Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
    • Articles by Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
    • Media Kit
  • Conversations with Leaders
  • Conference Coverage
    • Kidney Week 2024
    • CHEST 2024
    • ACR Convergence 2023
    • Kidney Week 2023
    • ObesityWeek 2023
    • IDWeek 2023
    • CHEST 2023
    • MDS 2023
    • IAS 2023
    • ACP 2023
    • AAN 2023
    • ACC / WCC 2023
    • AAAAI Meeting 2023
    • ACR Convergence 2022
    • Kidney Week 2022
    • AIDS 2022
  • Other Publications
    • www.clevelandclinic.org

User menu

  • Register
  • Log in

Search

  • Advanced search
Cleveland Clinic Journal of Medicine
  • Other Publications
    • www.clevelandclinic.org
  • Register
  • Log in
Cleveland Clinic Journal of Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
    • Articles by Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
    • Media Kit
  • Conversations with Leaders
  • Conference Coverage
    • Kidney Week 2024
    • CHEST 2024
    • ACR Convergence 2023
    • Kidney Week 2023
    • ObesityWeek 2023
    • IDWeek 2023
    • CHEST 2023
    • MDS 2023
    • IAS 2023
    • ACP 2023
    • AAN 2023
    • ACC / WCC 2023
    • AAAAI Meeting 2023
    • ACR Convergence 2022
    • Kidney Week 2022
    • AIDS 2022
From the Editor

Continuous glucose monitoring: High-tech devices still need some low-tech backup

Brian F. Mandell, MD, PhD
Cleveland Clinic Journal of Medicine October 2024, 91 (10) 585-586; DOI: https://doi.org/10.3949/ccjm.91b.10024
Brian F. Mandell
Roles: Editor in Chief
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Find this author on Cleveland Clinic
  • Article
  • Info & Metrics
  • PDF
Loading

Embedded Image

It doesn’t take a lot of reflection to appreciate the dramatic effect that technology has played in reshaping our day-to-day behaviors. We carry computers in our pockets that can answer our verbalized questions that range from grocery store hours to the impact of MTHFR polymorphisms on the risk of developing psychiatric disorders. We don’t need to carry change to use a “pay phone” to make an emergency call, and certainly don’t need to consult a map or stop at a gas station to ask for directions (which of course many of us carrying the Y chromosome rarely did anyway).

But what happens when technology fails us—our phone battery dies and there is no available charger, or we enter the twilight zone where there is no signal? Without my phone, navigating beyond my home and work neighborhoods often becomes a challenge. I need to consciously think through potential driving routes, and I rarely can rely on visual clues because when I drive now I respond instead to the audible instructions issued in an Australian accent by my phone-based GPS app while focusing on the car in front of me. As inconvenient and potentially embarrassing as phone failures may be, they are not health-threatening, while failures of medical technologies that many of us increasingly rely upon on a day-to-day basis can be. And what if we don’t recognize that our health monitoring device has not completely “failed,” but is malfunctioning and is providing us with inaccurate data?

I recently got a phone call from my brother-in-law about his blood glucose “numbers.” When he is not playing tennis, he works as a consultant for various companies analyzing large data sets. He has late-onset autoimmune diabetes for which he takes a cocktail of insulins and other medications, keeping his hemoglobin A1c around 6%. He called to discuss his suddenly out-of-control glucose “numbers,” which included an early-morning value around 300 mg/dL that was not the result of a midnight Twinkie break. He had no symptoms (or monitor-reported glucose values) to suggest that these reflected a Somogyi effect, and, other than having been playing tennis outside in temperatures hovering in the high-90°F range, he had no reason to suspect a cognitive, behavioral, or systemic problem that might explain the hyperglycemia. A short chat and the mutual recognition that the “numbers” had not changed as they should have with an extra self-administered dose of short-acting insulin and a brisk walk led to him finding a lancet and test strip and discovering that his actual blood sugar was under 100 mg/dL. This was a sensor malfunction, not a primary medical issue.

