The Use of Continuous Glucose Monitoring to Evaluate the Glycemic Response to Food

Abstract

After evaluating numerous patient glucose records, clinicians have remarked that if they could simply take food out of the equation, diabetes management would be so much easier. Achieving optimal postprandial glycemic control has proven to be a major challenge for clinicians and patients. Wide glucose excursions are potent activators of oxidative stress, one of the main contributors to vascular complications.1 Current nutrition recommendations for individuals with diabetes stress the importance of implementing mealtime interventions that reduce postprandial glucose (PPG) excursions.2 Yet doing so is challenging with available tools. Patients are frequently encouraged to check blood glucose levels preprandially and again 2 hours after the start of the meal to determine their glycemic response to the meal. This method often underestimates the peak glucose value and fails to identify the duration of the PPG excursion.3 Continuous glucose monitoring (CGM) has opened up a new world of opportunity to evaluate the glycemic effect of food, activity, medication, stress, and other factors. With the introduction of the MiniMed CGMS in 1999, a 3-day retrospective sensor, continuous monitoring data began to validate some of the theories on the glycemic effects of various foods and provided some unexpected discoveries. Today, real-time CGM systems display glucose readings every few minutes throughout the day and night, giving clinicians and patients a glimpse of information previously unavailable or difficult to ascertain through episodic self-monitoring of blood glucose (SMBG). CGM systems provide the opportunity for immediate feedback on the glycemic response of food choices. Glucose values, trend arrows, line graphs, and alarms viewed on the device screen provide real-time perspective. Patients and clinicians can also evaluate glycemic responses to foods and meals retrospectively by analyzing glucose trends and patterns from data management reports. Initially, clinicians were concerned that the extra data provided by CGM might be …