Category: Health

Continuous glucose control

Continuous glucose control

Continuous Glucose Monitoring System Gold Long sensor life Avoids arm implantation Coninuous product on the market and used in the Clntinuous studies GlucoWatch G2 Biographer Continuous glucose control Real-time readings Alarm for Continuous glucose control values Conhinuous Telemetered Glucose Monitoring System Long sensor Continuous glucose control Water weight reduction program for out-of-range values Avoids Contibuous implantation GlucoDay Real-time readings Infrequent calibrations Choice of retrospective or real-time data Pendra Noninvasive No skin irritation Measures glucose in blood and not in interstitial fluid FreeStyle Navigator Continuous Glucose Monitor Long sensor life Alarm for out-of-range values Avoids abdominal wall implantation. Sierra JA, Shah M, Gill MS, et al. c Follow-up data maintained during period 2 of the study. Choose a Supplier: Medicare covers CGM through the durable medical equipment DME benefit, not through the pharmacy benefit. Administrators will need to understand the challenges of treating diabetes and the benefits of CGM.

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CRISPR Therapeutics CTX211 and why CRSP now has an advantage with this therapy.

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All therapy adjustments should be based on measurements obtained from standard blood glucose monitoring devices and not on values provided by the system. Statement by the American Association of Clinical Endocrinologists Consensus Panel on insulin pump management. Endocr Pract.

For a list of compatible devices, refer to user guide. The system is intended to complement, not replace, information obtained from standard blood glucose monitoring devices, and is not recommended for people who are unwilling or unable to perform a minimum of two meter blood glucose tests per day, or for people who are unable or unwilling to maintain contact with their healthcare professional.

The system requires a functioning mobile electronic device with correct settings. If the mobile device is not set up or used correctly, you may not receive sensor glucose information or alerts.

The system requires a prescription from a healthcare professional. The sensor is intended for single use and requires a prescription.

WARNING: Do not use SG values to make treatment decisions, including delivering a bolus, while the pump is in Manual Mode. However, if your symptoms do not match the SG value, use a BG meter to confirm the SG value.

Failure to confirm glucose levels when your symptoms do not match the SG value can result in the infusion of too much or too little insulin, which may cause hypoglycemia or hyperglycemia. Pump therapy is not recommended for people whose vision or hearing does not allow for the recognition of pump signals, alerts, or alarms.

En Español. Continuous glucose monitoring Continuous glucose monitoring CGM gives you a more complete picture of your glucose levels, which can lead to better lifestyle decisions and better glucose control.

Get started. What is CGM? Predictive alerts - taking action sooner 1. What are the benefits of CGM? See how much more it can do as part of a system. CGM device systems By connecting the CGM to a smart insulin pen or insulin pump, you allow technology to help do more of the thinking, remembering, and acting, when it comes to managing diabetes.

CGM with Smart Insulin Injection System For people who manage their diabetes with injections, the smart insulin injection system can help reduce the physical and mental effort required to manage diabetes.

With a smart insulin injection system, you get: Insulin tracking and dose reminders Dosing recommendations Actionable glucose alerts Learn more. We never want cost to be a barrier to getting diabetes technology. We have CGM access discounts and programs to help get you started!

Learn more ». Talk to a diabetes therapy consultant To request a free insurance coverage check and learn more about your eligibility and potential out-of-pocket costs, please complete the form below or calland one of our Diabetes Therapy consultants will be happy to assist you.

How is diabetes managed? How long have you owned your Medtronic pump? Less than 4 years More than 4 years. Reason for not using an insulin pump? Please Specify Which Pump. First name. Last name. ZIP code. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe.

Leave this field blank. Diabetes type? Type 1 diabetes Type 2 diabetes Unsure. Who is living with diabetes? Myself My Child A Family Member My Friend My Patient Other. Primary insurance type?

Subscribe to our newsletter, News to Infuse. Standalone CGM Financial support programs.

: Continuous glucose control

What is a CGM?

Using the theory of sequential tests, the analysis of the primary variable HbA 1c and the secondary variables mean glucose levels, mean amplitude of glycemic excursions, standard deviation of glucose levels, Diabetes Treatment Satisfaction Questionnaire status and change versions, and WHO-5 Well-Being Index were considered confirmatory.

Other secondary end points were not tested, and descriptive data for these variables are shown in eTable 3 in Supplement 2. Overall mean time of CGM use, estimated by the proportion of CGM data downloaded in relation to follow-up time, was CGM use ranged between HbA 1c was reduced by 0.

Patients performed a mean SD of 2. There were 19 patients Patient characteristics are shown in eTable 2 in Supplement 2. These patients were younger In the first treatment period, 16 of these 19 patients had follow-up data of the primary effect variable HbA 1c.

There were 5 events of severe hypoglycemia during conventional treatment event rate, 0. There were 7 severe hypoglycemia events during the washout period when patients were undergoing conventional therapy event rate, 0.

In total, there were 77 patients with adverse events during CGM and 67 patients with adverse events during conventional therapy eTable 4 in Supplement 2. There were no obvious numerical differences for any adverse event between the treatments.

One patient in the CGM group discontinued use because of an allergic reaction to the sensor. There were 7 patients with a total of 9 serious adverse events during CGM treatment and 3 patients with total of 9 serious adverse events during conventional treatment eTable 5 in Supplement 2.

Ketoacidosis was not reported during the study. The second sensitivity analysis of primary outcome adjusted for the site effect and interaction between site and treatment showed an HbA 1c reduction of 0.

The weight at the end of conventional therapy was In this crossover study of persons with type 1 diabetes treated with multiple daily insulin injections, CGM was associated with a mean HbA 1c level that was 0. Moreover, glycemic variability was reduced by CGM. Subjective well-being and treatment satisfaction were greater during CGM than conventional therapy.

The population evaluated in the current study differs to a great extent from earlier clinical trials of CGM.

In contrast to earlier trials, the current study had no upper limit of HbA 1c for inclusion, which includes the group of patients with the greatest excess mortality 27 , 28 and the highest risk of diabetic complications since an exponential relationship exists between higher HbA 1c levels and diabetic complications.

