Continuous Blood Glucose Monitoring: Potential Applications from Diabetes Management
Main Article Content
Abstract
Continuous glucose monitoring (CGM) is a transformative technology in diabetes management. By providing real-time interstitial glucose readings, CGM offers insights into glycemic patterns that were previously inaccessible with traditional self-monitoring of blood glucose. This review delves into the fundamentals of CGM, including sensor technology, placement considerations, and factors affecting measurement accuracy. Various CGM-derived metrics, such as Time in Range (TIR), Ambulatory Glucose Profile (AGP), Continuous Overall Nett Glycemic Action (CONGA), and Mean of Daily Differences (MODD), are examined, highlighting their distinct roles in assessing glycemic control. This review discusses the current clinical applications of CGM and its potential benefits for personalized therapy and patient self-management. Furthermore, this review explores ongoing research to refine CGM technology, develop novel metrics, and expand its applications beyond established diabetes care into areas such as prediabetes and athletic performance. Ultimately, CGM is poised to play an increasingly central role in optimizing glucose control, reducing diabetes-related complications, and improving the quality of life in individuals with diabetes.
Downloads
Article Details
References
Kubiak T, Mann CG, Barnard KC, Heinemann L. Psychosocial Aspects of Continuous Glucose Monitoring: Connecting to the Patients' Experience. J Diabetes Sci Technol. 2016;10(4):859-63. DOI: 10.1177/1932296816651450
Vashist SK. Continuous Glucose Monitoring Systems: A Review. Diagnostics (Basel). 2013;3(4):385-412. DOI: 10.3390/diagnostics3040385
Bailey CJ, Gavin JR, 3rd. Flash Continuous Glucose Monitoring: A Summary Review of Recent Real-World Evidence. Clin Diabetes. 2021;39(1):64-71. DOI: 10.2337/cd20-0076
Laffel LM, Kanapka LG, Beck RW, Bergamo K, Clements MA, Criego A, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA. 2020;323(23):2388-96. DOI: 10.1001/jama.2020.6940
Mauras N, Beck R, Xing D, Ruedy K, Buckingham B, Tansey M, et al. A randomized clinical trial to assess the efficacy and safety of real-time continuous glucose monitoring in the management of type 1 diabetes in young children aged 4 to <10 years. Diabetes Care. 2012;35(2):204-10. DOI: 10.2337/dc11-1746
Gal RL, Cohen NJ, Kruger D, Beck RW, Bergenstal RM, Calhoun P, et al. Diabetes Telehealth Solutions: Improving Self-Management Through Remote Initiation of Continuous Glucose Monitoring. J Endocr Soc. 2020;4(9):bvaa076. DOI: 10.1210/jendso/bvaa076
Williams L, Deacon E, Van Rensburg E, Segal D. Continuous glucose monitoring empowers adolescents to take responsibility of diabetes management. Afr J Prim Health Care Fam Med. 2023;15(1):e1-e6. DOI: 10.4102/phcfm.v15i1.3879
Signal M, Thomas F, Shaw GM, Chase JG. Complexity of continuous glucose monitoring data in critically ill patients: continuous glucose monitoring devices, sensor locations, and detrended fluctuation analysis methods. J Diabetes Sci Technol. 2013;7(6):1492-506. DOI: 10.1177/193229681300700609
Thomas F, Signal M, Harris DL, Weston PJ, Harding JE, Shaw GM, et al. Continuous glucose monitoring in newborn infants: how do errors in calibration measurements affect detected hypoglycemia? J Diabetes Sci Technol. 2014;8(3):543-50. DOI: 10.1177/1932296814524857
