Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care
CGM has revolutionized the diabetes management process by giving real-time information about the level of sugar in the blood. CGM devices measure the glucose pattern during the day and the night, unlike finger-prick tests, where a person should make decisions about the lifestyle and their treatment. Although the advantages of CGM are the benefits in glycemic control, a decrease in emergencies, and benefits in convenience, it also has valuable risks and limitations to observe. This article explores the key benefits and risks of continuous glucose monitoring, offering a balanced view for anyone considering this technology.
What is Continuous Glucose Monitoring?
A CGM is a technology employed mostly by individuals with diabetes that continuously measures glucose (blood sugar) over the day and night. This is unlike conventional blood glucose meters that often demand frequent fingerstick blood samples instead of real-time, continuous data where glucose in the interstitial fluid located under the skin is measured by the CGMs.
A CGM system typically consists of three parts:
- The tiny sensor is put into skin (usually in arm or belly) and senses the amount of glucose levels in fluid around a cell.
- A transmitter which transports glucose readings via wireless to the sensor.
- A receiver or suitable smartphone/insulin pump with glucose levels and trends.
CGMs give regular glucose values every 1 to 15 minutes, thereby creating a clear picture of how glucose levels rise or fall. Users may identify patterns, spot trends in glucose, and get an alert on high or low glucose in this real-time data, which is vital in preventing hypoglycemia and hyperglycemia. Other functions incorporated by many CGMs include caregiver or healthcare provider data sharing and alarms.
The Key Benefits of Continuous Glucose Monitoring
The key benefits of Continuous Glucose Monitoring (CGM) include:
- Real-Time, Continuous Data: CGMs output continuous, real-time blood glucose readings, 24 hours a day, 7 days a week, providing a detailed view of glucose trends and trends over time that simple finger-prick measurements cannot detect.
- Insights into Glucose Trends: They can show users where blood sugar has been, where it is trending, and how it is shifting over time, which can help users see how food, exercise, stress and medications and other factors affect blood sugar.
- Better Decision-Making: The alerts of elevated and lowered glucose rates enable people to act in time to avoid hazardous hypoglycemia or hyperglycemia rates and adjust insulin doses to a more accurate degree.
- Finger-Prick Tests Reduction: CGMs displace the repetitive use of finger-prick-based blood testing, which drives a reduction in the invasiveness of glucose testing.
- Improved Safety and Peace of Mind: Alarms and data sharing with caregivers or healthcare teams will prevent emergencies and bring peace of mind, mostly to those at risk of serious lows or living alone.
- Improved long-term health: Improved day-to-day glucose management with CGM use may result in reduced diabetes complications and improved overall glycemic control, such as improved HbA1c levels.
- Remote Monitoring and Support of Healthcare Providers: CGM data can be transferred to healthcare providers and support timely management of therapy as well as diabetes management.
- Applicable to multiple diabetes types: CGM can serve type 1 and type 2 diabetics using insulin and other diabetes drugs and personalized treatment strategies.
Risks and Limitations
The risks and limitations of Continuous Glucose Monitoring (CGM) include:
- Lag Time during Glucose Measurement: CGMs also measure glucose in the interstitial fluid instead of the blood directly leading to a lag of approximately 15-20 minutes between real time blood glucose and sensor readings. This delay may interfere with timely treatment in changing glucose levels, particularly low and high glucose levels.
- Sensor Life and Calibration: Sensors are designed to work over a range of 7-14 days and usually require calibration 2-3 times each day by fingerstick to provide accurate reading results; this is inconvenient.
- Accuracy Problems and Signal Loss: Early in sensor life, readings can be less accurate, sensors may lose signal or fail when not used as directed or miss glucose information.
- Narrow Glucose Sensitivity: Certain CGM devices indicate a narrower range of glucose level detection (e.g. 40- 400 mg/dL), incapable of monitoring critically high or low glucose levels of ill patients.
- False Readings and Interferences: Temporary False Readings, especially by CGM models can be caused by medications such as acetaminophen that give false high glucose readings several hours later.
- Physical, Psychological: Users could be affected by discomfort or body image issues with respect to sensor size, insertion locations, or visibility. It may even be physically intrusive that the visibility of a sensor needs to be always worn.
- Cost and Insurance Coverage: Due to insurance coverage, CGMs are not always fully covered, which may interfere with the ability of a patient group to afford it.
- User Challenges: The inaccuracy of data may cause users to over-correct with either food or insulin that may cause a person to become unstable in their glucose levels. The barrier to optimal use may also be driven by the lack of familiarity of healthcare providers with CGM technology.
