringer Ingelheim, ProventionBio, Insulet, Adocia, and Intuity outside the submitted work.

Dr Price reported being an employee of Dexcom and holding stock in the company. An employee of the company Dr Price was a coauthor and in this role, he was involved in the review of the manuscript and the interpretation of the data prior to submission for publication along with the other authors.

The company had no approval authority for the manuscript prior to submission, including no right to veto publication and no control on the decision regarding to which journal the manuscript was submitted. Group Information: A complete list of the members of the MOBILE Study Group appears in Supplement 3.

Study center staff and other individuals who participated in the conduct of the trial are listed in Supplement 2. Data Sharing Statement: See Supplement 4. full text icon Full Text. Download PDF Top of Article Key Points Abstract Introduction Methods Results Discussion Conclusions Article Information References.

Visual Abstract. Effect of CGM on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin. View Large Download. Figure 1. Screening, Allocation, and Study Follow-up. b One participant in each group was missing baseline data.

Figure 2. Hemoglobin A 1c HbA 1c Values at 8 Months. BGM indicates blood glucose meter; and CGM, continuous glucose monitoring. Table 1. Baseline Demographics, Medical History, and Insulin Therapies. Table 2. Glycemic Outcomes a.

Table 3. Adverse Events and Serious Adverse Events a. Supplement 1. Trial Protocol. Supplement 2. MOBILE Study Group Listing eFigure 1. Flow Chart of Screening eFigure 2. Flow Chart of Visit Completion Rates eFigure 3. Mean Glucose Over 24 Hours at 8 Months eTable 1.

Patient Eligibility Criteria eTable 2. Description of Quality of Life and Satisfaction Questionnaires eTable 3. Secondary and Exploratory Study Outcomes and Additional Statistical Methods eTable 4. Glucose Lowering Medications in Use at Time of Randomization in Addition to Insulin eTable 5.

CGM Use in CGM Group eTable 6. Frequency of Blood Glucose Meter Testing eTable 7. Change in HbA1c: Per-Protocol Analysis and Sensitivity Analyses eTable 8.

Change in HbA1c According to Baseline HbA1c Group eTable 9. Change in HbA1c According to Baseline Subgroups eTable CGM Outcomes According to Time of Day eTable Daily Insulin Delivery eTable Additions and Discontinuations of Diabetes Medications and Insulin Use eTable Medications Added and Stopped During Follow-up eTable Body Weight, Blood Pressure, and Cholesterol eTable Listing of Types of Reported Adverse Events eTable CGM Satisfaction Scale.

Supplement 3. Nonauthor Collaborators. MOBILE Study Group. Supplement 4. Data Sharing Statement. Selvin E, Parrinello CM, Daya N, Bergenstal RM. Trends in insulin use and diabetes control in the US: and doi: Kazemian P, Shebl FM, McCann N, Walensky RP, Wexler DJ. Evaluation of the cascade of diabetes care in the United States, Schnell O, Hanefeld M, Monnier L.

Self-monitoring of blood glucose: a prerequisite for diabetes management in outcome trials. Murata GH, Shah JH, Hoffman RM, et al; Diabetes Outcomes in Veterans Study DOVES. Intensified blood glucose monitoring improves glycemic control in stable, insulin-treated veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study DOVES.

Falk J, Friesen KJ, Okunnu A, Bugden S. Patterns, policy and appropriateness: a year utilization review of blood glucose test strip use in insulin users.

Rossi MC, Lucisano G, Ceriello A, et al; AMD Annals-SMBG Study Group. Real-world use of self-monitoring of blood glucose in people with type 2 diabetes: an urgent need for improvement. Beck RW, Riddlesworth T, Ruedy K, et al; DIAMOND Study Group. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial.

Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Hermanns N, Schumann B, Kulzer B, Haak T.

The impact of continuous glucose monitoring on low interstitial glucose values and low blood glucose values assessed by point-of-care blood glucose meters: results of a crossover trial.

Lind M, Polonsky W, Hirsch IB, et al. 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.

van Beers CA, DeVries JH, Kleijer SJ, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia IN CONTROL : a randomised, open-label, crossover trial. Wong JC, Foster NC, Maahs DM, et al; T1D Exchange Clinic Network.

