Continuous Glucose Monitoring (CGM) Technology: Current Challenges and Future Promises for a Better Diabetic Lifestyle

Continuous Glucose Monitoring (CGM) is a relatively new technology which has the potential to assist people living with type 1 or type 2 diabetes and treated with insulin to achieve the goal of optimum control of blood glucose. Devices for continuous glucose monitoring (CGM) are currently a major focus of research in diabetes management. It is envisioned that such devices will have the ability to alert a diabetes patient of impending hypoglycemic/ hyperglycemic events and thereby enable the patient to avoid extreme hypoglycemic/ hyperglycemic excursions as well as minimize deviations outside the normal glucose range, thus preventing both lifethreatening events and the debilitating complications associated with diabetes. It is anticipated that CGM devices will utilize constant feedback of analytical information from a glucose sensor to activate an insulin delivery pump. Depending on whether the CGM device penetrates/breaks the skin and/or the sample is measured extracorporeally, these devices can be categorized as totally invasive, minimally invasive, and noninvasive. However, at present, most of these technologies are plagued by a variety of issues that affect their accuracy and long-term performance. Considering the advantages and some of the disadvantages of this technology and comments on it from the point of view of a health professional working in a resource limited setting. In the final analysis, judgements as to its usefulness will be based not only on its effectiveness but also its cost effectiveness. This article presents the components, working and benefits of existing CGM technologies, highlighting critical aspects of its use and importance in diabetes and many clinical settings. Mohsin Ali Siddiqui* 1 , Sana Ahmed 2 , Syed Ibrahim 1 , Mohammed Abrar 1 , Mohd. Aleemuddin 1 1 Student, B. Pharmacy, Deccan School of Pharmacy, Hyderabad-500001 2 Assistant Professor, Department of Pharmaceutics, Deccan School of Pharmacy, Hyderabad-500001 Submission: 7 July 2017 Accepted: 12 July 2017 Published: 25 July 2017 www.ijppr.humanjournals.com Citation: Mohsin Ali Siddiqui et al. Ijppr.Human, 2017; Vol. 9 (4): 183-190. 184 INTRODUCTION Diabetes often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin or both. For people with Type 1 Diabetes or Diabetes Insipidus: Patients body does not produce insulin and for people with Type 2 Diabetes or Diabetes Mellitus. The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance). Gestational Diabetes is a type that affects females during pregnancy, as women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all the glucose into their cells, resulting in progressively rising levels of glucose. In 2013, it was estimated that over 382 million people throughout the world had diabetes. The most common diabetes symptoms include frequent urination, intense thirst and hunger, weight gain, unusual weight loss, fatigue, cuts and bruises that do not heal male sexual dysfunction, numbness and tingling in hands and feet. Approximately 90% of all cases of diabetes worldwide are of type 2. If you have Type 1 and follow a healthy eating plan, do adequate exercise, and take insulin, you can lead a normal life. Type 2 patients need to eat healthily, be physically active and test their blood glucose. They may also need to take oral medication, and/or insulin to control blood glucose levels. As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that blood pressure and cholesterol levels are monitored regularly. As suggested by the Diabetes Control and Complications Trial report, complications arising from diabetes can be reduced and even prevented via careful management that includes regular checking of glucose levels. It is recommended that a T1DM patient should check his/her glucose levels at least four times per day, while a T2DM patient should check his/her glucose levels at least two times per day. For this, at present, most diabetes patients rely on glucose strips along with handheld glucose meters that record glucose levels in blood drawn via finger pricking, i.e., self-monitoring of blood glucose (SMBG). However, the pain associated with finger pricking together with the inability of test strips to reflect the overall trend in the glucose level of individual patients, i.e., the direction and the pattern associated with the patients daily habits, renders user-independent continuous glucose monitoring (CGM) a highly desirable proposition. Use of CGM devices will enable the identification of glucose trends, thereby assisting physicians in optimizing treatment plans and facilitating appropriate clinical decisions in cases of emergency. In addition, theoretical modelling has predicted that an additional 5 years of life, 8 years of sight, 6 years free from www.ijppr.humanjournals.com Citation: Mohsin Ali Siddiqui et al. Ijppr.Human, 2017; Vol. 9 (4): 183-190. 185 kidney disease, and 6 years free from amputations can be gained by a diabetes patient who follows tight CGM glucose control versus the standard SMBG. MATERIALS AND METHODS Mechanism of CGM Technology: CGM is a way to measure glucose levels in real-time throughout the day and night. A tiny electrode called a glucose sensor is inserted under the skin to measure glucose levels in tissue fluid. It is connected to a transmitter that sends the information via wireless radio frequency to a monitoring and display device. Fig. 1. Tracking blood glucose level on an iOS device through the Dexcom G5 Mobile