Continuous Glucose Monitoring: A modern approach to managing Diabetes.

Considering the ever-growing number of patients with diabetes, their commitment to sufficient and high-quality glycemic control appears to be extremely important. And nowadays, more and more patients are beginning to use modern technologies to control their disease. This also applies to continuous glycemic monitoring. 

The prevalence of diabetes mellitus (DM) has been steadily increasing in recent years, which is a serious threat to the entire population and represents one of the main medical and social health problems. Currently, chronic hyperglycemia, as well as pronounced fluctuations in glycemic levels during the day, are considered as the leading factors in the development of vascular complications of diabetes. According to the results of the DCCT (Diabetes Control and Complication Trial) and other large studies, intensive therapy for diabetes, including frequent regular self-monitoring of glycemia, can reduce the severity of complications of diabetes and prevent their formation. Such visibility contributes to both greater adherence of patients to the recommendations of the attending physician, and improving their quality of life due to the ability to manage their own disease.

Measuring the level of glycated hemoglobin (HbA1c) remains an important indicator for assessing glycemic control and predicting the risk of long-term complications; it also has some limitations: it provides an idea only of the average glucose concentration over the last 2-3 months; does not detect episodes of hypo- or hyperglycemia on a daily basis; is an unreliable indicator in patients with anemia, hemoglobinopathy and iron deficiency, as well as during pregnancy; does not reflect daily glycemic variability associated with both micro- and macrovascular complications.

    Thus, although such traditional methods of monitoring carbohydrate metabolism as measuring HbA1c and periodic self-monitoring of glycemia using a glucometer confirm their value in managing patients and assessing the effectiveness of their treatment, these parameters are currently losing their relevance because they do not provide individual approach in modern diabetes management. In this sense, modern practice is using continuous glucose monitoring, or CGM, more and more.Without a doubt, this approach plays a crucial role in the management of both type 1 and type 2 diabetes and greatly broadens our understanding of the quality of compensation for carbohydrate metabolism.
Causes Of Diabetes: 

1.    Genetic predisposition. There are genes that can increase the risk of developing diabetes. 

2.    Pancreatic dysfunction. The pancreas does not produce enough insulin or cannot use it effectively. 

3.    Insufficient physical activity. Not getting enough physical activity can lead to weight gain and the development of type 2 diabetes. 

4.    Obesity. Excess weight puts additional stress on the body and can cause the development of type 2 diabetes. 

5.    Poor nutrition. Eating large amounts of foods rich in sugar and fat may increase your risk of developing diabetes. 

Consequences of diabetes: 

1.     Cardiovascular diseases. Long-term elevated blood sugar levels can lead to vascular damage and heart disease. 

2.    Visual impairment. Blood sugar levels can damage the retina of the eye and lead to retinopathy or even blindness. 

3.    Damage to the nervous system. High blood sugar can cause diabetic neuropathy, which is accompanied by burning, numbness and pain in the legs and arms. 

4.    Kidney problems. Having diabetes increases your risk of developing chronic kidney disease and kidney failure. 

5.    Reproductive system health problems. Blood sugar levels can affect the health of the male and female reproductive organs, leading to problems with sexual function and genital diseases.

What is Continuous Glucose Monitoring (CGM) ?

Continuous glucose monitoring (CGM) is a key tool for diabetes management, allowing patients to know their blood glucose levels in real time. Technological innovations in CGM are constantly evolving, improving the quality of life of diabetics.

 One of the most significant innovations is the introduction of non-piercing needle sensors, which allow continuous glucose measurements without the need to pierce the skin each time. This significantly reduces pain and the risk of infection and improves patient compliance with monitoring procedures.

Traditional methods of controlling diabetes mellitus :

High blood glucose is a hallmark of diabetes mellitus, a chronic illness. Using a glucometer to measure blood glucose is the primary way to check sugar levels. With the help of this portable gadget, patients may keep an eye on their own blood sugar levels by puncturing their finger and adding a drop of blood to a test strip, which is subsequently measured by a glucometer. 

Another traditional method of controlling diabetes is physical activity. Regular exercise can help lower blood glucose levels, improve overall health, and reduce the risk of complications. Patients are encouraged to participate in aerobic exercise such as walking, swimming or cycling, as well as strength training to improve overall body fitness.

The need for continuous glucose monitoring :

Diabetes mellitus is a serious disease that requires constant monitoring of blood glucose levels. Continuous glucose monitoring (CGM) allows patients to monitor changes in their body's sugar levels in real time and take appropriate action to maintain optimal health. 

One of the advantages of CGM is the ability to observe not only the current glucose level, but also its dynamics. This allows patients and their doctors to notice trends and tendencies affecting their sugar levels and take appropriate measures to correct them. 

CGM also helps patients understand how various factors, such as diet, physical activity or stress, affect their glucose levels. This allows us to develop an individual diabetes management plan that takes into account the specific needs and characteristics of each patient.

The ease of use of CGM also plays an important role. Modern glucose monitoring systems can be compact and discrete, allowing patients to optimally integrate them into their daily lives. In addition, some systems offer the ability to transmit data directly to the doctor through mobile applications, which simplifies the process of monitoring and managing the disease.

How Continuous Glucose Monitoring Works?

Continuous glucose monitoring is an innovative technology designed to continuously monitor blood sugar levels in patients with diabetes. The basic principle of operation of this system is to continuously measure the level of glucose in the intercellular fluid using a special sensor. 

