Description
Continuous Glucose Monitoring (CGM) is a technology used to monitor glucose levels in individuals with diabetes. It involves the use of a small sensor inserted under the skin, usually in the abdomen, that measures glucose levels in the interstitial fluid. The sensor sends real-time data to a receiver or a smartphone, providing users with a continuous stream of information about their glucose levels. CGM helps individuals make informed decisions about their diet, medication, and activities, leading to better diabetes management and improved glycemic control.
Résumé
- Glucose monitoring is crucial for diagnosing, screening, and managing diabetes. Monitoring helps identify blood glucose fluctuations due to diet, exercise, or medications, and it aids in detecting hypo- and hyperglycemia for timely intervention. It also assists in adjusting medication dosages based on sugar control levels.
- Diabetes technology has evolved significantly, from urine tasting to advanced continuous glucose monitoring (CGM) systems. Current methods include capillary blood glucose testing (GRBS), venous plasma glucose testing, HbA1c, and CGM, with urine glucose testing largely obsolete.
- Capillary glucose testing (GRBS) involves a fingertip prick to measure blood glucose using a glucose meter and test strips. It offers advantages such as small blood sample size, testing site flexibility, rapid results, easy-to-read displays, and at-home self-monitoring. However, disadvantages include the cost of strips, expiry dates, temperature and humidity sensitivity, sample size limitations, and potential inaccuracies during stress or critical illness.
- Venous blood glucose testing, collected via venipuncture and processed in a lab, provides superior accuracy compared to GRBS. However, frequent testing can be a hassle due to larger blood samples and potential tissue damage. HbA1c provides a reliable measure of mean plasma glucose over the past three to four months, reflecting the average glycosylated hemoglobin level, but can be affected by erythropoiesis, liver disease, hemoglobinopathies, and renal failure.
- Self-monitoring of blood glucose (SMBG) involves checking blood glucose using a glucometer or CGM to monitor levels, adjust insulin dosages, identify hyper- or hypoglycemia risks, and guide lifestyle or medication changes. SMBG often involves maintaining a log and testing glucose levels multiple times daily, especially for insulin-treated patients.
- CGM devices provide real-time glucose readings, trend information, and alerts for high or low glucose levels. CGM systems consist of a sensor inserted under the skin, a transmitter, and a receiver, measuring glucose levels in the interstitial fluid every one to five minutes.
- Available CGM systems in India include Abbott's FreeStyle Libre, Medtronic, and Dexcom. CGM offers two types of measurements: real-time, which reduces HbA1c and hypoglycemic episodes, and professional, blinded measurement, where data is downloaded later for analysis. Sensors can be worn for up to 14 days.
- CGM data is presented in trend graphs, trend arrows, and alarms, enabling retrospective analysis and personalized adjustments. Calibration is crucial to align CGM values with finger-stick glucose readings.
- Benefits of CGM include real-time glucose information, predictive capabilities, remote monitoring, multiple alarm settings, and reduced need for finger pricks. CGM has demonstrated significant reductions in hypoglycemia in both type 1 and type 2 diabetes.
- Ideal candidates for CGM include individuals and families willing to use the device, those with good diabetes care and support systems, and those prone to frequent hypoglycemia. CGM aids in preventing high and low blood sugars, minimizing glucose fluctuations, and promoting behavior modification through visual representation of glucose patterns.
- Despite the advantages, realistic expectations are essential. CGM users may still need to check blood sugar levels for calibration, dosing, and addressing spikes or symptoms. Wearing a CGM alone does not guarantee sugar control, and readings may not always match blood sugar values due to a lag between blood and interstitial fluid glucose levels.
- Emerging technologies include miniature glucose sensors and tear-based glucose monitoring using nanoparticles embedded in contact lenses. Hybrid closed-loop systems, combining CGM and continuous subcutaneous insulin infusion, offer automated insulin delivery based on real-time glucose monitoring, potentially improving the quality of life for patients with type 1 diabetes.
Exemple de certificat
À propos des intervenants
Dr Ramya Bevoor
Consultant Physician, Diabetologist, Faculty at CMC, Vellore
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