19,20 This is particularly concerning when the patient is sleeping or engaged in activities that require full cognition (e.g., driving a car), especially when hypoglycaemia awareness is impaired. Because SMBG is dependent upon the patient’s decision to test, nocturnal and asymptomatic hypoglycaemia may go undetected. 19,20 Moreover, SMBG devices do not automatically warn patients of immediate or impending low/high glucose.
As such, it cannot predict impending hypoglycaemia or hyperglycaemia. First, SMBG only measures glucose at a single point in time, which provides no indication of the direction or velocity of changing glucose. 16–18 However, as with HbA1c measurement, SMBG also has notable limitations. Self-monitoring of blood glucose (SMBG) has long been considered a fundamental tool for effective management of insulin-treated diabetes, 13–15 and its usefulness in non-insulin-treated diabetes is now being recognised. 3,11,12 CGM is required to perform these calculations. Such parameters are time in hypoglycaemia, target and hyperglycaemia ranges, frequency of hypoglycaemic events (for at least 20 minutes) and glycaemic variability (coefficient of variation ), as recently proposed by several international medical organisations and others. Parameters other than HbA1c may prove to be of greater importance to future risk of complications. 10 Importantly, HbA1c does not provide guidance for daily adjustments in therapy. 5,6 We also know that HbA1c can be an unreliable measure during pregnancy 7 and in patients with iron deficiencies, 8 anemia 9 and haemoglobinopathies.
Nor does it reflect the occurrence or degree of daily glucose variability, which has been shown to be a consistent predictor of hypoglycaemia. For example, it does not reflect intra- and inter-day glycaemic excursions that may lead to hypoglycaemia or postprandial hyperglycaemia. However, HbA1c has several limitations that hinder its usefulness in daily diabetes self-management. It is a valuable tool for characterising population health and the primary intermediate outcome measure used by payers to assess the risk of developing complications. Glycated haemoglobin (HbA1c) remains the gold standard for assessing glycaemic control and predicting the risk of development of long-term complications by providing an average glucose level, as measured over the previous 2–3 months. The aim of this article is help healthcare professionals understand the differences between these new technologies and provide guidance in selecting the system that is most appropriate to the individual needs of their patients. Each has its own unique strengths and limitations that can impact their usefulness and acceptability within specific patient groups. Two types of CGM systems are currently available for daily diabetes self-management: real-time CGM (rtCGM) and intermittently scanned continuous glucose monitoring (isCGM), often referred to as ‘flash’ monitoring. Use of CGM is universally recommended by national and international medical organisations and expert clinician consensus. Unlike SMBG, CGM devices offer the ability to collect glucose information in a way that allows diabetes patients and their healthcare professionals to dynamically assess glucose levels and trends through a continuous stream of data. Type 1 diabetes, type 2 diabetes, selfmonitoringĭuring the past decade, we have seen a dramatic and growing shift from traditional self-monitoring of blood glucose (SMBG) to continuous glucose monitoring (CGM). Glucose monitoring (isCGM), flash, insulin, (rtCGM), intermittently scanned continuous Type that is most appropriate to the individual needs of their patients. This article explores the strengths and limitations of each approach and provides guidance to healthcare professionals in selecting the CGM
Both approaches provide continuous measurement of glucose concentrations in the interstitialįluid however, each has its own unique features that can impact their usefulness and acceptability within specific patient groups. Two types of continuous glucose monitoring (CGM) systems are currently available for daily diabetes self-management: real-time CGMĪnd intermittently scanned CGM.
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