US Pharm. 2013;38(9):64-68.
More than 347 million people worldwide
and over 26 million people in the United States have been diagnosed
with diabetes mellitus.1 Type 2 diabetes accounts for more
than 90% of all diagnosed cases. Additionally, the incidence of new
cases is steadily increasing with an estimated 54 million Americans
characterized as having prediabetes. A contributing factor to an
increase in the number of new cases may be associated with childhood
obesity. As a result, the cost of treatment in 2007 was
estimated at 174 billion dollars and is speculated to increase in the
years to come.2
If left untreated, patients will
maintain an elevated blood glucose level (hyperglycemia) though the
body starves for energy. The main symptoms of hyperglycemia include
polyuria, polydipsia, polyphagia, and fatigue. Complications of
diabetes may be microvascular (i.e., retinopathy, nephropathy,
peripheral neuropathy, and autonomic neuropathy) or macrovascular
(i.e., cardiovascular disease, cerebrovascular disease, peripheral
artery disease). As such, it is important for individuals to start
lifestyle modifications and pharmacologic therapy upon diagnosis.
Though therapy is typically evaluated using daily glucose monitoring
and hemoglobin A1C levels, recent advances in technology have led to
the development of continuous glucose monitoring devices, which afford
the ability to better visualize fluctuations in daily glucose levels.
The purpose of this article is to discuss Dexcom’s newest continuous
glucose monitor, the G4 Platinum, and its possible implications in the
management of diabetes.
G4 Platinum Continuous Glucose Monitor
The G4 Platinum glucose monitor is an
advancement to Dexcom’s Seven Plus device. The G4 Platinum consists of
three parts (sensor, transmitter, and receiver), which will be
discussed in greater detail later in this article.3
Available only by prescription, this device has new features that
include longer transmission range, color LCD display screen,
customizable glucose alerts, and a slimmer, more discrete design. Used
as adjunct therapy, the G4 Platinum is indicated for individuals 18
years of age or older and is covered by most insurance companies for
patients who have been prescribed insulin. This device measures an
individual’s glucose readings every 5 minutes for 7 days and appears to
be ideal for patients who experience frequent fluctuations in glucose
levels. Dexcom provided initial findings that indicated “approximately
19% improvement in overall accuracy for the Dexcom G4 Platinum compared
to the Seven Plus, and approximately a 30% improvement in accuracy in
the hypoglycemia range (i.e., when blood glucose level is less than 70
A comparison of continuous glucose monitors is shown in TABLE 1.
G4 Platinum Sensor:
sensor is a fine, hair-like needle that is inserted into the patient’s
abdominal region, similar to an insulin pump. The needle is inserted
using a detachable plunger and held in place with a circular adhesive
patch for 7 days. Sensor durability surpasses that of the Seven Plus
with a decreased incidence of fracture when exposed to repetitive
bending and resistance. In the event the sensor breaks under the skin
or a problem occurs, the patient should contact his or her prescriber
and call Dexcom’s technical support. Step-by-step sensor application
instructions are shown in
G4 Platinum Transmitter:
transmitter is a grey chip that snaps into the sensor pod. It is
responsible for relaying glucose readings to the receiver every 5
minutes through wireless data transmission. While the sensors are only
good for 7 days, the life of the transmitter is approximately 6 months
and should not be discarded after initial use. Should a low battery
indicator light appear, patients should order a new transmitter. Each
transmitter comes with its own specific ID code, which must be
synchronized with the receiver before it can be used.
G4 Platinum Receiver:
receiver is a small device similar in size to a standard smartphone.
The receiver has an LCD color screen that displays current glucose
readings, battery life, time frame, and glucose trends. Each dot that
appears on the screen represents a specific glucose reading. Dots that
appear red or yellow indicate hypoglycemic or hyperglycemic
measurements, respectively. A unique feature of this model is a greater
receiver transmitter range, giving patients more freedom and mobility.
Compared to other continuous glucose monitoring devices, this model
requires less calibration (every 12 hours) in addition to the inclusion
of a standard feature: a nonchangeable hypoglycemic alert that is set
at 55 mg/dL. Blood glucose trends may also be recorded by this device.
Several clinical studies have been
completed demonstrating the efficacy of continuous glucose monitoring
in the management of diabetes.5-7 Vigersky et al.
demonstrated the benefits of using continuous blood glucose monitoring
in a randomized, controlled trial with patients using the Seven Series
Dexcom model. This trial compared diet and exercise alone to other
glucose-lowering therapies (except prandial insulin). At the end of the
52-week study, results indicated that self-monitoring of blood glucose
along with the Seven Series was more effective in lowering hemoglobin
A1C and regulating blood glucose levels.8 A new clinical
trial is being conducted comparing the accuracy of the new Dexcom G4
Platinum and Medtronic Enlite System in patients with type 1 diabetes.
This trial should be completed in January 2014.9
The Dexcom G4 Platinum allows patients
to continuously monitor their blood glucose throughout the day for up
to 7 days. New features include improved accuracy and monitoring
continuous glucose fluctuations, affording patients to be more active
with their diabetes management. For more information on the G4
Platinum, visit www.dexcom.com or call 1-858-200-0200.
1. World Health Organization, Diabetes Fact Sheet, 2012.
February 4, 2013.
2. U.S. Department of Human Health
Services, Centers for Disease Control and Prevention, 2011. National
diabetes fact sheet national estimates and general information on
diabetes and prediabetes in the United States, 2011.
www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed February 2, 2013.
3. Dexcom G4 PLATINUM User Guide, 2012.
4. Dexcom. U.S. FDA Approves the Dexcom G4™ PLATINUM Continuous Glucose Monitor (CGM). http://files.shareholder.com/downloads/DXCM/2303969857x0x603924/e6216098-1d6b-45b4-b4ed-1aa03740e97f/DXCM_News_2012_10_8_General.pdf.
Accessed February 4, 2013.
5. Tamborlane W, Beck R, Bode B, et al.
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring
Study Group. Continuous glucose monitoring and intensive treatment of
type 1 diabetes. N Engl J Med. 2008;359:1464-1476.
6. Deiss D, Bolinder J, Riveline J, et
al. Improved glycemic control in poorly controlled patients with type 1
diabetes using real-time continuous glucose monitoring. Diabetes Care. 2006;29:2730-2732.
7. Zick R, Petersen B, Richter M, Haug C. SAFIR Study
Group. Comparison of continuous blood glucose measurement with
conventional documentation of hypoglycemia in patients with type 2
diabetes on multiple daily insulin injection therapy. Diabetes Technol Ther. 2007;9:483-492.
8. Vigersky R, Fonda S, Chellappa M, et
al. Short-and long-term effects of real-time continuous glucose
monitoring in patients with type 2 diabetes. Diabetes Care. 2012;35:32-38.
9. U.S. National Institutes of Health,
Clinical Trials.gov. Standardized Procedure for the Assessment of
New-to-market Continuous Glucose Monitoring Systems (SPACE2).
trials.gov/ct2/show/NCT01751932?term=dexcom+g4+platinum &rank=1. Accessed February 2, 2013.
10. Dexcom.com. Professionals;
Comparison of ontinuous Blood Glucose Monitors.
www.dexcom.com/healthcare-professionals/hypoglycemia. Accessed February
11. Dexcom.com. Quick Start Guide. www.dexcom.com/sites/dexcom.com/files/professionals/education/Quick_Start_Guide_G4_USLBL010799Rev10.pdf. Accessed February 1, 2013.
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