CGM systems are more expensive than conventional glucose monitoring, but they may enable better glucose control. CGM devices produced by Abbott, DexCom, and Medtronic have been approved by the U.S. Food and Drug Administration (FDA) and are available by prescription. These devices provide real-time measurements of glucose levels, with glucose levels displayed at 5-minute or 1-minute intervals. Users can set alarms to alert them when glucose levels are too low or too high. The Endocrine Society recommends that adults with T1DM and HbA1c levels less than 7.0% should use RT-CGM devices if they can use them on a nearly daily basis. It also says: “Pediatric, adolescent, and adult outpatients with T1DM and HbA1c levels of 7.0% or more should use RT-CGM if they are able to use these devices on a nearly daily basis.” It did not recommend the use of these devices in acute care settings.

When comments on this guideline appeared, the issue of training of patients and providers in this fairly complex management system had come up. There remain concerns that training may not be adequate and that using these devices in patients who are not fully committed may decrease their effectiveness.

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SAMSCA should be initiated and re-initiated in patients only in a hospital where serum sodium can be monitored closely. This allows observing for side effects and to titrate to an appropriate dose. The FDA aproved Prescribing information says: “The usual starting dose for SAMSCA is 15 mg administered once daily without regard to meals. Increase the dose to 30 mg once daily, after at least 24 hours, to a maximum of 60 mg once daily, as needed to achieve the desired level of serum sodium. ”

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