Real-time continuous glucose monitoring among participants in the T1D Exchange clinic registry. Beck RW, Riddlesworth TD, Ruedy K, et al; DIAMOND Study Group. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial.

Peters A, Cohen N, Calhoun P, et al. Glycaemic profiles of diverse patients with type 2 diabetes using basal insulin: MOBILE study baseline data. PubMed Google Scholar Crossref. Beck RW, Bocchino LE, Lum JW, et al. An evaluation of two capillary sample collection kits for laboratory measurement of HBALC.

PubMed Google Scholar. Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range. Danne T, Nimri R, Battelino T, et al. Español Spanish Print. Minus Related Pages.

Make Friends With Your Numbers. Getting an A1C Test Make sure to get an A1C test at least twice a year. Your A1C result will be reported in two ways: A1C as a percentage. Estimated average glucose eAG , in the same kind of numbers as your day-to-day blood sugar readings.

Questions To Ask Your Doctor When visiting your doctor, you might keep these questions in mind to ask during your appointment. What is my target blood sugar range? How often should I check my blood sugar?

What do these numbers mean? Are there patterns that show I need to change my diabetes treatment? What changes need to be made to my diabetes care plan? Top of Page. Getting Tested What is Low Blood Sugar hypoglycemia?

What is High Blood Sugar hyperglycemia? Education and Support. Last Reviewed: December 30, Source: Centers for Disease Control and Prevention.

Facebook Twitter LinkedIn Syndicate. home Diabetes Home. To receive updates about diabetes topics, enter your email address: Email Address. What's this. Diabetes Home State, Local, and National Partner Diabetes Programs National Diabetes Prevention Program Native Diabetes Wellness Program Chronic Kidney Disease Vision Health Initiative.

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Whether you manage your diabetes with an insulin pump, insulin injections MDI , oral medications, or through diet and exercise ¶ , Medtronic offers CGM products and insulin pump systems that give you, your loved ones and healthcare professionals the insights to stay ahead of diabetes and help you live life on your terms.

For people who manage their diabetes with injections, the smart insulin injection system can help reduce the physical and mental effort required to manage diabetes. To request a free insurance coverage check and learn more about your eligibility and potential out-of-pocket costs, please complete the form below or call , and one of our Diabetes Therapy consultants will be happy to assist you.

At this time, insurance coverage for our CGM is most often available for those that use multiple daily insulin injections to manage their diabetes. This form is for customers in the Unites States only. For more information about our products in your region please see our list of international locations.

All therapy adjustments should be based on measurements obtained from standard blood glucose monitoring devices and not on values provided by the system. Statement by the American Association of Clinical Endocrinologists Consensus Panel on insulin pump management.

Endocr Pract. For a list of compatible devices, refer to user guide. The system is intended to complement, not replace, information obtained from standard blood glucose monitoring devices, and is not recommended for people who are unwilling or unable to perform a minimum of two meter blood glucose tests per day, or for people who are unable or unwilling to maintain contact with their healthcare professional.

The system requires a functioning mobile electronic device with correct settings. If the mobile device is not set up or used correctly, you may not receive sensor glucose information or alerts.

The system requires a prescription from a healthcare professional. The sensor is intended for single use and requires a prescription.

WARNING: Do not use SG values to make treatment decisions, including delivering a bolus, while the pump is in Manual Mode. However, if your symptoms do not match the SG value, use a BG meter to confirm the SG value.

Failure to confirm glucose levels when your symptoms do not match the SG value can result in the infusion of too much or too little insulin, which may cause hypoglycemia or hyperglycemia. But you will need to scan the CGM with a separate receiver or smartphone every few hours to view and store the data.

A third type of CGM collects data about your blood glucose level for your doctor to download and review later. Doctors provide this type of CGM to check on your diabetes care, and you wear it for a limited time.

For some CGM models, you may need to do a finger-stick test with a standard blood glucose monitor to calibrate the system and make sure the CGM readings are correct. Many CGMs work with apps that have special features, such as.

For safety, it is important to act quickly if a CGM alarm sounds when your glucose level is too low or too high. You should get help or follow your treatment plan to bring your glucose level into a healthy range. The CGM will create an alert and might display a graphic that shows whether your glucose level is rising or dropping—and how quickly—so you can choose the best way to reach your target range.

Over time, keeping your glucose levels in the healthy range can help you stay well and prevent diabetes complications.