Thomas F, Pretty CG, Desaive T, Chase JG. Blood Glucose Levels of Subelite Athletes During 6 Days of Free Living. J Diabetes Sci Technol. 2016;10(6):1335-43. DOI: 10.1177/1932296816648344
Mohd Daud SM, Sukri NM, Johari MH, Gnanou J, Manaf FA. Pure Juice Supplementation: Its Effect on Muscle Recovery and Sports Performance. Malays J Med Sci. 2023;30(1):31-48. DOI: 10.21315/mjms2023.30.1.4
Mohd Sukri N, Ooi FK, Chen CK, Sirajudeen KNS. Effect of Acacia Honey Drink Consumed Pre and During Exercise on Glucose Metabolism, Total Antioxidant Status, and Running Performance in the Heat. IIUM Medical Journal Malaysia. 2022;21(3). DOI: 10.31436/imjm.v21i3.1732
Ishihara K, Uchiyama N, Kizaki S, Mori E, Nonaka T, Oneda H. Application of Continuous Glucose Monitoring for Assessment of Individual Carbohydrate Requirement during Ultramarathon Race. Nutrients. 2020;12(4). DOI: 10.3390/nu12041121
Francois ME, Cosgrove SD, Walker NM, Lucas SJ, Black KE. Physiological responses to a five-day adventure race: Continuous blood glucose, hemodynamics and metabolites the 2012 GODZone field-study. J Exerc Sci Fit. 2018;16(3):78-82. DOI: 10.1016/j.jesf.2018.07.002
Sengoku Y, Nakamura K, Ogata H, Nabekura Y, Nagasaka S, Tokuyama K. Continuous glucose monitoring during a 100-km race: a case study in an elite ultramarathon runner. Int J Sports Physiol Perform. 2015;10(1):124-7. DOI: 10.1123/ijspp.2013-0493
Shah VN, DuBose SN, Li Z, Beck RW, Peters AL, Weinstock RS, et al. Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study. J Clin Endocrinol Metab. 2019;104(10):4356-64. DOI: 10.1210/jc.2018-02763
Holzer R, Bloch W, Brinkmann C. Continuous Glucose Monitoring in Healthy Adults-Possible Applications in Health Care, Wellness, and Sports. Sensors (Basel). 2022;22(5). DOI: 10.3390/s22052030
Klonoff DC, Ahn D, Drincic A. Continuous glucose monitoring: A review of the technology and clinical use. Diabetes Res Clin Pract. 2017;133:178-92. DOI: 10.1016/j.diabres.2017.08.005
Rodbard D. Continuous Glucose Monitoring: A Review of Successes, Challenges, and Opportunities. Diabetes Technol Ther. 2016;18 Suppl 2(Suppl 2):S3-S13. DOI: 10.1089/dia.2015.0417
Reddy M, Jugnee N, El Laboudi A, Spanudakis E, Anantharaja S, Oliver N. A randomized controlled pilot study of continuous glucose monitoring and flash glucose monitoring in people with Type 1 diabetes and impaired awareness of hypoglycaemia. Diabet Med. 2018;35(4):483-90. DOI: 10.1111/dme.13561
Wysham CH, Kruger DF. Practical Considerations for Initiating and Utilizing Flash Continuous Glucose Monitoring in Clinical Practice. J Endocr Soc. 2021;5(9):bvab064. DOI: 10.1210/jendso/bvab064
Slattery D, Choudhary P. Clinical Use of Continuous Glucose Monitoring in Adults with Type 1 Diabetes. Diabetes Technol Ther. 2017;19(S2):S55-S61. DOI: 10.1089/dia.2017.0051
Reddy M, Jugnee N, Anantharaja S, Oliver N. Switching from Flash Glucose Monitoring to Continuous Glucose Monitoring on Hypoglycemia in Adults with Type 1 Diabetes at High Hypoglycemia Risk: The Extension Phase of the I HART CGM Study. Diabetes Technol Ther. 2018;20(11):751-7. DOI: 10.1089/dia.2018.0252