- Special Populations Limitations: Special conditions in popAs factors such as severe edema, hypoalbuminemia, or hepatic failure can influence the associations between blood and interstitial levels of glucose, eliminating CGM validity.
Who Should Consider Using a CGM?
People who should consider using a Continuous Glucose Monitor (CGM) generally include:
Adults with type 1 diabetes who:
- Have more than one event of severe hypoglycemia annually with no apparent cause.
- Lose hypoglycemia awareness.
- A higher frequency of asymptomatic hypoglycemia (more than 2 episodes/week) impacting daily life.
- Are afraid of hypoglycemia.
- High HbA1C with high testing of glucose levels (e.g. > 10 times per day).
- Be in their pregnancy (especially advisable to type 1 diabetic pregnant women).
- Express willingness to use the CGM device on a regular basis (e.g. more than 70 percent).
- Require specialist assistance in the use of CGMs.
Children with diabetes who:
- Experience regular, severe hypoglycemia.
- Experience hypo unawareness and have serious consequences.
- Unable to describe symptoms of hypoglycemia because of developmental or neurological impairments.
- Are under school age, competitive athletes, or have comorbid conditions that complicate treatment.
People with type 2 diabetes who:
- Receive multiple insulin injections or insulin pumps every day,
- Are prone to episodes of frequent hypoglycemia or hypoglycemia unawareness,
- Excessive glycemic swings or inability to attain glucose goals,
- Experience unstable blood sugar or serious hypoglycemia (such as pregnant women with diabetes type 2 or diabetes in pregnancy).
You may also like to read: Role of Insulin Pumps in Diabetes Management
Additional criteria for CGM eligibility may include:
· Capacity to be trained to use the system effectively.
· The presence of healthcare to use it appropriately and control it.
· Satisfying requirements of 3 insurers or healthcare programs.
Insurance and healthcare program criteria are diverse, although most will suggest CGM in those at risk of adverse hypoglycemia in insulin-treated diabetics.
Practical Tips for Using CGM Effectively
Here are practical tips for using Continuous Glucose Monitoring (CGM) effectively:
- Establish Very Specific Targets: In collaboration with the healthcare providers, develop personalized goals that can be useful or related to the levels of glucose, including time in range (TIR), time below range (TBR), and time above range (TAR). This aids in planning insulin, meals and physical activity.
- Record Contextual Data: Note what influences the glucose levels, e.g. carbohydrate intake, insulin or medication dosage, exercise, stress, sleep, and illnesses. Several CGM apps automate or manually track these data to provide their insights.
- Review Data Consistently: Instead of looking at individual glucose value, look at trends over days or weeks values. Determining the patterns across the day such as pre-meal, post-meal, overnight, or exercise-related can guide specific changes.
- Ensure Accurate Sensor Use:
- Place sensors on clean dry skin and consider adhesive reinforcements to fix these sensors into place.
- It is best not to calibrate CGM when glucose is changing rapidly or when there is a low glucose level.
- Day-one accuracy is lower; result: some users delay sensors start to enhance day-one accuracy.
- Wash hands prior to fingerstick tests that are used to calibrate or check CGM results.
- Trend Arrows to make Insulin Decisions: Trend arrows are a display in CGM devices specifying the direction and pace of glucose change. They enable prediction of highs or lows and corrective proactive adjustments in insulin or carbs.
- Don t Overrespond to Alarms: Do not react harshly to high or low alerts without regard to active insulin on board and glucose trends to avoid overcorrection (rage bolus).
- Check with Fingersticks as Necessary: If symptoms do not correlate with CGM, or device indicates problems, a fingerstick can confirm glucose values to make treatment decisions.
- Sensor Adhesion: Secure Sensors by using tapes or adhesives such as Skin-Tac or Simpatch to keep them on and avoid peeling off, particularly during physical activity or showering.
- Know When to Call Healthcare Providers: Call or text in case of repetitive unexplained elevations or lows, sensor malfunctions, glucose trends shifts or unusual CGM values.
Conclusion
CGMs have their potent benefits, including the real-time monitoring process and a reduced number of finger-pricking sessions to diabetes management and awareness of lifestyles. Simultaneously, the difficulty of cost, the accuracy of the devices, skin irritation, and information overload make it not without flaws. CGM is life-changing for ordinary individuals with diabetes and primarily for those undergoing insulin treatment. Nevertheless, it is necessary to evaluate the advantages and dangers of continuous glucose monitoring to decide whether this device is the one you need to improve your health.