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.

David C. Klonoffat al, Continuous Glucose Monitoring: An Endocrine Society Clinical Practice Guideline, JCEM 96 (10): 2968

J Hans DeVries  Continuous glucose monitoring: coming of age? Eur J Endocrinol 2012 166: 1-4

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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 efects and to titrate to an appropraite 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. ”

Cavalcante JL, Khan S, Gheorghiade M EVEREST study: Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan. Expert Review of Cardiovascular Therapy 2008 Nov;6(10):1331-8

Madias NE Effects of tolvaptan, an oral vasopressin V2 receptor antagonist, in hyponatremia. American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation 2007 Aug;50(2):184-7

Miyazaki T, Fujiki H, Yamamura Y, Nakamura S, Mori T Tolvaptan, an orally active vasopressin V(2)-receptor antagonist – pharmacology and clinical trials. Cardiovascular Drug Reviews 2007 Spring;25(1):1-13

Konstam MA, Gheorghiade M, Burnett JC Jr, Grinfeld L, Maggioni AP, Swedberg K, Udelson JE, Zannad F, Cook T, Ouyang J, Zimmer C, Orlandi C; Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) Investigators Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA : the journal of the American Medical Association 2007 Mar 28;297(12):1319-31

Read the Layperson version here.