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The use of continuous glucose monitoring (CGM) for blood glucose control is increasing and is effective in changing treatment methods and improving lifestyle by identifying problems in blood sugar patterns. However, adverse skin events are increasing due to the insertion of invasive tools or attachment of sensors to the skin for 14 days for intermittent CGM. These adverse events can be the reason for the discontinuation of CGM. Therefore, this paper aims to determine methods to identify and manage skin irritation and side effects caused by CGM accessories. [ABSTRACT FROM AUTHOR]

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements. [ABSTRACT FROM AUTHOR]

Medical nutrition therapy plays an integral role in diabetes management. There is no “one-size-fits-all” eating pattern for those with diabetes, and meal planning should be individualized. For many people with diabetes, glucose monitoring is key for glycemic control. Continuous glucose monitoring (CGM) metrics are suggested to provide a personalized diabetes management plan. Use of CGM continues to expand in clinical practice. Integrating CGM results into diabetes management can be useful for guiding medical nutrition therapy and physical activity, preventing hypoglycemia, and adjusting medications. Clinical dietitians should develop personalized nutrition management using CGM to help people with diabetes optimize dietary intake. [ABSTRACT FROM AUTHOR]

Impaired awareness of hypoglycemia has been found to be prevalent in 20% to 40% of people with type 1 diabetes. If a similar prevalence exists in Koreans with type 1 diabetes, at a minimum, thousands of people with type 1 diabetes suffer at least one unpredicted episode of severe hypoglycemia per year in Korea. For patients with problematic hypoglycemia, an evidence-based stepwise approach was suggested in 2015. The first step is structured education regarding multiple daily injections of an insulin analog, and the second step is adding a technological intervention, such as continuous subcutaneous insulin infusion or real-time continuous glucose monitoring. The next step is a sensor-augmented pump, preferably with a low glucose suspension feature or very frequent contact, and the final step is islet or pancreas transplantation. In Korea, however, none of these treatments are reimbursed by the National Health Insurance, and thus have not been widely implemented. The low prevalence of type 1 diabetes means that Korean physicians are relatively unfamiliar with the new technologies in this field. Therefore, the roles of new technologies and pancreas or islet transplantation in the treatment of problematic hypoglycemia need to be defined in the current clinical setting of Korea.

In the Diabetes Care Guidelines of the Korean Diabetes Association in 2015, the use of continuous glucose monitoring in patients with type 1 diabetes who undergo multiple insulin therapy or insulin pump therapy is helpful in controlling blood sugar and monitoring blood glucose level when fluctuation is high or hypoglycemia is frequent. Recently, the American Diabetes Association published in the 2019 Standard of Care in Diabetes in the new diabetes technology part the criteria for use and methods of the continuous blood glucose meter. Continuous and real-time blood glucose meters emphasize the importance of education prior to use. In particular, the real-time blood glucose meter is a useful device for prevention of hypoglycemia in type 1 diabetes in children and adults. The purpose of this study is to summarize the contents of the continuous blood glucose measurement part of the 2019 Standard of Care in Diabetes. [ABSTRACT FROM AUTHOR]

Because of the low incidence of type 1 diabetes in Korea, some Korean patients with type 1 diabetes are still being treated like type 2 diabetes patients. In 2011, the national health insurance launched a reimbursement program for the use of blood glucose test strips in type 1 diabetes. The initiation of the reimbursement program could provide an opportunity to assess the national status of type 1 diabetes management. In this context, we will discuss the lessons from the studies involving major national type 1 diabetes registries and the results of recent studies on multiple daily injection of insulin, continuous glucose monitoring, continuous subcutaneous insulin infusion, use of sensor-augmented insulin pumps, and the structure education program for patients with type 1 diabetes. [ABSTRACT FROM AUTHOR]