The sensor is inserted into the subcutaneous tissue and comes into contact with the intercellular fluid, where glucose oxidation occurs, accompanied by the release of electrons. A special electrode in the sensor measures these electrochemical signals and converts them into numerical data.

The collected data is transferred to a wearable device, which analyzes the information and displays the current glucose level on the screen. Many systems can also transmit data to a smartphone or other device for additional monitoring and analysis.  
In addition to continuous measurement, glucose monitoring systems often have additional features such as glucose spike alerts, glucose trends, and the ability to set thresholds for hypo- or hyperglycemia warnings. 

 Accuracy and reliability of continuous glucose monitoring :

Continuous glucose monitoring (CGM) is an innovative technology that allows diabetic patients to monitor their blood glucose levels throughout the day and night. One of the key criteria for the effectiveness of CGM is its accuracy and reliability.

Manufacturers routinely conduct studies to evaluate the accuracy and reliability of their continuous glucose monitoring systems. As a result of this research, algorithms and software are being developed that can improve the quality of data received from sensors.

The accuracy and reliability of the CGM depends not only on the sensor, but also on proper calibration and use of the system. It is critical for patients to follow the instructions for use and regularly check their results with a blood glucose meter. It is through the accuracy and reliability of continuous glucose monitoring that diabetic patients can get a clearer picture of their condition and take effective measures to maintain stable blood glucose levels.

 Ease of use of continuous glucose monitoring :

 Continuous glucose monitoring (CGM) provides diabetic patients with the ability to more accurately monitor their blood sugar levels in real time. One of the main advantages of NMG is its ease of use.

 With continuous glucose monitoring, patients no longer have to undergo multiple blood tests and injections throughout the day. A body-mounted continuous glucose monitoring sensor is capable of automatically measuring blood sugar levels without patient intervention. 

 The information obtained about glucose is displayed on a special device or mobile application, allowing the patient to promptly respond to changes in sugar levels and take appropriate measures to maintain them within normal limits. 

 In addition, continuous glucose monitoring offers patients benefits in terms of convenience in performing daily tasks. When using a CGM, patients can sleep with a glucose monitor without worrying about data loss or incorrect measurements. Some CGM sensors are also waterproof, allowing patients to shower or swim without having to remove them.  

Benefits of CGM compared to traditional methods :

1.    CGM provides continuous data on blood glucose levels throughout the day. This allows you to more accurately track the dynamics of sugar changes and identify trends. Such information is useful for patients with diabetes to make more informed decisions about sugar control and adjust their treatment regimen. 

2.     It significantly reduces the need for finger pricking to obtain blood for glucose testing. A special sensor embedded in the tissue under the skin allows you to measure glucose levels in a painless way. This is especially important for children and people who are afraid of injections.  

3.    It provides the ability to set low or high glucose alerts. This helps prevent acute complications and take timely measures. For example, if glucose levels decrease, the patient can immediately take fast carbohydrates to prevent hypoglycemia. This reduces the risk of serious complications and helps maintain stable blood sugar levels. 

 Individualise therapy using continuous glucose monitoring :

 Continuous glucose monitoring (CGM) opens up new opportunities for an individualised approach to the treatment of diabetes mellitus. This technology allows patients to monitor their blood glucose levels in real time, providing a more accurate and detailed view of their blood sugar trends. 

 CGM can identify peaks and valleys in glucose that may go undetected using traditional self-monitoring. Such data allows doctors to more accurately adjust their insulin therapy regimen and help patients achieve optimal glycemic levels. CGM also helps patients better understand how factors such as diet, physical activity and stress affect glucose levels. This allows patients to more effectively manage their condition and take steps to avoid acute and chronic complications of diabetes. 
 
To successfully individualize therapy with CGM, it is important not only to collect glucose data, but also to analyze it. Doctors use special programs and algorithms to interpret data and make decisions about adjusting doses of insulin or other medications. This process requires close interaction between the doctor and the patient, which allows the treatment to be optimally tailored and tailored to the individual needs of each patient.  

 Healthy lifestyle and continuous glucose monitoring :

A healthy lifestyle is key to successfully managing diabetes. It includes regular physical activity, a balanced diet and giving up bad habits. But along with this, continuous glucose monitoring also plays an important role. 

 This approach to glucose monitoring allows patients to be aware of their glycemic status at any given time. This helps prevent dangerous spikes or drops in glucose levels, optimize your insulin regimen, and take timely steps to maintain optimal blood sugar levels. 

 The combination of a healthy lifestyle and continuous glucose monitoring gives patients optimal control over their health. Understanding how physical activity, diet, and habits will affect your glucose levels allows you to make better decisions and take steps to keep your glucose levels stable.

Conclusions :

1.    More precise glucose control. 
2.    Faster detection and correction of hyperglycemia and hypoglycemia. 
3.    Improving the quality of life of patients with diabetes. 
4.    Reducing the risk of diabetes complications. 

Continuous glucose monitoring also allows patients and their doctors to better understand the relationship between physical activity, diet, and insulin use and glucose levels. This helps optimize treatment and achieve more stable glycemic levels. Although continuous glucose monitoring has many benefits, it is still an expensive procedure. However, with advances in technology and improved availability of devices, its use is becoming more common and accessible to patients. 

Overall, continuous glucose monitoring is an important tool in diabetes management and helps patients achieve more stable blood sugar control, improve quality of life, and prevent complications.

Contributed by Dr. Rakesh Kumavat (MBBS)
Team Proceed.Fit

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