Role of continuous glucose monitoring in diabetes management

Continuous Glucose Monitoring (CGM) is among the most important recentadvances in diabetes technology for better diabetes management. The CGMprovides patients with real-time information about glucose levels, direction andrate of change, and glucose trends. There are currently four continuous glucosemonitoring devices (sensors) in clinical use which measure interstitialfluid to calculate blood glucose levels using several algorithms. These devicesinclude sensors developed by GlucoWatch®, DexComTM (DexCom SEVEN®PLUS), Medtronic (MiniMed Paradigm® REAL-Time and Guardian® REALTime),and Abbott Diabetes Care (FreeStyle Navigator®). Continuous GlucoseMonitoring is currently approved as adjunctive to Self-Monitoring of Blood Glucose(SMBG), and the CGM data should be confirmed using SMBG for treatmentdecisions. The use of CGM, both in research and clinical settings, hasbeen documented to decrease blood glucose excursions, lower HbA1c values,and reduce hypoglycemic episodes, which together diminish the risk of complicationsassociated with diabetes. In addition, use of CGM helps in reducingglucose variability. The CGM is also useful associated with special patient populationssuch as pregnant women with gestational diabetes or type 1 diabetes,children, and subjects with unexplained hypoglycemic unawareness, eventhough it is not approved by the Food and Drug Administration (FDA) for manyof these special circumstances(AU)

Educational and health services innovation to improve care for rural Hispanic communities in the USA.

BACKGROUND: Access to comprehensive and quality healthcare services is difficult for socioeonomically disadvantaged groups in rural regions. Barriers to health care for rural Latinos include lack of insurance, language barriers and cultural differences. For the Latino immigrant population in rural areas, barriers to access are compounded. HEALTH NEEDS OF RURAL AREAS: THE CASE OF WALHALLA, SC: The town of Walhalla, South Carolina, USA, is a rural community located in Oconee County, the northwest corner of the state. Disparities exist between rural and urban residents in several health categories, and these disparities illustrate the need to provide competent, appropriate and affordable healthcare to rural populations. The Hispanic population of Oconee has dramatically increased in the past decade, and the majority of these immigrants have no health insurance and have limited access to health services. DESIGNING A PROGRAM TO FIT THE COMMUNITY--THE "WALHALLA EXPERIENCE": The purpose of the Accessible and Culturally Competent Health Care Project (ACCHCP) is to provide care for underserved populations, in Oconee County, South Carolina while providing rural educational opportunities for health services students. Funded by the Health Resources and Services Administration of DHHS, the program is designed to offer culturally appropriate, sensitive, accessible, affordable and compassionate care in a mobile clinic setting. In this interdisplinary program, nurse practitioners, health educators, bilingual interpreters, medical residents and Clemson University students and professors all played key roles. Women in the community also serve as promotoras or lay health advisors. The program is unique in using educational initiatives and innovative strategies for bringing health care to this underserved community and offers important information for rural healthcare initiatives targeting minority groups. This article reports on the challenges and successes in the development and implementation of the ACCHCP program in Walhalla, South Carolina.