Written instructions that come with the sensor and clinical practice guidelines recommend checking a fingerstick capillary glucose level when the monitor reports glucose values that don’t jibe with symptoms or expectations. Even so, we wondered out loud how often this happens, and what might be the repercussions to someone busy with life activities who, with trust in their previously well-functioning technology, repeats their initial insulin bolus in response to an apparent glucose of 300 mg/dL with a rising trend, which markedly drops their actual already normal blood glucose (potentially clouding their judgment), before considering a device malfunction.

The benefits of continuously collected and reported (in almost real time) interstitial glucose levels are many, as highlighted by Martens et al1 in this issue of the Journal. Before my brother-in-law started using a monitor, he less often met his hemoglobin A1c target. But glucose monitoring device malfunctions and disruptions are not rare events. In a survey study (N = 99) that asked patients with diabetes who used glucose monitoring devices about adverse events due to monitor “disruption,” hyperglycemia occurred 4 times or more in 37% of the surveyed patients.2 Reported identified causes for monitor inaccuracy include poor insertion, poor adhesion, and local inflammation or infection.3

Thus, it is not a bad idea to regularly remind our patients, even the most astute ones, as they become increasingly reliant on high-end devices to monitor their physiology (glucose, blood pressure, heart rhythm, oxygen saturation), that their devices are not without occasional glitches, and they should be prepared to use a low-end backup monitoring alternative or have the “numbers” validated in a healthcare facility when the numbers go awry without obvious explanation.

  • Copyright © 2024 The Cleveland Clinic Foundation. All Rights Reserved.

References

  1. ↵
    1. Martens TW,
    2. Simonson GD,
    3. Bergenstal RM
    . Using continuous glucose monitoring data in daily clinical practice. Cleve Clin J Med 2024; 91(10):611–620. doi:10.3949/ccjm.91a.23090
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Markov AM,
    2. Krutilova P,
    3. Cedeno AE,
    4. McGill JB,
    5. McKee AM
    . Interruption of continuous glucose monitoring: frequency and adverse consequences. J Diabetes Sci Technol 2024; 18(5):1096–1101. doi:10.1177/19322968231156572
    OpenUrlCrossRef
  3. ↵
    1. Herrod SS,
    2. Liversedge G,
    3. Vaidya B,
    4. Walker N
    . Continuous glucose monitoring for diabetes: potential pitfalls for the general physician. Clin Med (Lond) 2022; 22(5):482–484. doi:10.7861/CM-2022-0199.R1
    OpenUrlCrossRef
PreviousNext
Back to top

In this issue

Cleveland Clinic Journal of Medicine: 91 (10)
Cleveland Clinic Journal of Medicine
Vol. 91, Issue 10
1 Oct 2024
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Cleveland Clinic Journal of Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Continuous glucose monitoring: High-tech devices still need some low-tech backup
(Your Name) has sent you a message from Cleveland Clinic Journal of Medicine
(Your Name) thought you would like to see the Cleveland Clinic Journal of Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Continuous glucose monitoring: High-tech devices still need some low-tech backup
Brian F. Mandell
Cleveland Clinic Journal of Medicine Oct 2024, 91 (10) 585-586; DOI: 10.3949/ccjm.91b.10024

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Continuous glucose monitoring: High-tech devices still need some low-tech backup
Brian F. Mandell
Cleveland Clinic Journal of Medicine Oct 2024, 91 (10) 585-586; DOI: 10.3949/ccjm.91b.10024
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Linkedin Share Button

Jump to section

  • Article
    • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • The gift of lasting immunity
  • Psychedelics in the medical toolbox?
  • All sulfa drugs are not created equal
Show more From the Editor

Similar Articles

Subjects

  • Diabetes
  • Endocrinology

Navigate

  • Current Issue
  • Past Issues
  • Supplements
  • Article Type
  • Specialty
  • CME/MOC Articles
  • CME/MOC Calendar
  • Media Kit

Authors & Reviewers

  • Manuscript Submission
  • Authors & Reviewers
  • Subscriptions
  • About CCJM
  • Contact Us
  • Cleveland Clinic Center for Continuing Education
  • Consult QD

Share your suggestions!

Copyright © 2025 The Cleveland Clinic Foundation. All rights reserved. The information provided is for educational purposes only. Use of this website is subject to the website terms of use and privacy policy. 

Powered by HighWire