While there are recommendations regarding the frequency of testing, the frequency of BGM depends on the type of diabetes, the complexity of treatment, and individual characteristics along with how the data will be used. For example, the patient with well- controlled type 2 diabetes using meal planning and exercise may only need to monitor fasting levels daily or several times per week. The patient with type 2 taking oral medication may be asked to monitor fasting and postprandial levels. The patient using flexible insulin dosing and carbohydrate counting is likely to test before each meal, at bedtime, and periodically after meals. Patients are also encouraged to test more often when any changes to their treatment regimens occur. For example, the patient moving from oral agents to insulin or the patient moving from two to three daily Continuous glucose monitoring Blood glucose levels fluctuate widely throughout the day and are influenced by a multiple of internal and external factors. Intermit - tent glucose testing regimens may not reflect these fluctuations and increased testing may be inconvenient or unachievable for a given patient. BGM is paramount in achieving optimal glycemic targets but only to the extent that the readings are accurate and timely. In the early 2000s, real-time continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitor- The technology of a CGM A CGM device is a wearable body sensor that automatically and repeatedly measures blood glucose levels 24 hours a day (every 5 to 15 minutes). Parts of a CGM device include a wearable sensor, a transmitter that wirelessly sends readings, and a receiver that displays the readings to the user. Figure 4 displays the various parts of a CGM. A CGM provides an accurate picture of blood glucose levels, allowing the patient to assess glycemic patterns quickly. Figure 4. CGM Device
injections will benefit from testing four times a day. Regardless of testing frequency, the most critical issue is whether the patient knows what to do with the information obtained with BGM 8,9 . Diabetes educators and other healthcare professionals often use BGM results to demonstrate the impact of exercise, medications, and specific foods on blood glucose levels. It is also common for a patient to have elevated blood glucose values during periods of physiologic stress, such as during acute illness. For this reason, all patients are advised to monitor more often on sick days. Capillary blood glucose levels for hospitalized patients with diabetes should be performed four times daily. ing became available and recommended by the ADA and AACE for all persons with diabetes, especially those on intensive insulin therapy. Study findings have demonstrated that use of CGM has significantly reduced hypoglycemia compared to BGM alone in patients with type 1 diabetes 10 . In addition, significant reduc - tions have been shown in A1C among children, adults, and older adults 11,12 using CGM. real-time glucose readings wirelessly to a receiver to view the in- formation. Data are viewed on the receiver and can be down- loaded for reports. The technology used in CGM systems, and most home blood glucose meters, relies on measuring an elec- trochemical signal generated from the reaction of an enzyme, glucose-oxidase, with glucose. CGM measures blood glucose continuously, as often as every 5 minutes, with close to 300 measurements per day. With so many glucose measurements throughout the day, CGM provides trend information about the direction and rate of changing glucose con- centrations. Furthermore, many CGM devices sound alarms to warn of low or high, or falling or rising glucose levels. In addition, a CGM can connect to an insulin pump that automatically adjusts or suspends insulin delivery in response to glycemic trends 13 . Evidence-Based Practice: Continuous glucose monitoring (CGM) is clinically valuable in reducing risks of hypoglycemia and hyperglycemia, improving glycemic variability, and im- proving the quality of life for people with type 1 and type 2 diabetes 4 . CGM should be offered to everyone with diabetes who uses multiple daily insulin injections. Depending on the brand of CGM, it may have the ability to integrate with an in- sulin pump. Self-Assessment Quiz Question #1 What is the added value of continuous glucose monitoring (CGM) over fingerstick blood glucose monitoring (BGM)? a. CGM is less expense, since there is no need to purchase a lancet or test strips to use with a glucometer. b. CGMs provide a direct measure of glucose in the plasma. c. CGMs provide a more complete picture of how blood glucose levels change over time. d. CGMs tell why blood glucose increases or decreases. People also have the option to self-pay. The pumps are similar but vary in some of their features. For example, the Guardian Con- nect does not use a receiver, whereas the other three monitors do. Three of the monitors have an iPhone and an Android app, while the Libre 2 does not. The Dexcom G6 and Guardian Con- nect CGMs provide real-time readings, while the Libre models re- quire the user to scan the sensor to get a reading. For most of the current CGMs, the sensor is worn on either the abdomen or the upper arm depending on the monitor. And only some monitors
From Popov, A. Woman holding smartphone in hand with bad level of blood sugar on the screen. (https://www.dreamstime.com/woman- holding-smartphone-hand-bad-level-blood-sugar-screen-woman- checking-blood-sugar-level-smart-phone-image182255889). Copyright © 2000-2022 Dreamstime. All rights reserved. CGM works by utilizing a tiny sensor inserted under the skin via an applicator and secured with an adhesive patch. The sensor is inserted into the abdomen or back of the arm. Attached to the sensor is a glucose-oxidase platinum electrode that measures the glucose concentration found in interstitial fluid throughout the day and night. A transmitter connects to the sensor and sends Selecting a CGM device There are currently (as of September 2022) four continuous glu- cose monitors available for people with diabetes who are not us- ing an insulin pump. Some of the insulin pumps have a specific CGM to be used in tandem with the specific insulin pump (e.g., the Tandem insulin pump integrates with a Decom G6 CGM, and the Medtronic insulin pump integrates with a Guardian 3 CGM). People not on an insulin pump can choose a Dexcom G6, a Li- bre 14, a Libre 2, or a Guardian Connect. Insurance companies vary in their requirements for coverage and the brands they cover.
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