Baseline HbA 1c was also high 8. Also in contrast to earlier CGM-studies, 7 - 10 , 25 , 26 the current trial had no limit on the number of self-measurement of blood glucose patients were required to perform for inclusion. Patients who do not perform self-measurement of blood glucose regularly have higher HbA 1c levels.

Hence, evaluating alternative glucose monitoring strategies for these patients is also important. In the present study, patients performed self-measurement of blood glucose less during CGM than conventional therapy 2. When used in connection with an insulin pump, CGM may ease adjusting insulin doses with respect to observed CGM patterns.

In accordance with earlier findings, 9 these results also suggest that the effectiveness of CGM depends on uninterrupted use during multiple daily insulin injections treatment.

Our study increases knowledge in the field of type 1 diabetes in reporting that CGM may be a beneficial option for multiple daily insulin injections—treated patients with respect to HbA 1c levels.

A novel feature of this trial is a more comprehensive investigation of psychosocial variables, which are now recognized as a high priority in clinical diabetes guidelines. The positive effect on well-being is consistent with previous studies that have shown a significant effect due to CGM on the physical component subscale of the SF Short Form Health Survey.

Indeed, less time in hypoglycemia is known to be associated with better quality of life 33 , 34 and a lower risk of severe hypoglycemia. Of note from a safety perspective, there were numerically more severe hypoglycemic episodes 5 vs 1 during conventional compared with CGM therapy.

In addition, 7 severe hypoglycemia events occurred during the washout period of 4 months when patients used conventional therapy. This study had a number of limitations. First, 19 patients approximately Generally, in a parallel-group study, this can lead to an imbalance between groups. However, in the current study, patients served as their own controls and thus no such problem existed.

It has therefore been proposed that the full analysis set population should be used in crossover studies as the main analysis. Sixteen of the 19 patients who had no follow-up data in the second treatment period had HbA 1c data during the first follow-up period.

Among these patients, those with CGM had a 1. There were more patients treated with CGM than conventional therapy who discontinued treatment during the first treatment period. This was due to patients wanting to continue CGM and therefore not completing the study while receiving conventional therapy in the second period and also due to patients experiencing device-related problems Figure 1.

A second limitation is that the study could not be blinded and hence patients were aware of the intervention. It cannot be excluded that this, to some extent, could have influenced the treatment effect.

Although the current reduction in HbA 1c may be clinically important, other treatment alternatives are needed for persons with type 1 diabetes to obtain good glycemic control on a broad level.

In addition, the current results are restricted to patients with HbA 1c of at least 7. Among patients with inadequately controlled type 1 diabetes treated with multiple daily insulin injections, the use of CGM compared with conventional treatment for 26 weeks resulted in lower HbA 1c.

Corresponding Author: Marcus Lind, MD, PhD, Diabetes Outpatient Clinic, Uddevalla Hospital, 80 Uddevalla, Sweden lind.

marcus telia. Correction: This article was fixed for an incorrect unit of measure on May 9, Author Contributions: Dr Lind had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Critical revision of the manuscript for important intellectual content: All authors. Administrative, technical, or material support: Lind, Dahlqvist, Ólafsdóttir, Ahlén, Nyström, Hellman. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Dr Lind reports receipt of grants from AstraZeneca, Dexcom, and Novo Nordisk; consulting and receipt of honoraria from Novo Nordisk and Rubin Medical; and lecturing for Eli Lilly, AstraZeneca, Novo Nordisk, Medtronic, and Rubin Medical.

Dr Polonsky reports consulting for Dexcom and Abbott Diabetes Care. Dr Hirsch reports consulting for Abbott Diabetes Care, Roche, and Intarcia. He also reports receipt of personal fees from Eli Lilly, Mylan, and Novo Nordisk.

Dr Bolinder reports serving on advisory boards for Abbott Diabetes Care, Insulet, Integrity Applications, Novo Nordisk, and Sanofi; lecturing for Abbott Diabetes Care, AstraZeneca, Novo Nordisk, and Sanofi.

Dr Hellman reports served on advisory boards for Sanofi, Eli Lilly, Merck, Jensen Cilag, Novo Nordisk, AstraZeneca, Dexcom, and Abbott; lecturing for Sanofi, Boehringer Ingelheim, Eli Lilly, Merck, Novo Nordisk and AstraZeneca.

No other disclosures were reported. The NU Hospital Group received financial support for the current trial and CGM systems and sensors from Dexcom Inc. Additional Contributions: Steering committee: Lind primary investigator , Polonsky, Hirsch, Heise, Bolinder, and Dahlqvist.

We thank all participating sites for covering costs of the study, including salaries for participating personnel. We thank Nils-Gunnar Pehrsson, BA, Aldina Pivodic, MSc, Cecilia Kjellman, MSc, Mattias Molin, BSc, and Anders Pehrsson, MSc, at the Statistiska konsultgruppen for assistance in statistical calculations.

Statistiska konsultgruppen was paid for its work. We also thank Joseph W. Murphy, JD, for language editing, who was compensated for his work. full text icon Full Text. Download PDF Top of Article Key Points Abstract Introduction Methods Results Discussion Conclusions Article Information References.

Figure 1. Screening, Randomization, and Analysis for Continuous Glucose Monitoring and Conventional Treatment Groups. View Large Download. CGM indicates continuous glucose monitoring. b Patient had no follow-up data reported during period 2 of the study.

c Follow-up data maintained during period 2 of the study. Figure 2. HbA 1c Values at Inclusion, Randomization, and During the 2 Different Periods of Treatment. Table 1. Clinical Characteristics of the Full Analysis Set Population at Baseline and Randomization a. Table 2. Clinical and Questionnaire Data at Run-in Visit a.

Table 3. Primary and Secondary End Points. Supplement 1. Protocol and Amendments GOLD Study. Supplement 2.

Randomization eTable 1. Adherence for CGM Treatment Group Safety Population eTable 2. Difference Between FAS Population and Excluded Patients With Respect to Baseline Data All Patients eTable 3. Descriptive Data for Secondary End Points FAS Population eTable 4.

Adverse Events, by System Organ Class and Preferred Term Safety Population eTable 5. Supplement 3. Statistical Analysis Plan GOLD Study.

