Page 134 - Glucose Monitoring Devices

CHAPTER

7
Clinical impact of CGM use

1
2
Chukwuma Uduku, MBBS, BSc, MRCP , Monika Reddy, MBChB, MRCP (UK), PhD ,
Nick Oliver, FRCP 3
1
Clinical Research Fellow and Specialist Registrar in Endocrinology, Diabetes and Internal
Medicine, Imperial College London, St. Mary’s Hospital Medical School Building, London, United
2
Kingdom; Honorary Senior Clinical Lecturer, Consultant in Endocrinology, Diabetes and Internal
Medicine, Imperial College London, St. Mary’s Hospital Medical School Building, London, United
3
Kingdom; Wynn Professor of Human Metabolism, Consultant in Endocrinology, Diabetes and
Internal Medicine, Imperial College London, St. Mary’s Hospital Medical School Building,
London, United Kingdom

Introduction

History and general rationale for glucose monitoring
Diabetes mellitus is a chronic metabolic condition characterized by hyperglycemia
and impaired glucose homeostasis. The rising global prevalence of diabetes places
greater importance on preventing the immediate and long-term complications associ-
ated with suboptimal glucose management. Glycated hemoglobin (HbA1c) is the
most commonly referenced metric for assessing long-term glycemic control and
complication risk association. However, its inability to identify rapid changes in
glycemia and detect glycemic extremes such as hypoglycemia highlights the need
for dynamic, real-time glucose monitoring. Self-monitoring blood glucose (SMBG)
technology allows clinicians and people with diabetes the ability to make timely ther-
apeutic decisions based on their blood glucose levels and is a cornerstone in diabetes
management. Blood glucose monitoring is particularly integral in delivering safe dia-
betes care in those at risk of iatrogenic hypoglycemia from intensified insulin therapy.
Normal glucose homeostasis is maintained by insulin and counterregulatory hor-
mones responding to blood glucose levels in real time. Similar to most diabetes care
initiatives, regular glucose monitoring attempts to safely achieve physiological glyce-
mic control and modify complication-associated risk factors without compromising
the patient experience. Early SMBG meters utilized light photometry to derive blood
glucose levels from solid dry-reagent test strips. However, they were confined to use
only in clinical areas due to expensive costs and their bulky profile. It was not until the
late 1970s and 1980s when smaller meters with fewer operator-dependent steps made
self-testing feasible. Current glucose meters apply enzyme electrode technology to es-
timate blood glucose levels and are a staple fixture across all levels of diabetes care.

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