All diabetics know that regularly monitoring the level of glucose in their blood is necessary if they are to control their diabetes, but many find regular testing difficult. A novel monitoring system … flash glucose monitoring … is currently undergoing clinical testing. But what is FGM and will it indeed be an improvement over traditional self-monitoring?
Monitoring is vital for ensuring ensure proper management of your diabetes.
Common sense would suggest that if you don’t know what your blood glucose levels are, you will find it impossible to control those levels using diet and exercise.
Type 2 diabetics are usually expected to check their blood glucose levels on awaking in the morning and two hours after each meal. Most of us who do so use a self-monitoring device.
Self-monitoring involves extracting a pin prick of blood using a lancet and then using a disposable test strip inserted into a small glucose meter to measure the glucose level in the sample of blood.
The method is accurate and reliable. Yet 67 percent of persons with type 2 diabetes and 60 percent of those with type 1 diabetes fail to monitor their glucose levels adequately.
A recent pan-European survey asked diabetics why they don’t monitor their glucose levels regularly.
Forgetfulness was cited as a reason by 40 percent, another 33 percent said they were tired of testing, 21 percent found it to be inconvenient, while 16 percent said they dislike the pain involved.
Others cited a lack of time, a lack of privacy, the cost of test-strips, and a feeling of embarrassment if they are not at home when it is time to do the test.
Continuous glucose monitoring
Continuous glucose monitoring (CGM) was introduced in 1999. As it overcomes many of the problems associated with traditional self-monitoring, it is viewed as an improvement.
In GCM a tiny sensor is inserted under the skin to check glucose levels. The sensor can stay in place for up to a week after which it must be replaced.
A radio transmitter sends data from the sensor to a receiver worn by the patient. The receiver looks like an old-fashioned pager and is usually worn on a belt.
CGM enables better tracking of glucose levels and hence improved glucose control. The system provides real-time measurements of glucose, with levels being recorded at regular intervals of five minutes or less. Users can set alarms to alert them when glucose is too high or too low. A CGM device comes with software for downloading to a computer for analysis.
A major drawback for CGM is that the devices are not as accurate and reliable as self-monitoring meters. In addition, before use, a CGM needs to be calibrated by checking samples of blood with a glucose meter.
CGM is also expensive and very few diabetics can afford to use them.
Flash glucose monitoring
In order to improve accuracy, avoid the need for calibration and (perhaps) reduce costs, flash glucose monitoring (FGM) is being introduced by Abbott, a pharmaceutical company.
The device, which is still at the clinical trials stage, collects glucose data continuously.
Similar to the current CGM, FGM will be based on a glucose sensor worn on the skin for up to 14 days. The sensor will be about the size of a silver-dollar and about as thick as the width of a finger.
The system will include a touchscreen reader. A user will have to scan the reader over the sensor to get a glucose value in real-time, a trend line and a graph covering the previous eight hours.
The system will be calibrated at the factory, so users will not have to use a traditional monitor for calibration before using the device.
FGM has been designed as an improvement over traditional self-monitoring and for overcoming some of the limitations of CGM.
The device will not have an alarm for levels that are too low or too high because the user must physically scan the reader over the patch in order to obtain information on his glucose level. In doing so the user will be able to see the levels so an alarm is not needed.
FGM is expected, provided clinical trials prove satisfactory, to be on the market in late 2014. It should enable patients to check their glucose levels without the problems associated with traditional self-monitoring.
The system could be particularly useful for children and the elderly who may feel the pain of the finger-pricking that is an integral part of self-monitoring more than others.
It is also expected to be useful for pregnant women who may have to test ten times a day or more, and patients in hospital.
The continuous real-time nature of the data and the trends that will be visible should also benefit people with prediabetes, as they should be able to learn what makes their blood glucose levels rise by studying the data. This should enable them to control their glucose before they become full-blown diabetics.
Overall, the continuous availability of glucose data though FGM should make it much easier for all diabetics to optimise the management of their diabetes.