Monday, April 10, 2006

Let's Define Continuous Glucose Monitoring

When Is Continuous Not Really Continuous?

Lots of people I talk to are confused about the various approaches to technology and how they will be used to improve diabetes care and subsequently outcomes. I think most people would agree that having a way to monitor glucose continuously will be a good thing. However, when you stop to think about it, what definition of 'continuous' are we talking about? I would bet that if you asked 100 people with diabetes to give us their definition we would get at least 4 or 5 different answers.

As the technologies are getting closer to reality and delivering a useful and practical advancement in the state o f the art, we will most likely need to come up with more useful ways to describe these new devices and how they benefit us beyond just using the word continuous.

If you look at how everyone is using the word 'Wireless' across many different ways that it is used in diabetes you know what I mean. Wireless Diabetes Management System - is that for eliminating a cable between the meter and a PC, automatically inserting glucose values into a pump, using a handheld device to send commands 2 feet away to the insulin pump, or wirelessly transmitting useful data and information around the world from the patient in real-time to somebody else who can make effective use of the data and reports? Wow, that's a lot of different ways to talk about wireless in the context of diabetes!

With 'Continuous' we really have an even bigger challenge. Currently, most people who pay attention to this stuff think about continuous glucose monitoring as a 2 or 3 day wearable device with an inserted sensor or even a watch that you wear similarly for 2 or 3 days. These devices while continuous in the sense that they give us glucose data every several seconds or minutes can only do so for a very short period of time. These sensors are certainly not continuous and the continuous drain on a person's wallet may also prevent the current versions from ever being truly continuous at $15 a day (ouch!).

In addition, who among us really wants to deal with Continuous Glucose Data? Lots of us are working hard to address that problem by adding some intelligence to the data that's created so that it can be made more manageable and realistic in its usefulness. "Just tell me when I'm going high or going low", for example.

Another version of Continuous would have to do with getting data perhaps not every 5 seconds but delivering spot test data 6 to 12 times a day to an interested caregiver each and every time a test is taken... for years on end, continuously! That's the kind of thing we've been doing at Diabetech for the past 4 years with our GlucoMON wireless glucose meter accessory device. We just announced our GlucoMON Right Now! Diabetes Technology Study this past week and are busy recruiting people from around the USA to participate. Quite simply, this device allows people who depend on others for mentoring and support to be continuously monitored day after day after day each time they test and to continuously receive trending reports. Real-Time Alerts are a major part of this study as we want to better understand how people use this information away from the point of care and if it improves glycemic control and various other quality of life issues.

Wait! I just introduced yet another phrase we need to better define; Real-Time? So what does that mean?