Glucose monitoring in diabetes: from clinical studies to real‐world practice

Abstract

AbstractLowering glucose levels in diabetes prevents microvascular complications and long‐term macrovascular disease. HbA1c has long been used to guide management decisions, but it fails to address hypoglycaemia and glycaemic variability, both of which are associated with adverse clinical outcome.While self‐monitoring of blood glucose (SMBG) has had a pivotal role in improving glycaemia in diabetes, it provides incomplete glucose data and can be inconvenient to patients. Continuous glucose monitoring (CGM) has the advantage of greater convenience, comprehensive glucose measurements and hypoglycaemia alarms; the latter are particularly useful in individuals with hypoglycaemia unawareness. However, these devices are relatively expensive, limiting widespread use, and most require continued capillary glucose testing for calibration.The newer flash continuous glucose monitoring (FCGM) device has the advantage of lower costs, long sensor life and factory calibration, negating the need for routine SMBG. However, the lack of hypoglycaemia alarms can be an issue, although a newer generation of sensors will have alarm capability but yet to be released in the UK. Studies have conclusively shown that CGM and FCGM improve glycaemic parameters in individuals with type 1 diabetes, and studies in type 2 diabetes are also promising but limited to draw definitive conclusions on the best subgroup(s) to benefit from this technology.Despite some reluctance to use CGM and FCGM due to costs and lack of familiarity, there has been a gradual shift from SMBG to these newer glucose monitoring strategies in those with type 1 diabetes, thus improving glycaemic control and the quality of life of these individuals. Copyright © 2019 John Wiley & Sons.