Zaharieva DP, Riddell MC, Henske J. The Accuracy of Continuous Glucose Monitoring and Flash Glucose Monitoring During Aerobic Exercise in Type 1 Diabetes. J Diabetes Sci Technol. 2019;13(1):140-1. DOI: 10.1177/1932296818804550
Bauhaus H, Erdogan P, Braun H, Thevis M. Continuous Glucose Monitoring (CGM) in Sports-A Comparison between a CGM Device and Lab-Based Glucose Analyser under Resting and Exercising Conditions in Athletes. Int J Environ Res Public Health. 2023;20(15). DOI: 10.3390/ijerph20156440
Cash KJ, Clark HA. Nanosensors and nanomaterials for monitoring glucose in diabetes. Trends Mol Med. 2010;16(12):584-93. DOI: 10.1016/j.molmed.2010.08.002
Ravi SJ, Coakley A, Vigers T, Pyle L, Forlenza GP, Alonso T. Pediatric Medicaid Patients With Type 1 Diabetes Benefit From Continuous Glucose Monitor Technology. J Diabetes Sci Technol. 2021;15(3):630-5. DOI: 10.1177/1932296820906214
Nik Shanita S, Rahman AHA, Azimah A, Mohamad Izham M, Othman NE, Chan YT, et al., editors. DietScore™: Sports Nutrition-based Mobile Application for Athletes and Active Individuals. 3rd International Conference on Movement, Health and Exercise; 2017 2017//; Singapore: Springer Singapore. DOI: 10.1007/97898110373751
Forlenza GP, Kushner T, Messer LH, Wadwa RP, Sankaranarayanan S. Factory-Calibrated Continuous Glucose Monitoring: How and Why It Works, and the Dangers of Reuse Beyond Approved Duration of Wear. Diabetes Technol Ther. 2019;21(4):222-9. DOI: 10.1089/dia.2018.0401
Vettoretti M, Cappon G, Acciaroli G, Facchinetti A, Sparacino G. Continuous Glucose Monitoring: Current Use in Diabetes Management and Possible Future Applications. J Diabetes Sci Technol. 2018;12(5):1064-71. DOI: 10.1177/1932296818774078
Castle JR, Jacobs PG. Nonadjunctive Use of Continuous Glucose Monitoring for Diabetes Treatment Decisions. J Diabetes Sci Technol. 2016;10(5):1169-73. DOI: 10.1177/1932296816631569
Roux de Bezieux H, Bullard J, Kolterman O, Souza M, Perraudeau F. Medical Food Assessment Using a Smartphone App With Continuous Glucose Monitoring Sensors: Proof-of-Concept Study. JMIR Form Res. 2021;5(3):e20175. DOI: 10.2196/20175
Dehghani Zahedani A, Shariat Torbaghan S, Rahili S, Karlin K, Scilley D, Thakkar R, et al. Improvement in Glucose Regulation Using a Digital Tracker and Continuous Glucose Monitoring in Healthy Adults and Those with Type 2 Diabetes. Diabetes Ther. 2021;12(7):1871-86. DOI: 10.1007/s13300-021-01081-3
Fokkert MJ, van Dijk PR, Edens MA, Abbes S, de Jong D, Slingerland RJ, et al. Performance of the FreeStyle Libre Flash glucose monitoring system in patients with type 1 and 2 diabetes mellitus. BMJ Open Diabetes Res Care. 2017;5(1):e000320. DOI: 10.1136/bmjdrc-2016-000320
Kawakatsu S, Liu X, Tran B, Tran BP, Manzanero L, Shih E, et al. Differences in Glucose Readings Between Right Arm and Left Arm Using a Continuous Glucose Monitor. J Diabetes Sci Technol. 2022;16(5):1183-9. DOI: 10.1177/19322968211008838
Coates AM, Cohen JN, Burr JF. Investigating sensor location on the effectiveness of continuous glucose monitoring during exercise in a non-diabetic population. Eur J Sport Sci. 2023;23(10):2109-17. DOI: 10.1080/17461391.2023.2174452
Freckmann G, Pleus S, Grady M, Setford S, Levy B. Measures of Accuracy for Continuous Glucose Monitoring and Blood Glucose Monitoring Devices. J Diabetes Sci Technol. 2019;13(3):575-83. DOI: 10.1177/1932296818812062
