It’s been almost 2 decades since the first continuous blood glucose monitoring system was introduced in the diabetes market. Earlier, it was a huge, clunky device, and when a doctor tried to explain how this machine worked, it was almost certain that the patient would now start looking for a new doctor! But, things have changed and now CBGM is a cute little device that looks just like another glucometer yet is very powerful.

If you ask me, I’ll vote for a continuous glucose monitoring system as one of the most effective weapons to keep diabetes under control. This article is about why you should start using the continuous glucose monitoring system.

What is a Continuous Glucose Monitoring system?

Just like its name suggests, this is a small device that keeps a continuous track of your glucose values all throughout the day. So, unlike a traditional blood glucose monitor, which just takes one reading of your blood glucose at a given point in time, the new continuous glucose monitoring system does it for a long time, usually up to 14 days and in some cases for one month. The best part is that it does all the pricking, tracking, and monitoring automatically. So, no more getting ready for the needle prick, wiping, cleaning, huffing and bloodshed to measure your blood glucose.

How does the continuous glucose monitor work?

It comes in 2 pieces. The first piece is a small patch-like device that you can apply to your skin. This small device has small nano-sized needles which keep drawing interstitial fluid from your skin at regular intervals, then measure the glucose content in that small sample, and finally transmit the information wirelessly to the second piece. Note that most continuous glucose monitoring devices use interstitial fluid instead of blood for measuring glucose. Interstitial fluid is different from blood and is found in all parts of our body including the skin. In 2016, FDA approved the accuracy of continuous glucose monitoring devices to be used as standalone monitors avoiding the need to calibrate glucose values with traditional blood glucose monitoring devices.

The second piece receives the transmitted information and displays it on a small screen, which looks just like a traditional glucose monitoring device. In some cases, this display could be your smartphone! There are devices that measure glucose at 5-minute intervals and store it. Some devices are capable of tracking glucose values for 7 consecutive days, while others are capable of doing this for 14 days and more. The Freestyle Libre also communicates with your smartphone and the whole data can be downloaded in real-time with a few swipes.

If you are worried about the accuracy of continuous glucose monitoring devices, just relax. Advancements in technology have made interstitial fluid glucose monitoring as accurate as blood glucose monitoring. Otherwise, why would FDA approve it? Advantages of continuous glucose monitoring systems

• Real-time analysis of glucose is possible without suffering pain. Drawing a blood sample is not required in most of the commercial personal continuous glucose monitors.
• The accuracy of continuous glucose monitors has improved incredibly! Unlike the previous generation monitors, treatment can be initiated without confirming with a blood glucose monitoring device.
• Multiple values in one day enable the patient to understand how glucose values keep changing with their lifestyle, and the food they eat. This gives them the power to understand their glucose profile and to make those badly needed changes in diet and lifestyle.
• Glucose level during sleep is also available. No more tension and fear of low blood glucose levels after the insulin injection that you took late at night!
• Real-time Continuous glucose monitoring in conjunction with insulin therapy is a useful tool to lower A1C levels and/or reduce hypoglycemia (very low blood glucose levels) in adults with type 1 diabetes who are not meeting glycemic targets,
• No need to worry about writing down the glucose values every time as the continuous glucose monitor does this automatically. Some devices store it internally, others connect via Bluetooth to an app in your smartphone, and others sync with a cloud server making it possible for your doctor to see the changes in your glucose profile in real-time. How cool is that?
• No more buying refill strips for your finger-pricking blood glucose monitor. Trust me, this is an expense that makes it difficult for most diabetic patients to keep using their blood glucose monitor. Those strips are damn expensive, particularly when you try to buy less than 10 strips at a time.
• Continuous glucose monitoring enables you to use an insulin pump, a device that works together with it to deliver insulin to your body avoiding the need for frequent insulin injections. I recently read an article that talked about the research on developing an artificial pancreas, another device that can work only if it gets the data from the continuous glucose monitoring system. So, in the future, even if your pancreas is all fried and useless, there’s hope!
• The report generated from your continuous glucose monitor if it’s in a standard format will enable your doctor to advise you on some more effective medicines, change the dose of insulin or even change your diet plan. Many manufacturers are now working on the Ambulatory glucose profile, a single-page report. your glucose values with details on spikes, dips, and many averages and percentages.

In patients with type 2 diabetes, even in patients not on insulin, real-time continuous glucose monitoring may act as a motivator and positive influence for patients to improve their lifestyle. The change in behavior can potentially lead to better glucose control.

Disadvantages of continuous glucose monitors

• The Freestyle Libre monitor is 4500 Indian Rupees. This will give you a free applicator that works for 14 days. After 14 days, you need to buy another applicator and that will cost you 4000 Rupees. Even if you have the monitor, you cannot use it without the skin applicator! So, a continuous glucose monitor is expensive.
• Many patients have experienced itching and rashes on the skin where the applicator was applied. I am not saying that you will experience it, but, there’s a chance!
• The learning curve of using Freestyle Libre is longer when compared to a normal blood glucose monitor.
• You need to be careful while wearing the applicator. If you go swimming or play football or wrestle after wearing it, you can say goodbye to 4500 as you might need to buy it again!
• Children with type 1 diabetes who use continuous glucose monitoring devices were found to miss more school days.

Conclusion

Continuous glucose monitoring should be considered for patients with type 1 diabetes and insulin-treated type 2 diabetes who are not achieving targets or those with hypoglycemia. It has become an important tool for children, adolescents, and adults diagnosed with type 1 diabetes and for all type 2 diabetes patients who are on insulin injections. Moreover, if you are a type 2 diabetic and are looking for more motivation to take control of your blood glucose level, a continuous glucose monitor like the Freestyle Libre might be the best answer! Many new types of technology are increasingly being developed and applied to fight diabetes and its complications. New technologies will improve the lives of people with diabetes by measuring glucose and other biomarkers of glycemic control and linking glucose levels with insulin delivery to improve the lives of people with diabetes.

Reference article – https://www.ncbi.nlm.nih.gov/books/NBK279046/