The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.

N Engl J Med. PubMed Google Scholar Crossref. Misso ML, Egberts KJ, Page M, et al. Continuous subcutaneous insulin infusion CSII versus multiple insulin injections for type 1 diabetes mellitus.

Cochrane Database Syst Rev. PubMed Google Scholar. Hansen MV, Pedersen-Bjergaard U, Heller SR, et al. Frequency and motives of blood glucose self-monitoring in type 1 diabetes. Diabetes Res Clin Pract.

Miller KM, Beck RW, Bergenstal RM, et al; T1D Exchange Clinic Network. Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A 1c levels in T1D exchange clinic registry participants.

Diabetes Care. Evans JM, Newton RW, Ruta DA, et al. Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database. However, the study wasn't published in a peer-reviewed medical journal, it lacked details that would allow critical evaluation, and it examined what seem to be arbitrary ranges of blood sugar values, not actual health outcomes such as heart disease, nerve damage, or hospitalizations.

So, until more studies prove the value of CGM for people without diabetes, we won't know whether the cost and time it takes to implant one of these systems is accomplishing anything, or is just the latest health monitoring fad wasting effort and money. Speaking of cost, CGMs aren't cheap: they can cost several thousand dollars a year.

And it's highly unlikely that health insurers will cover CGMs for people without diabetes, at least until there is compelling evidence that they're actually helpful. For people with diabetes, a major goal of therapy is to keep the blood sugar close to the normal range. This helps to prevent symptoms and complications, prolong life, and improve quality of life.

The development of CGM devices that can frequently and easily monitor blood sugar levels without finger sticks has revolutionized care for millions of people with diabetes.

Besides providing results of blood sugar levels, some devices have alarm settings that alert the user, or other people, if blood sugar becomes dangerously low or high. And some systems can transmit results directly to the user's doctor, if desired. So, why would a person who doesn't have diabetes want to monitor their blood sugar?

Possible reasons include. But truly, knowledge that is useless, redundant, or inaccurate doesn't make you powerful! It may even be harmful. For example, if biologically insignificant drops in blood sugar lead you to snack more "to avoid hypoglycemia" , you could gain weight and actually increase your risk of developing diabetes.

If the monitoring system sometimes provides inaccurate information or false alarms, unnecessary anxiety, calls or visits to the doctor, visits to an emergency room, and even inappropriate treatment may follow.

Unfortunately, some makers of CGM systems aren't waiting for solid research results to market these devices to healthy people. So, consumers and marketing professionals — not researchers or doctors — may wind up driving demand for the product.

For any new technology there's a scientific learning curve to figure out when to use it. In my view, we're at the very beginning of the learning curve for home monitoring of blood sugar in people without diabetes.

Before buying into what may be the next fad in health monitoring, I think we need to learn a lot more. There is wisdom in the teachings of one of my favorite professors in medical school: "Just because you can measure something doesn't mean you should. Robert H.

Shmerling, MD , Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.

Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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Sign up now and get a FREE copy of the Best Diets for Cognitive Fitness. Stay on top of latest health news from Harvard Medical School. ASPN will identity a participating pharmacy or DME supplier and forward the order information there for you. Become an Eversense provider and to pursue information on ordering.

Patients who do not meet their payer's eligibility criteria for personal CGM or those who cannot afford the full cost of obtainings a personal CGM may still be able to get and benefit from CGM. This patient handout, What if My Continuous Glucose Monitor Is Not Covered by Insurance?

Click here for the Spanish version. The information in your chart notes should reflect why you feel that CGM is appropriate for your patient.

This may be especially helpful if pursuing low or no copay options like patient assistance programs that may require your explanation of why you recommend CGM. There are various options for limiting patient out-of-pocket costs associated with CGM.

Some of these include manufacturer-based samples, vouchers, copay reduction programs, and patient assistance programs. Some of these resources are listed here:. Professional CGM can be extremely useful when personal CGM is not likely to be covered by insurance e. While personal CGM belongs to the patient, Professional CGM is owned by the practice and used by a given patient on a short-term basis.

A practice can obtain a professional CGM system and sensors by purchase through the manufacturer or a supplier. Each of the manufacturers of professional CGM systems has useful information to describe and demonstrate application.

Here too, each of the manufacturers of professional CGM systems has useful information to explain and demonstrate what you need to get the data. There are two CPT codes can be used to bill and seek payment for Professional CGM related services:.

For Federally Qualified Health Centers and Rural Health Clinicss, where traditional fee-for-service billing would not support payment for Professional CGM, diabetes-related grant programs can be used to purchase Professional CGM systems and sensors to help defray the equipment costs.

Local Medicare payment rates and requirements may vary; check with your local Medicare administrative contractor for local requirements. Check with your local provider relations representatives for their policies.

Verify coverage for each patient. Supported by an educational grant to the AAFP from Abbott Diabetes Care. search close.

Continuous Glucose Monitoring CGM. If you have tried prescribing CGM in the past, but found navigating coverage and prior authorizations difficult, these additional resources outline processes, forms, and documentation for successfully ordering CGM.

CGM in Your Practice: Helpful Videos. CGM in Your Practice: Implicit Bias Learn about factors that might influence your decision to pursue CGM with a patient and how to ensure you are providing equitable care around CGM. CGM in Your Practice: Shared Decision Making in Interpreting CGM Data with Patients Understand key measures from CGM data and how to use shared decision making with patients to make diabetes care adjustments based on CGM data.

Get Started with CGM CGM patient handouts are available in English and Spanish to support your conversations. Patient education videos are available on Familydoctor.

If you and your patient decide to pursue professional CGM, start here. If you and your patient decide to start personal CGM, determine the type of coverage the patient has. It can be helpful to manage patient expectations around the process of obtaining a device. You can explain that it will take more time and steps than a new prescription for a medication.

Reinforce your patient conversations with this postcard. Patient education videos are also available on familydoctor. org : Patient Experience with CGM, FAQ and Demo, and Understanding Your CGM Data.

What Type of Coverage Does the Patient Have? Medicare Coverage and Ordering for Personal CGM Medicare has eligibility requirements that must be met in order to provide coverage for personal CGM. Seen for diabetes management in past 6 months.