The people who benefit the most from a CGM are those who use it every day or nearly every day. Researchers are working to make CGMs more accurate and easier to use. However, you may experience some issues while using a CGM. For safety, you may sometimes need to compare your CGM glucose readings with a finger-stick test and a standard blood glucose meter.

This could be needed if you doubt the accuracy of your CGM readings, if you are changing your insulin dose, or if your CGM gives a warning alert. You might have to replace parts of your CGM over time. Disposable CGM sensors should be replaced every 7 to 14 days, depending on the model.

Some implantable sensors can last up to days. You may have to replace the transmitters of some CGMs. You may also need to reconnect the CGM, transmitter, and receiver or smartphone if your CGM is not working correctly.

Skin redness or irritation from the sticky patches used to attach the sensor may occur for some people. A CGM costs more than using a standard glucose meter, but it may be covered by your health insurance. You might be able to get financial help for diabetes care from your health insurance or other resources.

Check with your health insurance plan or Medicare to see if the costs will be covered. An artificial pancreas , also called an automated insulin delivery system AID , mimics how a healthy pancreas controls blood glucose in the body.

A CGM, an insulin pump, and a software program that shares information between the CGM and insulin pump make up the artificial pancreas. The CGM estimates glucose levels and wirelessly sends the information to a software program on a smartphone or insulin pump.

The program calculates how much insulin your body needs, and the insulin pump delivers the insulin when glucose levels rise higher than your target range. On the other hand, if your glucose levels fall lower than your target range, the artificial pancreas can lower or stop the amount of insulin given by the insulin pump.

The artificial pancreas is mainly used to help people with type 1 diabetes keep their glucose levels in their target range. Change in HbA1c According to Baseline HbA1c Group eTable 9.

Change in HbA1c According to Baseline Subgroups eTable CGM Outcomes According to Time of Day eTable Daily Insulin Delivery eTable Additions and Discontinuations of Diabetes Medications and Insulin Use eTable Medications Added and Stopped During Follow-up eTable Body Weight, Blood Pressure, and Cholesterol eTable Listing of Types of Reported Adverse Events eTable CGM Satisfaction Scale.

Supplement 3. Nonauthor Collaborators. MOBILE Study Group. Supplement 4. Data Sharing Statement. Selvin E, Parrinello CM, Daya N, Bergenstal RM. Trends in insulin use and diabetes control in the US: and doi: Kazemian P, Shebl FM, McCann N, Walensky RP, Wexler DJ.

Evaluation of the cascade of diabetes care in the United States, Schnell O, Hanefeld M, Monnier L. Self-monitoring of blood glucose: a prerequisite for diabetes management in outcome trials. Murata GH, Shah JH, Hoffman RM, et al; Diabetes Outcomes in Veterans Study DOVES. Intensified blood glucose monitoring improves glycemic control in stable, insulin-treated veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study DOVES.

Falk J, Friesen KJ, Okunnu A, Bugden S. Patterns, policy and appropriateness: a year utilization review of blood glucose test strip use in insulin users.

Rossi MC, Lucisano G, Ceriello A, et al; AMD Annals-SMBG Study Group. Real-world use of self-monitoring of blood glucose in people with type 2 diabetes: an urgent need for improvement. Beck RW, Riddlesworth T, Ruedy K, et al; DIAMOND Study Group.

Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R.

Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Hermanns N, Schumann B, Kulzer B, Haak T. The impact of continuous glucose monitoring on low interstitial glucose values and low blood glucose values assessed by point-of-care blood glucose meters: results of a crossover trial.

Lind M, Polonsky W, Hirsch IB, et al. 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.

van Beers CA, DeVries JH, Kleijer SJ, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia IN CONTROL : a randomised, open-label, crossover trial. Wong JC, Foster NC, Maahs DM, et al; T1D Exchange Clinic Network.

Real-time continuous glucose monitoring among participants in the T1D Exchange clinic registry. Beck RW, Riddlesworth TD, Ruedy K, et al; DIAMOND Study Group. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial.

Peters A, Cohen N, Calhoun P, et al. Glycaemic profiles of diverse patients with type 2 diabetes using basal insulin: MOBILE study baseline data. PubMed Google Scholar Crossref. Beck RW, Bocchino LE, Lum JW, et al.

An evaluation of two capillary sample collection kits for laboratory measurement of HBALC. PubMed Google Scholar.

Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range.

Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. The Diabetes Control and Complications Trial Research Group. The relationship of glycemic exposure HbA1c to the risk of development and progression of retinopathy in the diabetes control and complications trial.

Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes UKPDS 35 : prospective observational study. Kleinman LC, Norton EC. a simple approach for estimating adjusted risk measures from nonlinear models including logistic regression.

x PubMed Google Scholar Crossref. Start-ups Tout Continuous Glucose Monitoring for People Without Diabetes. This Medical News article describes the marketing of continuous glucose monitoring devices to individuals without diabetes.

Real-time Continuous Glucose Monitoring and Glycemic Control in Insulin-Treated Patients With Diabetes. This cohort study investigates the effect of real-time continuous glucose monitoring on glycemic control among patients with insulin-treated diabetes. Andrew J. Karter, PhD; Melissa M.

Parker, MS; Howard H. Moffet, MPH; Lisa K. Gilliam, MD, PhD; Richard Dlott, MD. Broadening Access to Continuous Glucose Monitoring for Patients With Type 2 Diabetes.

Continuous Glucose Monitoring and Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin—Reply. Thomas W. Martens, MD; Roy W. Beck, MD, PhD; Richard M. Bergenstal, MD. Continuous Glucose Monitoring and Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin.

Wellbert Hernández-Núñez, MD; Jesús Zacarías Villareal-Pérez, MD; René Rodríguez-Gutiérrez, MD, MSc, PhD. See More About Diabetes Diabetes and Endocrinology. Select Your Interests Select Your Interests Customize your JAMA Network experience by selecting one or more topics from the list below.

Save Preferences. Privacy Policy Terms of Use. This Issue. Views 84, Citations View Metrics. X Facebook More LinkedIn. Cite This Citation Martens T , Beck RW , Bailey R, et al. Original Investigation. Thomas Martens, MD 1 ; Roy W.

Beck, MD, PhD 2 ; Ryan Bailey, MS 2 ; et al Katrina J. Ruedy, MSPH 2 ; Peter Calhoun, PhD 2 ; Anne L. Peters, MD 3 ; Rodica Pop-Busui, MD, PhD 4 ; Athena Philis-Tsimikas, MD 5 ; Shichun Bao, MD, PhD 6 ; Guillermo Umpierrez, MD 7 ; Georgia Davis, MD 7 ; Davida Kruger, MSN, APN-BC 8 ; Anuj Bhargava, MD 9 ; Laura Young, MD, PhD 10 ; Janet B.

McGill, MD 11 ; Grazia Aleppo, MD 12 ; Quang T. Nguyen, DO 13 ; Ian Orozco, MD 14 ; William Biggs, MD 15 ; K. Jean Lucas, MD 16 ; William H. Polonsky, PhD 17 ; John B.

Buse, MD, PhD 10 ; David Price, MD 18 ; Richard M. Bergenstal, MD 19 ; for the MOBILE Study Group.

Es ist zugelassen für Kinder ab 4 Jahren, Erwachsene und Schwangere. Informieren Sie sich in unserem Online-Live-Webinar oder in einer Präsenz­veranstaltung über die Vorteile des FreeStyle Libre 3 Messsystems und lernen Sie FreeStyle Libre 3 beim Probetragen kennen. Erhalten Sie Ihre Glukose­werte jede einzelne Minute 3 auto­matisch und ohne Scannen auf Ihr Smartphone oder Lesegerät.

Der derzeit kleinste und flachste 15 Sensor der Welt wird alle 14 Tage 2 einfach und schmerzfrei 10 zuhause angebracht. Fühlen Sie sich sicher mit minuten­genauen Glukose­werten und optionalen Alarmen, welche Sie vor einer Über- oder Unterzuckerung warnen. Fast alle gesetzlichen Krankenkassen übernehmen bereits die Kosten für FreeStyle Libre 3!

FreeStyle Libre 3 hat mit seinen zahlreichen Produktvorteilen bereits viele Menschen mit Diabetes gegenüber herkömmlichen Messverfahren BGM sowie anderen kontinuierlichen Glukosemesssystemen CGM überzeugt. Das bedeutet mir unendlich viel. Beim herkömmlichen Blutzuckermessen wird mit einer Stechhilfe in die Fingerkuppe gestochen.