Pleus S, Stuhr A, Link M, Haug C, Freckmann G. Variation of Mean Absolute Relative Differences of Continuous Glucose Monitoring Systems Throughout the Day. J Diabetes Sci Technol. 2022;16(3):649-58. DOI: 10.1177/1932296821992373
Schierenbeck F, Franco-Cereceda A, Liska J. Accuracy of 2 Different Continuous Glucose Monitoring Systems in Patients Undergoing Cardiac Surgery. J Diabetes Sci Technol. 2017;11(1):108-16. DOI: 10.1177/1932296816651632
Munekage M, Yatabe T, Sakaguchi M, Kitagawa H, Tamura T, Namikawa T, et al. Comparison of Subcutaneous and Intravenous Continuous Glucose Monitoring Accuracy in an Operating Room and an Intensive Care Unit. Journal of Artificial Organs. 2015;19(2):159-66. DOI: 10.1007/s10047-015-0877-2
Pleus S, Schoemaker M, Morgenstern K, Schmelzeisen-Redeker G, Haug C, Link M, et al. Rate-of-Change Dependence of the Performance of Two CGM Systems During Induced Glucose Swings. J Diabetes Sci Technol. 2015;9(4):801-7. DOI: 10.1177/1932296815578716
Moser O, Eckstein ML, Mueller A, Birnbaumer P, Aberer F, Koehler G, et al. Impact of physical exercise on sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system in people with Type 1 diabetes: a randomized crossover trial. Diabet Med. 2019;36(5):606-11. DOI: 10.1111/dme.13909
Kim YI, Choi Y, Park J. The role of continuous glucose monitoring in physical activity and nutrition management: perspectives on present and possible uses. Phys Act Nutr. 2023;27(3):44-51. DOI: 10.20463/pan.2023.0028
Ozaslan B, Patek SD, Grabman JH, Shepard JA, Dassau E, Breton MD, et al. Body Mass Index Effect on Differing Responses to Psychological Stress in Blood Glucose Dynamics in Patients With Type 1 Diabetes. J Diabetes Sci Technol. 2018;12(3):657-64. DOI: 10.1177/1932296818758103
Kovatchev BP. Metrics for glycaemic control - from HbA(1c) to continuous glucose monitoring. Nat Rev Endocrinol. 2017;13(7):425-36. DOI: 10.1038/nrendo.2017.3
Rodbard D. Interpretation of continuous glucose monitoring data: glycemic variability and quality of glycemic control. Diabetes Technol Ther. 2009;11 Suppl 1:S55-67. DOI: 10.1089/dia.2008.0132
Rodbard D. Optimizing display, analysis, interpretation and utility of self-monitoring of blood glucose (SMBG) data for management of patients with diabetes. J Diabetes Sci Technol. 2007;1(1):62-71. DOI: 10.1177/193229680700100111
Wakasugi S, Mita T, Katakami N, Okada Y, Yoshii H, Osonoi T, et al. Associations between continuous glucose monitoring-derived metrics and diabetic retinopathy and albuminuria in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2021;9(1). DOI: 10.1136/bmjdrc-2020-001923
Akaza M, Akaza I, Kanouchi T, Sasano T, Sumi Y, Yokota T. Nerve conduction study of the association between glycemic variability and diabetes neuropathy. Diabetol Metab Syndr. 2018;10:69. DOI: 10.1186/s13098-018-0371-0
Di Flaviani A, Picconi F, Di Stefano P, Giordani I, Malandrucco I, Maggio P, et al. Impact of glycemic and blood pressure variability on surrogate measures of cardiovascular outcomes in type 2 diabetic patients. Diabetes Care. 2011;34(7):1605-9. DOI: 10.2337/dc11-0034
Ryan EA, Shandro T, Green K, Paty BW, Senior PA, Bigam D, et al. Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation. Diabetes. 2004;53(4):955-62. DOI: 10.2337/diabetes.53.4.955