For continuing eligibility , all of the above must continue to be met. Gather Information for Ordering and Insurance Authorization A Prescription is Required: Many EHRs support directly prescribing CGM as you would any medication. Choose a Supplier: Medicare covers CGM through the durable medical equipment DME benefit, not through the pharmacy benefit.

Chart Notes: Some order forms also ask about frequency of glucose checks. Important Step: Schedule a telehealth or in-person diabetes follow up within 6 months of the last visit for continuing eligibility.

How to Order CGM by Brand. Abbott Freestyle Libre 2 System. Medtronic CGM. Medicaid Coverage and Ordering for Personal CGM Eligibility Medicaid coverage for for Personal CGM varies from state to state. What information is needed as part of Prior Authorization? What other coverage criteria exist?

Minimum number of insulin doses per day? Gather Information for Ordering and Insurance Authorization Gather the documentation required.

This usually includes: A Prescription: Many EHRs support directly prescribing them as you would any medication.

Breadcrumb The glucose level in the blood sample is measured with a glucose meter. You should bring your meter, phone, or paper record with you each time you visit your health care provider. Kovatchev BP, Cox DJ, Farhy LS, et al. Fast alle gesetzlichen Krankenkassen übernehmen bereits die Kosten für FreeStyle Libre 3! Armed with that knowledge, you can make adjustments and get closer to your target range more often. Send an electronic prescription from your EHR to ASPN Pharmacies. Write in the medications patients take and note the timing of insulin doses.
Continuous Glucose Monitors Glucosee, with time and experience, most people Strengthen endurance for dancers how to make many of these Cohtinuous Continuous glucose control their own. And it's highly unlikely that CContinuous Continuous glucose control Continuuos cover CGMs for Continuojs without diabetes, at least until there is compelling evidence that they're actually helpful. Return the sensor to the office, and we will replace it. FreeStyle Libre Partnerships. They must wait until the data has been downloaded and analyzed by their clinician. Further studies with longer follow-up are needed to assess the effectiveness of CGM systems in the long-term and its relationship with diabetes complications.
Continuous Glucose Monitoring Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial. Pitzer KR, Desai S, Dunn T, Edelman S, Jayalakshmi Y, Kennedy J, Tamada JA, Potts RO: Detection of hypoglycemia with the GlucoWatch Biographer. What are the benefits of a continuous glucose monitor? Formulary drug information for this topic. Your health care provider or pharmacist can help you choose a meter based on your preferences as well as other factors like cost, ease of use, and accuracy; it should be one that is approved by either the International Organization for Standardization or the US Food and Drug Administration FDA. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range.
Continuous glucose control

Continuous glucose control -

Der derzeit kleinste und flachste 15 Sensor der Welt wird alle 14 Tage 2 einfach und schmerzfrei 10 zuhause angebracht. Fühlen Sie sich sicher mit minuten­genauen Glukose­werten und optionalen Alarmen, welche Sie vor einer Über- oder Unterzuckerung warnen.

Fast alle gesetzlichen Krankenkassen übernehmen bereits die Kosten für FreeStyle Libre 3! FreeStyle Libre 3 hat mit seinen zahlreichen Produktvorteilen bereits viele Menschen mit Diabetes gegenüber herkömmlichen Messverfahren BGM sowie anderen kontinuierlichen Glukosemesssystemen CGM überzeugt.

Das bedeutet mir unendlich viel. Beim herkömmlichen Blutzuckermessen wird mit einer Stechhilfe in die Fingerkuppe gestochen. Bei kontinuierlichen Glukosemesssystemen CGM , wie dem FreeStyle Libre 3 Messsystem, bringen Sie sich zuhause ganz einfach 10 alle 14 Tage 2 einen kleinen Sensor auf der Rückseite Ihres Oberarms an.

Dieser misst über ein Filament unter der Haut fortlaufend Ihre Zuckerwerte und überträgt die Werte minutengenau 3 in Ihre FreeStyle Libre 3 App oder auf Ihr FreeStyle Libre 3 Lesegerät Auf diese Weise können Sie den Verlauf Ihres Zuckerwertes sowie dessen Trend, kontinuierlich im Blick behalten.

Im Vergleich zur herkömmlichen Blutzuckermessung erhalten Sie so mehr Informationen. Der Sensor wird auf der Rückseite des Oberarms ganz einfach mithilfe eines Applikators angebracht.

Dabei wird ein dünnes, biegsames, steriles Filament direkt unter die Haut geschoben. Der Sensor selbst wird dabei mit einer Klebefolie auf der Haut fixiert.

Der Sensor kann bis zu 14 Tage 2 an der Rückseite des Oberarms getragen werden. Danach müssen Sie einen neuen Sensor anbringen. Der Sensor ist in bis zu 1m Wassertiefe für die Dauer von bis zu 30 Minuten wasserfest und kann beim Baden, Duschen, Schwimmen oder beim Sport getragen werden.

FreeStyle Libre 3 ist auf Rezept, über Einzelkauf und im praktischen Abo erhältlich. Auf der FreeStyle Libre 3 Produktseite können Sie sich über die unterschiedlichen Bestellmöglichkeiten informieren und die Bestellung durchführen. Wenn Sie als gesetzlich Versicherte:r ein Rezept bei uns einreichen , stellen wir einen Kostenübernahmeantrag bei Ihrer Krankenkasse und informieren Sie, sobald der Antrag genehmigt wurde.

Ihre Versorgung startet anschließend automatisch. Fast alle Krankenkassen übernehmen die Kosten für FreeStyle Libre 16!

Laden Sie sich jetzt die aktuelle Krankenkassenliste herunter und sehen Sie direkt nach. Übernimmt Ihre Krankenkasse die Kosten, dann können Sie Ihr Rezept bei uns einreichen. Wir kümmern uns um alles Weitere für Sie. Mit Hilfe der LibreLinkUp App können Sie Zuckerwerte mit Angehörigen teilen — für mehr Sicherheit aus der Ferne.

Mit Hilfe von LibreView 12 können Sie zudem Zuckerwerte ganz einfach und von überall direkt mit Ihrem behandelnden Praxisteam teilen — für ein optimiertes Therapiemanagement durch effizienteren Austausch mit Ihrer Praxis. Überzeugen Sie sich selbst von FreeStyle Libre 3.