Bei kontinuierlichen Glukosemesssystemen CGM , wie dem FreeStyle Libre 3 Messsystem, bringen Sie sich zuhause ganz einfach 10 alle 14 Tage 2 einen kleinen Sensor auf der Rückseite Ihres Oberarms an. Dieser misst über ein Filament unter der Haut fortlaufend Ihre Zuckerwerte und überträgt die Werte minutengenau 3 in Ihre FreeStyle Libre 3 App oder auf Ihr FreeStyle Libre 3 Lesegerät Auf diese Weise können Sie den Verlauf Ihres Zuckerwertes sowie dessen Trend, kontinuierlich im Blick behalten.

Im Vergleich zur herkömmlichen Blutzuckermessung erhalten Sie so mehr Informationen. Der Sensor wird auf der Rückseite des Oberarms ganz einfach mithilfe eines Applikators angebracht. Dabei wird ein dünnes, biegsames, steriles Filament direkt unter die Haut geschoben. Der Sensor selbst wird dabei mit einer Klebefolie auf der Haut fixiert.

Der Sensor kann bis zu 14 Tage 2 an der Rückseite des Oberarms getragen werden. Danach müssen Sie einen neuen Sensor anbringen. Der Sensor ist in bis zu 1m Wassertiefe für die Dauer von bis zu 30 Minuten wasserfest und kann beim Baden, Duschen, Schwimmen oder beim Sport getragen werden.

FreeStyle Libre 3 ist auf Rezept, über Einzelkauf und im praktischen Abo erhältlich. Auf der FreeStyle Libre 3 Produktseite können Sie sich über die unterschiedlichen Bestellmöglichkeiten informieren und die Bestellung durchführen.

Wenn Sie als gesetzlich Versicherte:r ein Rezept bei uns einreichen , stellen wir einen Kostenübernahmeantrag bei Ihrer Krankenkasse und informieren Sie, sobald der Antrag genehmigt wurde. Ihre Versorgung startet anschließend automatisch.

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. To request a free insurance coverage check and learn more about your eligibility and potential out-of-pocket costs, please complete the form below or call , and one of our Diabetes Therapy consultants will be happy to assist you.

At this time, insurance coverage for our CGM is most often available for those that use multiple daily insulin injections to manage their diabetes. This form is for customers in the Unites States only. For more information about our products in your region please see our list of international locations.

All therapy adjustments should be based on measurements obtained from standard blood glucose monitoring devices and not on values provided by the system. Statement by the American Association of Clinical Endocrinologists Consensus Panel on insulin pump management.

Endocr Pract. For a list of compatible devices, refer to user guide. The system is intended to complement, not replace, information obtained from standard blood glucose monitoring devices, and is not recommended for people who are unwilling or unable to perform a minimum of two meter blood glucose tests per day, or for people who are unable or unwilling to maintain contact with their healthcare professional.

The system requires a functioning mobile electronic device with correct settings. If the mobile device is not set up or used correctly, you may not receive sensor glucose information or alerts.

The system requires a prescription from a healthcare professional. The sensor is intended for single use and requires a prescription. WARNING: Do not use SG values to make treatment decisions, including delivering a bolus, while the pump is in Manual Mode.

However, if your symptoms do not match the SG value, use a BG meter to confirm the SG value. Failure to confirm glucose levels when your symptoms do not match the SG value can result in the infusion of too much or too little insulin, which may cause hypoglycemia or hyperglycemia.

Pump therapy is not recommended for people whose vision or hearing does not allow for the recognition of pump signals, alerts, or alarms. En Español. The exact schedule you will follow depends on several different factors. See 'Frequency of glucose testing' below.

Glucose monitoring can be done in two ways, blood glucose monitoring BGM and continuous glucose monitoring CGM. Blood glucose monitoring — BGM requires fingersticks to get small samples of blood. The glucose level in the blood sample is measured with a glucose meter. The detailed steps for checking blood glucose through BGM are described below.

See 'How to check your blood glucose' below. Continuous glucose monitoring — CGM systems use a sensor to measure the level of glucose in the fluid under the skin. The sensor is attached to a transmitter placed on your skin, which is held in place with a sticky patch figure 1.

It wirelessly transmits results to a small recording device no larger than a cell phone or to a smartphone or other smart device. In some cases, it transmits the information directly to an insulin pump figure 2. You can attach the recording device to your clothing, carry it in a purse or bag, or place it near you eg, on a bedside table.

