The future of glucose monitoring: Why blood-based measurements are important

Diabetes management has undergone a significant shift in recent years with the increase in continuous glucose monitors (CGM). These devices provide patients with an easier way to maintain blood sugar levels on traditional finger stabs. However, a deeper understanding of these devices and their measurements is essential for optimal diabetes management.

Traditional finger pricks (called blood sugar monitors or BGMs) have been commercialized for decades and measure glucose directly from the blood capillaries of a person's finger. Although they are very accurate, they only provide a reading at a certain point in time, so it is impossible to know if glucose is rising or falling and how fast it is. Alternatively, commercial CGM devices measure glucose – the fluid surrounding the cells in interstitial fluid. These systems provide continuous readings as well as trend information, so the direction and speed of glucose levels can now be known.

When evaluating both methods, patients should carefully consider the limitations of each method. The next evolution of glucose monitoring will require addressing the fundamental limitations of BGM and CGM to continue to change diabetes care.

Location Issues: Key Challenges for Blood Sugar and Interstitial Fluid

A key difference between blood glucose monitoring and interstitial fluid monitoring is its measurement location and how that location is read for glucose. As mentioned earlier, blood glucose monitoring can directly measure glucose from blood capillaries and reflect the current highest glucose concentration. Interstitial fluid monitoring measures glucose levels in adipocytes around the skin and provides an indication of glucose concentrations within subcutaneous tissue.

Perhaps the most important effect of measuring blood and interstitial fluid is time lag. During rapid changes, interstitial fluid readings can lag behind actual blood sugar readings for 15 minutes. The delay in reading is due to the fact that glucose enters the blood first and eventually spreads from the capillaries into the interstitial fluid.

Although CGM technology revolutionizes the ease of glucose monitoring by providing a large amount of continuous data, the challenge remains to capture accurate, undeleted readings during periods of rapid glucose changes. This occurs during diet, exercise, and during periods of stress and illness. For patients who make daily insulin dose decisions, these rapid elevations and falls are not merely academic issues; instead, they directly affect health outcomes and quality of life.

Understanding this time lag is critical, especially for patients using an automated insulin delivery system, who may make delayed adjustments during these dynamic periods. This lag creates a significant gap for individuals with variable glucose patterns. By avoiding the delays when these fluctuations occur, patients can make better informed decisions around their diabetes management and ensure they get more precise insulin.

One emerging technology to address the challenge of time lag is continuous blood glucose monitoring (CBGM). Like the finger-punching BGM method, the technique can also measure blood sugar, but is similar to the continuous basis of CGM. Therefore, it captures the benefits of two approaches: continuous measurement of glucose data without any time lag.

Clinical impact on diabetes management

CGM technology enables patients to receive real-time alerts when glucose levels approach the hazard threshold. For example, the study found that patients with finger stabs to CGM had significantly improved blood glucose, with average HBA1C levels increasing from 11.2% to 7.0%. Another item by diabetes CGMS was found to reduce the cost of hospitalization related to diabetes by $329.53. Alerts, glucose trends, and increased glucose values combine overall improvements in patient care. New technologies such as CBGM may further accelerate these benefits by providing real-time glucose data that is not affected by time lag, thereby reducing the medical and psychological burden of diabetes management.

• Hypoglycemia test – Frequent and reliable glucose measurements and alerts can help prevent blood sugar-lowering events – periods where blood sugar hazards are low. These hypoglycemia events can lead to serious direct complications such as fatigue, dizziness, loss of consciousness, and in the worst case coma. CBGM technology continuously provides real-time blood glucose values, allowing patients to respond faster to these low glucose events, thereby facilitating early interventions (such as drinking orange juice) to avoid serious complications.
• Hyperglycemia test – Frequent and reliable glucose measurements and alerts can also help prevent hyperglycemia events – Time of excessive blood sugar. The cumulative amount and duration of these hyperglycemia events can lead to serious long-term complications such as ketoacidosis, renal problems, nephropathy, retinopathy, and even limb amputation and blindness. Similarly, CBGM technology continues to provide real-time blood glucose values, allowing patients to respond faster to these high glucose events, thereby facilitating early interventions (such as insulin administration) to minimize the time spent in a hyperglycemia state.

Today, people with diabetes have several ways to monitor glucose levels, whether through finger pricks or CGM. Both methods of measuring glucose levels have benefits and limitations.

Technology advances, such as continuous blood glucose monitoring, attempt to combine the real-time accuracy of direct blood measurements with increased data, trends and alarms for continuous monitoring. These innovations are not only gradual – they represent a fundamental shift in how we deal with diabetes management, from discontinuous monitoring (CGM) (CGM) to real-time continuous data (CBGM). Next-generation CBGM can significantly change the patient’s experience by addressing ongoing patient pain points such as device replacement, in vivo wearables, and diabetes management.

In addition to improving clinical outcomes, next-generation technologies can also reduce some of the burden of glucose management, thereby improving the lives of people with diabetes.

Photo: Murat Gocmen, Getty Images

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