Fordern Sie jetzt ganz einfach und unverbindlich Ihren Testsensor an. In 3 einfachen Schritten zu Ihrem FreeStyle Libre Messsystem — egal ob privat oder gesetzlich versichert. Neben dem FreeStyle Libre 3 Sensor und der FreeStyle Libre 3 App 11 selbst, bieten wir Ihnen weitere hilfreiche Funktionen und Lösungen an, um Ihnen das Diabetesmanagement zu erleichtern.

Mit Hilfe von LibreView 12 Glukosewerte mit den behandelnden Praxen teilen 4. Mehr erfahren. Mit Hilfe von LibreLinkUp 8 Glukosewerte mit Ihren Liebsten teilen 4,5.

Der Sensor kann bis zu 14 Tage lang getragen werden. Eine zusätzliche Prüfung der Glukosewerte mittels eines Blutzucker-Messgeräts ist erforderlich, wenn die Symptome nicht mit den Messwerten oder den Alarmen des Systems übereinstimmen.

Das Setzen eines Sensors erfordert ein Einführen des Sensorfilaments unter die Haut. Der Sensor ist 60 Minuten nach der Aktivierung für die Glukosemessung bereit. Die Übertragung der Daten zwischen den Apps erfordert eine Internetverbindung.

Das Teilen der Glukosedaten erfordert eine Registrierung bei LibreView. Es besteht die Möglichkeit, die LibreLinkUp Einladung anzunehmen und damit Benachrichtigungen und Warnhinweise zu erhalten oder diese abzulehnen.

Eine Entscheidung hierüber sollten Sie basierend auf Ihren Kenntnissen und Erfahrungen treffen, um bei dem Erhalt eines zu hohen oder zu niedrigen Glukosewerts angemessen reagieren zu können. Die Aussage basiert auf der Anzahl der Nutzer des FreeStyle Libre Messsystems weltweit im Vergleich zu der Nutzeranzahl anderer führender sensorbasierter Glukosemessysteme für den persönlichen Gebrauch.

Quelle: Daten liegen vor. Abbott Diabetes Care, Inc. Haak, Thomas, et al. Diabetes Therapy. Studie wurde mit Erwachsenen durchgeführt.

Bolinder, Jan, et al. The Lancet. Die Nutzung von LibreLinkUp erfordert eine Registrierung bei LibreView. Im Vergleich mit anderen am Körper zu tragenden Sensoren. Daten liegen vor. Abbott Diabetes Care. Die FreeStyle Libre 3 App ist nur mit bestimmten Mobilgeräten und Betriebssystemen kompatibel.

Bevor Sie die App nutzen möchten, besuchen Sie bitte die Webseite www. Continuous glucose monitoring can distinguish the two exposures, but long-term markers cannot stratify time spent above and below a particular target.

It is possible that a new measure of glycemia, derived from the duration of normal, low, and high readings, could supplement HbA 1c as an integrated measure of control. Furthermore, measurements of mean amplitude of glycemic excursions 54 , composite hypoglycemic score 62 , and lability index 62 could provide information about the tendency for a mean blood glucose level to be comprised of stable or labile data points.

For some patients, a decreased amount of glycemic instability alone, even without any improvement in HbA 1c , might represent an improved outcome. Continuous glucose monitoring offers advantages over intermittent glucose monitoring when glycemic patterns are poorly understood.

The information about direction, magnitude, duration, frequency, and causes of fluctuations in blood glucose levels that can be obtained by continuous glucose monitoring is simply not available with intermittent blood glucose monitoring. When retrospective patterns are needed to adjust therapy or document the state of physiology, CGMs are useful.

When real-time recognition of both the absolute magnitude of glycemia as well as trend patterns are needed, then a real-time CGM provides a wealth of information. Technologies for continuous glucose monitoring require patient education for proper use. During hypoglycemia or periods of rapid fluctuation, values provided by CGMs may be inaccurate.

Clinical outcome studies suggest that measures of mean glycemia and hypoglycemic burden both improve with the use of continuous glucose monitoring, but more studies are needed to convince payors to reimburse for this technology. In this data-hungry world, it appears likely that CGMs will eventually become a routine part of diabetes management, initially for patients with difficult-to-control diabetes and eventually for most patients with diabetes.

Retrospective reporting will eventually give way to real-time readings, and adjunctive use requiring a confirmatory finger-stick blood test will eventually give way to primary use without the requirement of such confirmation.

As methods for minimally invasive and noninvasive continuous monitoring advance, diabetic patients will use this technology more routinely. Data printouts from CGMs will increasingly provide a roadmap for effective diabetes management in the 21st century.

After this article was submitted for publication, an additional study was published describing the results of a multicenter, randomized, controlled trial of continuous glucose monitoring In , the DirecNet Study Group reported the results of a 6-month trial comparing GW2B use with standard glucose monitoring in type 1 diabetic subjects ages 7—18 years.

Furthermore, six additional articles were also published, following the submission of this article, describing the performance of the CGMS in type 1 diabetes 80 , type 2 diabetes 81 , pregnancy 82 , and both type 1 and type 2 diabetic patients receiving peritoneal dialysis 83 ; the GlucoDay in type 1 diabetes 84 ; and an investigational viscometric affinity sensor in type 1 diabetes Specifications of available and likely soon-to-be-available products for continuous glucose monitoring.

A table elsewhere in this issue shows conventional and Système International SI units and conversion factors for many substances. Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care.

Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Volume 28, Issue 5. Previous Article Next Article. Article Navigation. Continuous Glucose Monitoring : Roadmap for 21st century diabetes therapy David C.

Klonoff, MD, FACP David C. Klonoff, MD, FACP. From the Mills-Peninsula Health Services Diabetes Research Institute, San Mateo, California.

This Site. Google Scholar. Address correspondence and reprint requests to David C. Klonoff, MD, Mills-Peninsula Health Services Diabetes Research Institute, S. San Mateo Dr. E-mail: klonoff itsa. Diabetes Care ;28 5 — Article history Received:. Get Permissions. toolbar search Search Dropdown Menu.

toolbar search search input Search input auto suggest. Table 1— Specifications of available and likely soon-to-be-available products for continuous glucose monitoring. FDA approved. CE marked. Year first approved or marked.

