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Diabetes is a chronic disease that affects millions of people worldwide. It is characterized by high blood glucose levels, which can lead to serious complications such as cardiovascular disease, kidney failure, nerve damage, and vision loss. One of the primary goals of diabetes management is to keep blood glucose levels within a target range that reduces the risk of these complications.
People with diabetes have traditionally relied on self-monitoring of blood glucose (SMBG) via fingerstick tests or blood glucose meters. However, SMBG has some limitations, including being invasive, painful, and inconvenient, as well as providing only a snapshot of blood glucose levels at a single point in time. SMBG also does not account for fluctuations and trends in blood glucose levels throughout the day and night, which can be influenced by a variety of factors such as food intake, physical activity, stress, medication, and illness.
Continuous glucose monitoring (CGM) is a technology that can help to overcome some of these limitations. CGM devices use a small sensor inserted beneath the skin to measure glucose levels in the interstitial fluid (the fluid that surrounds the cells of the body). The sensor sends glucose readings to a receiver, smartphone, or insulin pump, which can display the current glucose level as well as the direction and rate of change of glucose levels. CGM devices can also notify the user when glucose levels are too high or too low, or when they are changing rapidly. CGM devices can save glucose data for later review and analysis, or they can share it with health-care providers or caregivers via cloud-based platforms.
CGM has been shown to be clinically useful for a wide range of patient populations and clinical indications. Several studies have shown that CGM can help reduce hemoglobin A1c (HbA1c), which is a measure of average blood glucose levels over the previous two to three months, and mean glucose, which is the average of all glucose readings. CGM can also help reduce the risk of hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose), as well as glycemic variability (GV), which is the degree of fluctuation in blood glucose levels. CGM can also improve patient quality of life by reducing the burden and distress of diabetes management and boosting self-confidence and self-care behaviours.
For example, a recent study published in The Lancet Diabetes & Endocrinology reviewed the use of CGM and metrics in clinical trials and concluded that CGM can supplement HbA1c findings and further assess the effects of therapeutic interventions on blood glucose levels. The study proposed a set of standardized CGM metrics that can be used to evaluate and compare the efficacy and safety of various diabetes treatments and interventions. The study also emphasized the importance of considering the patient’s perspective and preferences when using CGM, as well as the need for more CGM research and education.
Another recent study published in Diabetes Technology & Therapeutics reviewed the evidence and recommendations for CGM use in clinical practice and concluded that CGM can benefit people with type 1 and type 2 diabetes, as well as pregnant women with diabetes and people with impaired awareness of hypoglycemia. The study also discussed the challenges and barriers to CGM adoption, such as cost, access, education, and technical issues, and proposed some solutions, such as reimbursement policies, patient support programs, and device innovation.
To summarize, CGM is a powerful tool that can provide continuous and comprehensive information on blood glucose levels and trends, allowing people with diabetes and their health-care providers to optimize diabetes management and outcomes. CGM can also provide valuable insights and feedback for clinical trials and diabetes research. CGM, on the other hand, necessitates appropriate education, training, and support for both patients and health-care providers, as well as adequate reimbursement and access to the devices and supplies.
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1: Continuous glucose monitoring and metrics for clinical trials: an expert consensus report. The Lancet Diabetes & Endocrinology, 2022. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00319-9/fulltext
2: Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes. Diabetes Technology & Therapeutics, 2017. https://pubmed.ncbi.nlm.nih.gov/28585879/