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Practical implementation, education and interpretation guidelines for continuous glucose monitoring: A French position statement - 01/02/18

Doi : 10.1016/j.diabet.2017.10.009 
S. Borot a, , P.Y. Benhamou b, C. Atlan c, E. Bismuth d, E. Bonnemaison e, B. Catargi f, G. Charpentier g, A. Farret h, N. Filhol i, S. Franc j, k, D. Gouet l, B. Guerci m, I. Guilhem n, C. Guillot o, N. Jeandidier p, M. Joubert q, V. Melki r, E. Merlen s, A. Penfornis t, S. Picard u, E. Renard h, Y. Reznik p, J.P. Riveline t, S. Rudoni u, P. Schaepelynck i, A. Sola-Gazagnes v, N. Tubiana-Rufi d, O. Verier-Mine w, H. Hanaire q

Société francophone du diabète (SFD), Société française d’endocrinologie (SFE)

Évaluation dans le diabète des implants actifs Group (EVADIAC)

a Department of Endocrinology, Nutrition and Diabetes, Besançon University Hospital and Franche-Comté University, 25030 Besançon cedex, France 
b Department of Diabetology, pôle DigiDune, Grenoble University Hospital, Grenoble Alpes University, 38700 La Tronche, France 
c Department of Endocrinology, Luxembourg Hospital, 1210 Luxembourg,Luxembourg 
d Department of Pediatric Endocrinology and Diabetology, Robert-Debré Hospital, AP–HP, 75019 Paris, France 
e Department of Pediatric Medicine, Tours University Hospital, 37044 Tours cedex, France 
f Department of Endocrinology and Diabetes, Bordeaux University Hospital, 33000 Bordeaux, France 
g Center for Study and Research for Improvement of the Treatment of Diabetes (CERITD), 91058 Evry cedex, France 
h Department of Endocrinology and UMR CNRS, Montpellier University Hospital and University of Montpellier, 34090 Montpellier, France 
i Department of Diabetology, Marseille University Hospital, 13005 Marseille, France 
j Department of Diabetology, Sud-Francilien Hospital, 91110 Corbeil-Essonnes, France 
k Department of Diabetology, La Rochelle General Hospital, 17000 La Rochelle, France 
l Department of Endocrinology, Diabetology, Metabolic Diseases and Nutrition, Nancy University Hospital, 54500 Vandœuvre-lès-Nancy, France 
m Department of Endocrinology and Diabetology, Rennes University Hospital, 35200 Rennes, France 
n Diabetes LAB, French Diabetes Federation, 75011 Paris, France 
o Department of Endocrinology and Diabetology, Strasbourg University Hospital, 67091 Strasbourg, France 
p Department of Endocrinology and Diabetology, Caen University Hospital, 14033 Caen, France 
q Department of Diabetology, Toulouse University Hospital, 31400 Toulouse, France 
r Department of Endocrinology, Lille University Hospital, 59000 Lille, France 
s Point Medical, Dijon Dijon, France 
t Department of Diabetes and Endocrinology, Lariboisière Hospital, University Paris 7, AP–HP, 75475 Paris, France 
u Department of Endocrinology, Diabetes and Metabolic Diseases, Dijon University Hospital, 21000 Dijon, France 
v Department of Diabetes, Cochin Hospital, AP–HP, 75014 Paris, France 
w Department of Diabetes, Valencienne General Hospital, 59300 Valencienne, France 

Corresponding authorDepartment of Endocrinology, Nutrition and Diabetes, hôpital Jean-Minjoz, 3, boulevard Fleming, 25030 Besancon cedex France

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Abstract

The use by diabetes patients of real-time continuous interstitial glucose monitoring (CGM) or the FreeStyle Libre® (FSL) flash glucose monitoring (FGM) system is becoming widespread and has changed diabetic practice. The working group bringing together a number of French experts has proposed the present practical consensus. Training of professionals and patient education are crucial for the success of CGM. Also, institutional recommendations must pay particular attention to the indications for and reimbursement of CGM devices in populations at risk of hypoglycaemia. The rules of good practice for CGM are the precursors of those that need to be enacted, given the oncoming emergence of artificial pancreas devices. It is necessary to have software combining user-friendliness, multiplatform usage and average glucose profile (AGP) presentation, while integrating glucose and insulin data as well as events. Expression of CGM data must strive for standardization that facilitates patient phenotyping and their follow-up, while integrating indicators of variability. The introduction of CGM involves a transformation of treatment support, rendering it longer and more complex as it also includes specific educational and technical dimensions. This complexity must be taken into account in discussions of organization of diabetes care.

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Keywords : Continuous glucose monitoring, Flash glucose monitoring, Guidelines, Patient education, Subcutaneous insulin infusion, Type 1 diabetes, Type 2 diabetes

Abbreviations : AGP, AJD, CGM, CODEHG, CNP-EDMM, CV, EVADIAC, FFD, FGM, FSL, IG, IQR, PLGS, TLGS, SFD, SFE, SMBG, T1D, T2D, TIR


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Vol 44 - N° 1

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