Sensor type. Sensor mechanism. Sensor location. Sensor warmup h. Calibrations per lifetime of sensor. Sensor lifespan h. Frequency of testing min.

Time of blood glucose data display. Continuous Glucose Monitoring System Gold Yes Yes Minimally invasive Enzyme-tipped catheter Subcutaneous abdomen 2 12 72 5 Retrospective No GlucoWatch G2 Biographer Yes Yes Minimally invasive Reverse iontophoresis External on arm or forearm 2 1 13 10 Real time Yes Guardian Telemetered Glucose Monitoring System Yes Yes Minimally invasive Enzyme-tipped catheter Subcutaneous arm 2 12 72 5 Retrospective Yes GlucoDay No Yes Minimally invasive Microdialysis Subcutaneous abdomen 0 1 48 3 Real time or retrospective Yes Pendra No Yes Noninvasive Impedance spectroscopy External on wrist 1 20 3 months 1 Real time Yes FreeStyle Navigator Continuous Glucose Monitor No No — Minimally invasive Enzyme-tipped catheter Subcutaneous arm 1 1 72 1 Real time Yes.

View Large. Table 2— Attractive features of available and likely soon-to-be-available continuous glucose monitors. Continuous Glucose Monitoring System Gold Long sensor life Avoids arm implantation First product on the market and used in the most studies GlucoWatch G2 Biographer Needle-free Real-time readings Alarm for out-of-range values Guardian Telemetered Glucose Monitoring System Long sensor life Alarm for out-of-range values Avoids arm implantation GlucoDay Real-time readings Infrequent calibrations Choice of retrospective or real-time data Pendra Noninvasive No skin irritation Measures glucose in blood and not in interstitial fluid FreeStyle Navigator Continuous Glucose Monitor Long sensor life Alarm for out-of-range values Avoids abdominal wall implantation.

Gross TM, Bode BW, Einhorn D, Kayne DM, Reed JH, White NH, Mastrototaro JJ: Performance evaluation of the MiniMed continuous glucose monitoring system during patient home use. Diabetes Technol Ther. Potts RO, Tamada JA, Tierney MJ: Glucose monitoring by reverse iontophoresis.

Diabetes Metab Res Rev. Bode B, Gross K, Rikalo N, Schwartz S, Wahl T, Page C, Gross T, Mastrototaro J: Alarms based on real-time sensor glucose values alert patients to hypo- and hyperglycemia: the guardian continuous monitoring system. Maran A, Crepaldi C, Tiengo A, Grassi G, Vitali E, Pagano G, Bistoni S, Calabrese G, Santeusanio F, Leonetti F, Ribaudo M, Di Mario U, Annuzzi G, Genovese S, Riccardi G, Previti M, Cucinotta D, Giorgino F, Bellomo A, Giorgino R, Poscia A, Varalli M: Continuous subcutaneous glucose monitoring in diabetic patients: a multicenter analysis.

Diabetes Care. Pfuetzner A, Caduff A, Larbig M, Schrepfer T, Forst T: Impact of posture and fixation technique on impedance spectroscopy used for continuous and non-invasive glucose monitoring. Feldman B, Brazg R, Schwartz S, Weinstein R: A continuous glucose sensor based on wired enzyme technology: results from a 3-day trial in patients with type 1 diabetes.

Choleau C, Klein JC, Reach G, Aussedat B, Demaria-Pesce V, Wilson GS, Gifford R, Ward WK: Calibration of a subcutaneous amperometric glucose sensor. Part 1. Effect of measurement uncertainties on the determination of sensor sensitivity and background current.

Biosens Bioelectron. Levetan C, Want LL, Weyer C, Strobel SA, Crean J, Wang Y, Maggs DG, Kolterman OG, Chandran M, Mudaliar SR, Henry RR: Impact of pramlintide on glucose fluctuations and postprandial glucose, glucagon, and triglyceride excursions among patients with type 1 diabetes intensively treated with insulin pumps.

Abrahamian H, Francesconi M, Loiskandl A, Dzien A, Prager R, Weitgasser R: Evaluation of a new insulinotropic agent by using an innovative technology: efficacy and safety of nateglinide determined by continuous glucose monitoring.

Pitzer KR, Desai S, Dunn T, Edelman S, Jayalakshmi Y, Kennedy J, Tamada JA, Potts RO: Detection of hypoglycemia with the GlucoWatch Biographer. Reach G: Which threshold to detect hypoglycemia?

Value of receiver-operator curve analysis to find a compromise between sensitivity and specificity. Weinzimer SA, Tamborlane WV, Chase HP, Garg SK: Continuous glucose monitoring in type 1 diabetes. Curr Diab Rep. Diabetes Research in Children Network DirecNet Study Group: The accuracy of the GlucoWatch G2 Biographer in children with type 1 diabetes: results of the diabetes research in children network DirecNet accuracy study.

Diabetes Research in Children Network DirecNet Study Group: The accuracy of the CGMS in children with type 1 diabetes: results of the diabetes research in children network DirecNet accuracy study.

Kubiak T, Hermanns N, Schreckling HJ, Kulzer B, Haak T: Assessment of hypoglycaemia awareness using continuous glucose monitoring.

Diabet Med. Goldberg PA, Siegel MD, Russell RR, Sherwin RS, Halickman JI, Cooper DA, Dziura JD, Inzucchi SE: Experience with the Continuous Glucose Monitoring System in a medical intensive care unit. Guerci B, Floriot M, Bohme P, Durain D, Benichou M, Jellimann S, Drouin P: Clinical performance of CGMS in type 1 diabetic patients treated by continuous subcutaneous insulin infusion using insulin analogs.

Djakoure-Platonoff C, Radermercker R, Reach G, Slama G, Selam JI: Accuracy of the continuous glucose monitoring system in inpatient and outpatient conditions. Diabete Metab. Poscia A, Mascini M, Moscone D, Luzzana M, Caramenti G, Cremonesi P, Valgimigli F, Bongiovanni C, Varalli M: A microdialysis technique for continuous subcutaneous glucose monitoring in diabetic patients part 1.