If you use a CGM system, you will need to remove the sensor and replace it on a different part of your body approximately once every 7 to 14 days.

Different CGM systems are available; one implantable sensor can last up to days, but it needs to be inserted and removed by a physician, nurse practitioner, or physician assistant.

FREQUENCY OF GLUCOSE TESTING. Studies have proven that people with diabetes who maintain normal or near-normal blood glucose levels reduce their risk of diabetes-related complications.

Checking your glucose levels can play an important role in achieving your glucose goals and reducing the risk of complications.

See "Patient education: Preventing complications from diabetes Beyond the Basics ". Type 1 diabetes — For people with type 1 diabetes, frequent glucose testing is the only way to safely and effectively manage blood glucose levels.

People with type 1 diabetes may use blood glucose monitoring BGM with fingersticks and a glucose meter, or continuous glucose monitoring CGM. In people with type 1 diabetes, CGM is generally used if available and affordable. See 'Methods of glucose monitoring' above and 'Continuous glucose monitoring' below and "Patient education: Type 1 diabetes: Overview Beyond the Basics ".

Most people with type 1 diabetes who use BGM alone need to check their blood glucose level at least four times every day. If you use an insulin pump, give yourself three or more insulin injections per day, or are currently pregnant, you may need to test as many as 10 times a day or more.

See "Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics ". This way you will be able to access your testing equipment wherever you are, making it easier to manage your blood glucose.

Glucose monitoring is useful for people with type 2 diabetes who take insulin or certain medications that can cause hypoglycemia. It is generally unnecessary in people who manage their diabetes with diet alone or who take medications that do not cause hypoglycemia, especially if they have reached their glucose goals.

Your health care provider can help you determine how frequently to check your glucose based on your situation. Most people with type 2 diabetes who perform glucose monitoring use BGM.

For people taking insulin, CGM may be used if available and affordable. See 'Who should use CGM? How to check your blood glucose — The following steps include general guidelines for testing blood glucose levels. However, because the instructions can vary between devices, it's best to check the package insert for your glucose meter or talk with your health care provider.

It's important to never share monitoring equipment or fingerstick devices, as this could lead to infection. Lancets that are used more than once are not as sharp as a new lancet and can cause more pain and injury to the skin.

Alternate sites are often less painful than the fingertip. However, results from alternate sites are not as accurate as fingertip samples. This should not be a problem if you always use the same site.

However, when your blood glucose is rising rapidly eg, immediately after eating or falling rapidly in response to insulin or exercise , it's more accurate to use the fingertip, as testing at alternate sites may give significantly different results in these situations.

If you have difficulty getting a good drop of blood from your fingertip, try rinsing your fingers with warm water and shaking your hand below your waist. This can help get the blood flowing. The results will be displayed on the meter after several seconds. Blood glucose meters — There is no single blood glucose meter that is better than others.

Your health care provider or pharmacist can help you choose a meter based on your preferences as well as other factors like cost, ease of use, and accuracy; it should be one that is approved by either the International Organization for Standardization or the US Food and Drug Administration FDA.

Medicare also covers costs of BGM. Accuracy of home BGM — Blood glucose meters are reasonably accurate. However, there can be some variability between meters, so it is always wise to use caution and common sense.

If you get a result that does not fit with how you feel for example, if it says your blood glucose is very low but you don't have any symptoms , take a second reading or use an alternate method for testing your blood glucose such as a different meter.

Blood glucose meters are least accurate during episodes of low blood glucose. See "Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics ". The accuracy of BGM can be affected by several factors, including the type of blood glucose strip and meter. Inaccurate readings can be caused by the use of expired strips, improper storage of strips exposure to high temperature and humidity , inadequate cleansing of your skin, and ingestion of vitamin C and acetaminophen.

It's a good idea to check the accuracy of your blood glucose meter occasionally by bringing it with you when you have an appointment to get blood testing.

This way, you use your home monitor to check your blood glucose at the same time that blood is drawn and compare the results. If the results differ by more than 15 percent, there may be a problem with your meter or other equipment; your provider can help you figure out what's going on and how to correct the problem.

Help for people with vision impairment — People with vision impairment a common complication of diabetes sometimes have difficulty using glucose meters.