In this exclusive MedPage Today video, Steven Nissen, MD, of the Cleveland Clinic, joined us at the recent American College of Cardiology meeting in New Orleans to share his excitement for the potential of continuous glucose monitoring as a method for reducing cardiovascular risk.
Following is a transcript of his remarks:
I’m personally very excited about continuous glucose monitoring, and I’m particularly excited that we’re now seeing the first of a generation of closed-loop systems where there’s actually an adjustment of insulin dosage based upon real-time data with respect to blood glucose. We’ve waited for decades for this to mature and there are several things to think about. One is that hypoglycemic episodes are not good for people, and the problem with giving insulin based upon intermittent finger-stick glucoses is that you never know exactly at any given point in time what you’re actually doing. You don’t know in the middle of the night, for example, whether or not someone is getting a very low blood sugar.
There’s lots of reasons to believe that hypoglycemic episodes have adverse cardiovascular consequences. What happens when blood sugar goes low and the response is an adrenaline surge. Those surges in adrenaline raise heart rate. They raise blood pressure. They do a lot of other things that may have adverse effects on the cardiovascular system. Smoothing out those extreme oscillations in blood sugar in insulin-dependent diabetics has the potential to yield a reduction in adverse cardiovascular outcomes, but it needs to be studied.
One of the challenges we have in medicine is that the device industry doesn’t like to do big, complicated, and expensive trials for a variety of reasons that, again, are off topic, but can we get a … I mean, if you look at the diabetes trials now underway, some of them are more than 10,000 patients. I don’t think we would have an easy time getting funded a 10,000-patient study of continuous glucose monitoring as a means to lower cardiovascular risk, but it should be done because it has a lot of potential. It is a more physiological way to deliver insulin based upon continuous measurements. It’s not perfect, but it is a huge step in the right direction.