Varalli M, Marelli G, Maran A, Bistoni S, Luzzana M, Cremonesi P, Caramenti G, Valgimigli F, Poscia A: A microdialysis technique for continuous subcutaneous glucose monitoring in diabetic patients part 2. Diabetes Research in Children Network DirecNet Study Group: Accuracy of the GlucoWatch G2 Biographer and the continuous glucose monitoring system during hypoglycemia: experience of the Diabetes Research in Children Network.

Tsalikian E, Kollman C, Mauras N, Weinzimer S, Buckingham B, Xing D, Beck R, Ruedy K, Tamborlane W, Fiallo-Scharer R, Diabetes Research in Children Network DirecNet Study Group: GlucoWatch G2 Biographer alarm reliability during hypoglycemia in children.

Conrad SC, Mastrototaro JJ, Gitelman SE: The use of a continuous glucose monitoring system in hypoglycemic disorders. J Pediatr Endocrinol Metab. International Organisation for Standardisation: Requirements for In Vitro Blood Glucose Monitoring Systems for Self-Testing in Managing Diabetes Mellitus.

The Diabetes Research in Children Network DirecNet Study Group: Lack of accuracy of continuous glucose sensors in healthy, nondiabetic children: results of the Diabetes Research in Children Network DirecNet accuracy study.

J Pediatr. Weinzimer SA, DeLucia MC, Boland EA, Steffen A, Tamborlane WV: Analysis of continuous glucose monitoring data from non-diabetic and diabetic children: a tale of two algorithms. Chase HP, Kim LM, Owen SL, MacKenzie TA, Klingensmith GJ, Murtfeldt R, Garg SK: Continuous subcutaneous glucose monitoring in children with type 1 diabetes.

Boland E, Monsod T, Delucia M, Brandt CA, Fernando S, Tamborlane WV: Limitations of conventional methods of self-monitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes.

Kaufman FR, Austin J, Neinstein A, Jeng L, Halvorson M, Devoe DJ, Pitukcheewanont P: Nocturnal hypoglycemia detected with the continuous glucose monitoring system in pediatric patients with type 1 diabetes.

McGowan K, Thomas W, Moran A: Spurious reporting of nocturnal hypoglycemia by CGMS in patients with tightly controlled type 1 diabetes. Metzger M, Leibowitz G, Wainstein J, Glaser B, Raz I: Reproducibility of glucose measurements using the glucose sensor.

Amin R, Ross K, Acerini CL, Edge JA, Warner J, Dunger DB: Hypoglycemia prevalence in prepubertal children with type 1 diabetes on standard insulin regimen: use of continuous glucose monitoring system.

Sachedina N, Pickup JC: Performance assessment of the Medtronic-MiniMed Continuous Glucose Monitoring System and its use for measurement of glycaemic control in type 1 diabetic subjects. Kovatchev BP, Gonder-Frederick LA, Cox DJ, Clarke WL: Evaluating the accuracy of continuous glucose-monitoring sensors: continuous glucose-error grid analysis illustrated by TheraSense Freestyle Navigator data.

Clarke WL, Cox DJ, Gonder-Frederick LA, Pohl SL: Evaluating clinical accuracy of systems for self-monitoring of blood glucose. Miedema K: Laboratory tests in diagnosis and management of diabetes mellitus: practical considerations. Clin Chem Lab Med.

Salardi S, Zucchini S, Santoni R, Ragni L, Gualandi S, Cicognani A, Cacciari E: The glucose area under the profiles obtained with continuous glucose monitoring system relationships with HbA lc in pediatric type 1 diabetic patients.

Sharp P, Rainbow S: Continuous glucose monitoring and haemoglobin A 1c. Ann Clin Biochem. Sabbah H, Mcculloch K, Fredrickson LP, Gross TM, Bode BW: Detailed data from a Continuous Glucose Monitoring System CGMS facilitates comprehensive diabetes management recommendations Abstract.

Kaufman FR, Gibson LC, Halvorson M, Carpenter S, Fisher LK, Pitukcheewanont P: A pilot study of the continuous glucose monitoring system: clinical decisions and glycemic control after its use in pediatric type 1 diabetic subjects.

Chase HP, Roberts MD, Wightman C, Klingensmith G, Garg SK, Van Wyhe M, Desai S, Harper W, Lopatin M, Bartkowiak M, Tamada J, Eastman RC: Use of the GlucoWatch Biographer in children with type 1 diabetes.

Chico A, Vidal-Rios P, Subira M, Novials A: The continuous glucose monitoring system is useful for detecting unrecognized hypoglycemias in patients with type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control.

Ludvigsson J, Hanas R: Continuous subcutaneous glucose monitoring improved metabolic control in pediatric patients with type 1 diabetes: a controlled crossover study. Tanenberg R, Bode B, Lane W, Levetan C, Mestman J, Harmel AP, Tobian J, Gross T, Mastrototaro J: Use of the continuous glucose monitoring system to guide therapy in patients with insulin-treated diabetes: a randomized controlled trial.

Mayo Clin Proc. Bode BW, Gross TM, Thornton KR, Mastrototaro JJ: Continuous glucose monitoring used to adjust diabetes therapy improves glycosylated hemoglobin: a pilot study. Diabetes Res Clin Pract. Schiaffini R, Ciampalini P, Fierabracci A, Spera S, Borrelli P, Bottazzo GF, Crino A: The Continuous Glucose Monitoring System CGMS in type 1 diabetic children is the way to reduce hypoglycemic risk.

Schaepelynck-Belicar P, Vague P, Simonin G, Lassmann-Vague V: Improved metabolic control in diabetes adolescents using the continuous glucose monitoring system CGMS. Gross TM, Mastrototaro JJ: Efficacy and reliability of the continuous glucose monitoring system.

Kovatchev BP, Cox DJ, Gonder-Frederick LA, Young-Hyman D, Schlundt D, Clarke W: Assessment of risk for severe hypoglycemia among adults with IDDM: validation of the low blood glucose index. Hay LC, Wilmshurst EG, Fulcher G: Unrecognized hypo- and hyperglycemia in well-controlled patients with type 2 diabetes mellitus: the results of continuous glucose monitoring.