Hill NR, Oliver NS, Choudhary P, Levy JC, Hindmarsh P, Matthews DR. Normal reference range for mean tissue glucose and glycemic variability derived from continuous glucose monitoring for subjects without diabetes in different ethnic groups. Diabetes Technol Ther. 2011;13(9):921-8. DOI: 10.1089/dia.2010.0247
Choudhary A, Antal Z. Assessment of impaired fasting glucose in obese and overweight insulin-resistant children by continuous glucose monitoring. J Diabetes Sci Technol. 2013;7(6):1646-7. DOI: 10.1177/193229681300700626
Bergenstal RM, Beck RW, Close KL, Grunberger G, Sacks DB, Kowalski A, et al. Glucose Management Indicator (GMI): A New Term for Estimating A1C From Continuous Glucose Monitoring. Diabetes Care. 2018;41(11):2275-80. DOI: 10.2337/dc18-1581
Beck RW, Bergenstal RM, Riddlesworth TD, Kollman C, Li Z, Brown AS, et al. Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials. Diabetes Care. 2019;42(3):400-5. DOI: 10.2337/dc18-1444
Lu J, Ma X, Zhou J, Zhang L, Mo Y, Ying L, et al. Association of Time in Range, as Assessed by Continuous Glucose Monitoring, With Diabetic Retinopathy in Type 2 Diabetes. Diabetes Care. 2018;41(11):2370-6. DOI: 10.2337/dc18-1131
Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593-603. DOI: 10.2337/dci19-0028
Marco A, Pazos-Couselo M, Moreno-Fernandez J, Diez-Fernandez A, Alonso-Sampedro M, Fernandez-Merino C, et al. Time above range for predicting the development of type 2 diabetes. Front Public Health. 2022;10:1005513. DOI: 10.3389/fpubh.2022.1005513
McDonnell CM, Donath SM, Vidmar SI, Werther GA, Cameron FJ. A novel approach to continuous glucose analysis utilizing glycemic variation. Diabetes Technol Ther. 2005;7(2):253-63. DOI: 10.1089/dia.2005.7.253
Mori H, Okada Y, Kurozumi A, Narisawa M, Tanaka Y. Factors influencing inter-day glycemic variability in diabetic outpatients receiving insulin therapy. J Diabetes Investig. 2017;8(1):69-74. DOI: 10.1111/jdi.12551
Xu F, Zhao LH, Su JB, Chen T, Wang XQ, Chen JF, et al. The relationship between glycemic variability and diabetic peripheral neuropathy in type 2 diabetes with well-controlled HbA1c. Diabetol Metab Syndr. 2014;6(1):139. DOI: 10.1186/1758-5996-6-139
Wang YM, Zhao LH, Su JB, Qiao HF, Wang XH, Xu F, et al. Glycemic variability in normal glucose tolerance women with the previous gestational diabetes mellitus. Diabetol Metab Syndr. 2015;7:82. DOI: 10.1186/s13098-015-0077-5
Munoz Fabra E, Diez JL, Bondia J, Laguna Sanz AJ. A Comprehensive Review of Continuous Glucose Monitoring Accuracy during Exercise Periods. Sensors (Basel). 2021;21(2). DOI: 10.3390/s21020479
Schmelzeisen-Redeker G, Schoemaker M, Kirchsteiger H, Freckmann G, Heinemann L, Del Re L. Time Delay of CGM Sensors: Relevance, Causes, and Countermeasures. J Diabetes Sci Technol. 2015;9(5):1006-15. DOI: 10.1177/1932296815590154
Kropff J, Choudhary P, Neupane S, Barnard K, Bain SC, Kapitza C, et al. Accuracy and Longevity of an Implantable Continuous Glucose Sensor in the PRECISE Study: A 180-Day, Prospective, Multicenter, Pivotal Trial. Diabetes Care. 2017;40(1):63-8. DOI: 10.2337/dc16-1525
Aberer F, Hajnsek M, Rumpler M, Zenz S, Baumann PM, Elsayed H, et al. Evaluation of subcutaneous glucose monitoring systems under routine environmental conditions in patients with type 1 diabetes. Diabetes Obes Metab. 2017;19(7):1051-5. DOI: 10.1111/dom.12907