Dr. Francine Kaufman on CGM, presented live on TuDiabetes.com

1. The Use and Future Use of
Continuous Glucose Monitoring
Francine Ratner Kaufman, M.D.
Distinguished Professor Emerita of Pediatrics and Communications,
The Keck School of Medicine of the University of Southern California
Center for Diabetes and Endocrinology, Children’s Hospital Los Angeles
Chief Medical Officer of Medtronic Diabetes
Los Angeles, CA
•Medtronic
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2. Meet Dr. Kaufman
To register for a free copy of Insulin
Pumps and Continuous Glucose
Monitoring: A User’s Guide to
Diabetes Management, visit:
http://info.medtronicdiabetes.com/
2013-tudiabetes.html
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3. CGM Completes the Picture
Fingerstick A1C
Testing
CGM
Today’s diabetes management requires comprehensive
understanding of glucose control. •Medtronic
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4. More Information – MORE DATA
with Continuous Glucose Monitoring
NUMBER OF
CONTINUOUS
GLUCOSE
READINGS PER
105,120 YEAR
(288 per day x 365
days)
NUMBER OF FINGERSTICK
MEASUREMENTS PER
1,460 YEAR
(4 per day x 365 days) •Medtronic
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5. Continuous Glucose Monitoring Technology: Personal Use
Personal CGM
Paradigm and Guardian
• For use by people with insulin-dependent
diabetes
• Real time displays of glucose values and
trend graphs Allows You to Proactively
• Retrospective data through CareLink
Respond to Changes in
Your Glucose Levels to
Improve Control
Real time CGM reveals fluctuations in your glucose levels that you can’t
see through A1C tests alone*. •Medtronic
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Levetan C, et al. Diabetes Care 2003; 26:1-8 Diabetes

6. Site Differences in Glucose Testing:
Interstitial Versus Capillary
Meter Sensor mirrors its
Sensor and meter are
reading to match
testing at different
meter: a process called
Sensor sites
calibration
Skin
Interstitial Space
Cells
Capillary
Medtronic illustration: not to scale.
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7. Continuous Glucose Monitoring Technology
Glucose sensor readings
300 every 5 minutes (288/day)
REAL-Time Trend Graphs
reveal glucose patterns over
time
Glucose – mg/dL
200
REAL-Time Trend Arrows
show the direction and rate
of glucose level changes
100 Target REAL-Time Alerts can be
Zone customized to let people
with diabetes know when
they are out of range.
0 Offer’s three layers of
protection:
– Rate-of-Change Alerts
3AM 6AM 9AM 12PM 3PM 6PM 9PM
– Predictive Alerts
Time of Day
– Low and High Alerts
•Medtronic
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* Levetan C, et al. Diabetes Care 2003; 26:1-8 Diabetes

8. Personal CGM Alerts Patients to Intervene to
Avoid Dangerous High and Low Blood Glucose
Fewer highs = less complications
Alert Alert
Alert
Fewer lows = less accidents, coma, death
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9. Medtronic CareLink™ Personal Reports
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10. Safety and Comfort: Key Concepts for Success
Most important for success.
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11. Step 1: Set Low Sensor Glucose Alert
Low SG Alert ONLY
High SG Alert is OFF
60
Alert sounds when Sensor
Glucose is 60 mg/dl
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12. Step 2: Set High Sensor Glucose Alert
Turn on High SG Alert
300
60
•Range between High and Low Alerts
is WIDE.
•Focus on safety, while learning how
to understand CGM trends.
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13. Step 3: Tighten the Sensor Glucose Alerts
Low SG Alert is 70 mg/dl
High SG Alert is 250 mg/dl
250
70
• High and Low Sensor Glucose Alert
thresholds are now closer to target
range.
• Adjust based on individual needs.
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14. Step #4: Add High and Low Predictive Alerts
Predictive Alerts occur
BEFORE the threshold.
250
70
• Optional Alert setting.
1:33P HIGH
PREDICTED • Start with 10 minutes
for Predictive
Alerts, then adjust as
needed. •Medtronic
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15. Integrated Insulin Pump with Built-In CGM is the Platform
Upon Which the Artificial Pancreas Will Be Built
A All Subjects 204
MDI MDI
8.5
216
SAPSAP
*
* 8.1% *
* 8.0% 8.0%
7.9%
8.0
A1C (%)
†
** †
**
7.6%
7.6%
7.4% 7.4% 7.4%
7.5
7.3%
7.5% 7.5%
Study Phase Continuation Phase
7.0
0 3 6 9 12 15 18
Month
•Medtronic
*, P<0.001 for between-groups comparison; †, P<0.001 and ‡, P<0.05 for within-group
comparison using the crossover group’s 12-month A1C value as the comparator.
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16. Next Step: Threshold Suspend Automation
How it Works:
• User settable: On/Off 200
• Threshold range: 60 - 90 mg/dL
Sensor Glucose Values
160
• Suspends at threshold for 2
hours 120 Resumes after 2 hours
• During suspend:
80
• Patient can resume insulin
delivery at any time
40
• No bolus ability
• If sensor glucose value is below 0
threshold at 4 hrs after 30 90 150 210
resume, pump re-suspends Minutes
insulin delivery
•Medtronic
Not approved in the U.S. Currently under FDA review.
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17. The Steps to the Artificial Pancreas
Combines hardware, software and algorithms to shift control
from patient and lessen variability of glucose
Treat to Range
Closed Loop
Out of Range
Closed Loop
Closed Loop
at Night
Threshold Suspend
Automation
•Medtronic
Predicted Low Glucose
Future Product Concepts Not approved in the U.S.
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18. And Around the World – What are we doing?
Kazakhstan
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19. And Around the World – What are we doing?
Haiti
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20. •Medtronic
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21. Conclusions
Integrated Insulin Pump with Built-In CGM
– Providing a wealth of data and personalized alerts and alarms
can help you prevent dangerous highs and lows
The Iterative Steps to the Artificial Pancreas
– CGM is the foundation upon which the artificial pancreas will be
built
– Medtronic is taking iterative steps of automation to work toward
the ultimate goal of bringing to market a fully automated artificial
pancreas
Advocating for the Global Diabetes Community
– We can help by contributing our time, money and talents to
organizations that work to improve education, understanding
and resources for people living with diabetes around the globe
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22. Questions????
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