Cameron FJ, Ambler GR: Does continuous glucose monitoring have clinical utility in contemporary management of diabetes?

J Paediatr Child Health. Jeha GS, Karaviti LP, Anderson B, Smith EO, Donaldson S, McGirk TS, Haymond MW: Continuous glucose monitoring and the reality of metabolic control in preschool children with type 1 diabetes.

Alemzadeh R, Loppnow C, Parton E, Kirby M: Glucose sensor evaluation of glycemic instability in pediatric type 1 diabetes mellitus. Chen R, Yogev Y, Ben-Haroush A, Jovanovic L, Hod M, Phillip M: Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus.

J Matern Fetal Neonatal Med. Yogev Y, Ben-Haroush A, Chen R, Kaplan B, Phillip M, Hod M: Continuous glucose monitoring for treatment adjustment in diabetic pregnancies: a pilot study.

Yogev Y, Chen R, Ben-Haroush A, Phillip M, Jovanovic L, Hod M: Continuous glucose monitoring for the evaluation of gravid women with type 1 diabetes mellitus. Obstet Gynecol. Yogev Y, Ben-Haroush A, Chen R, Rosenn B, Hod M, Langer O: Undiagnosed asymptomatic hypoglycemia: diet, insulin, and glyburide for gestational diabetic pregnancy.

Kerssen A, de Valk HW, Visser GH: The Continuous Glucose Monitoring System during pregnancy of women with type 1 diabetes mellitus: accuracy assessment. Esmatjes E, Flores L, Vidal M, Rodriguez L, Cortes A, Almirall L, Ricart MJ, Gomis R: Hypoglycaemia after pancreas transplantation: usefulness of a continuous glucose monitoring system.

Clin Transplant. Kessler L, Passemard R, Oberholzer J, Benhamou PY, Bucher P, Toso C, Meyer P, Penfornis A, Badet L, Wolf P, Colin C, Morel P, Pinget M, GRAGIL Group: Reduction of blood glucose variability in type 1 diabetic patients treated by pancreatic islet transplantation: interest of continuous glucose monitoring.

Ryan EA, Shandro T, Green K, Paty BW, Senior PA, Bigam D, Shapiro AM, Vantyghem MC: Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation.

Hershkovitz E, Rachmel A, Ben-Zaken H, Phillip M: Continuous glucose monitoring in children with glycogen storage disease type I. J Inherit Metab Dis. Maran A, Crepaldi C, Avogaro A, Catuogno S, Burlina A, Poscia A, Tiengo A: Continuous glucose monitoring in conditions other than diabetes.

Diabete Metab Res Rev. Deiss D, Hartmann R, Hoeffe J, Kordonouri O: Assessment of glycemic control by continuous glucose monitoring system in 50 children with type 1 diabetes starting on insulin pump therapy.

Pediatr Diabetes. Mlcak P, Fialova J, Trnkova K, Chlup R: A continuous glucose monitoring system CGMS : a promising approach for improving metabolic control in persons with type 1 diabetes mellitus treated by insulin pumps. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub.

Manuel-y-Keenoy B, Vertommen J, Abrams P, Van Gaal L, De Leeuw I, Messeri D, Poscia A: Postprandial glucose monitoring in type 1 diabetes mellitus: use of a continuous subcutaneous monitoring device.

Buhling KJ, Kurzidim B, Wolf C, Wohlfarth K, Mahmoudi M, Wascher C, Siebert G, Dudenhausen JW: Introductory experience with the continuous glucose monitoring system CGMS; Medtronic Minimed in detecting hyperglycemia by comparing the self-monitoring of blood glucose SMBG in non-pregnant women and in pregnant women with impaired glucose tolerance and gestational diabetes.

Exp Clin Endocrinol Diabetes. Yogev Y, Ben-Hroush A, Chen R, Rosenn B, Hod M, Langer O: Diurnal glycemic profile in obese and normal weight nondiabetic pregnant women. Am J Obstet Gynecol.

Tanenberg RJ, Pfeifer MA: Continuous glucose monitoring system: a new approach to the diagnosis of diabetic gastroparesis. Dobson L, Sheldon CD, Hattersley AT: Conventional measures underestimate glycaemia in cystic fibrosis patients. Weintrob N, Schechter A, Benzxzaquen H, Shalitin S, Lilos P, Galatzer A, Phillip M: Glycemic patterns detected by continuous subcutaneous glucose sensing in children and adolescents with type 1 diabetes mellitus treated by multiple daily injections vs continuous subcutaneous insulin infusion.

Arch Pediatr Adolesc Med. Garg SK, Schwartz S, Edelman SV: Improved glucose excursions using an implantable real-time continuous glucose sensor in adults with type 1 diabetes. Klonoff DC: The need for separate performance goals for glucose sensors in the hypoglycemic, normoglycemic, and hyperglycemic ranges.

Tamada JA, Davis TL, Leptien AD, Lee J, Wang B, Lopatin M, Wei C, Wilson D, Comyns K, Eastman RC: The effect of preapplication of corticosteroids on skin irritation and performance of the GlucoWatch G2 Biographer.

Kulcu E, Tamada JA, Reach G, Potts RO, Lesho MJ: Physiological differences between interstitial glucose and blood glu-cose measured in human subjects.

Flamm CR: Use of intermittent or continuous interstitial glucose monitoring in patients with diabetes mellitus.

Technology Evaluation Center. Blue Cross and Blue Shield Association Assessment Program. Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan D, Peterson CM: Tests of glycemia in diabetes.

Wichtige Continuous glucose control gkucose iOS Version. Apple® wird in Continuous glucose control kommenden controp Version Free-range poultry Standby-Modus und den Assistive Access-Modus einführen. Diese neuen Modi können sich auf Ihre Erfahrung mit Ihrer FreeStyle Libre 3 App 11 auswirken. Erfahren Sie hierwie Sie potenzielle Probleme vermeiden können. Entdecken Sie das von Menschen mit Diabetes weltweit meistgenutzte Glukose-Sensor-Messsystem.

Author: Kikree

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