The self-monitoring of blood sugar, as performed by diabetic patients several times a day, only provides a snapshot of metabolism. It shows a value at a specific point in time, for which a “prick” is required each time to obtain blood – five to seven times a day, sometimes more often.
Continuous Glucose Monitoring (CGM), on the other hand, provides many individual glucose values at short intervals. These values come together to form an overall picture that makes it possible to observe metabolism around the clock – and without a “prick” on the finger.
Here is how a CGM works:
- CGM measures glucose via a patch attached to the skin
- Filament in the skin interacts with sugar molecules in interstitial fluid
- Important for people with diabetes who need to monitor blood glucose quickly
- Interstitial fluid monitoring is preferable from a general wellness point of view
Continuous glucose monitoring (CGM) represents a major advance in the treatment of diabetes. The first measuring system came onto the market in 1999, and technology has continued to develop since then. Today CGM systems have high-quality standards. In addition, CGMs along with insulin pumps, are part of what is termed a closed system, or artificial pancreas (AP). This is expected to revolutionize the treatment of insulin dependent diabetics in the future.
Based on the feedback received from our patients, most would love to use CGMs. In fact, GluCare gets as many inquiries from diabetics looking for CGMs as those who are not diabetic but could benefit from understanding their glycemic variability (pre-diabetics, wellness, overweight patients, endocrine patients). Reimbursement coverage for CGMs in the United Arab Emirates, despite being clearly mentioned in guidelines, remains a challenge.
Many studies have shown that using CGMs in diabetic patients (independent which type) can improve glycemic control (1,2,3,4).
The data on CGMs has been so convincing that the American Diabetes Association, in its latest 2021 diabetes guidelines, recommended the use of CGMs for all type 1 and type 2 insulin dependent patients. It is no longer seen as a nice to have, but necessary if one is to follow evidenced-based medicine.
We use CGM differently at GluCare
CGMs are usually a tool for self-management of diabetes patients and has already shown improved outcomes.
The way GluCare uses CGMs is to be part of that journey with patients when it comes to glucose monitoring and becoming a part of optimizing our patient’s self-management.
CGM data is continuously transferred to our clinic portal via our app, which is installed on the patient’s phone. This data becomes part of the patient’s Electronic Medical Record (EMR) and is not siloed information.
We have reinvented diabetes care by practicing an Integrated Continuous Monitoring (ICM) approach to the disease, rather than an episodic symptomatic model that traditional providers follow.
ICM is a completely new category of personalized healthcare services that utilize continuous health information, such as CGM data, sleep data, heart rate (HR), heart rate variability (HRV), activity and many more, from users. This data is combined with cloud based artificial intelligence (AI) tools working alongside medical professionals to take care of users daily.
Why does GluCare need to track so many parameters…. why not just Glucose?
There are over 40 parameters that affect glucose. To really understand what is going on with our patients, we need to monitor these parameters. More information means better insights.
A case study on the benefits of ICM:
An example of a patient, wrongly diagnosed as type 2 diabetes, with initial HbA1c (average blood glucose of 90 days) of 8.3% which classifies this patient as uncontrolled diabetic.
Our real-time and onsite laboratory determined that the patient was a type 1 diabetic, and the GluCare team immediately started her therapeutic correction with insulin and connected her with our ICM system. She was given a CGM in addition to our proprietary multi-spectral wearable (to track other parameters).
The patient’s initial Glucose Time in Range (TIR) is shown. A 50% TIR is not good. The recommended TIR needs to be above 70%.
Phase 2 included the patient learning carb counting and calculating the correct insulin dosage.
Traditional providers might require the patient to visit the clinic many times with physicians, diabetes educators and nutritionists, provided that these services are available in the first place. Most healthcare providers in the UAE do readily provide enhanced support services around diabetes.
Here is where ICM comes into play. We started by educating the patient remotely and in real-time, observing her glycemic reaction to food, alongside her insulin dosages from day 1.
Wait….how?
Our food logging feature allows the care team to overlay CGM data received with dietary choices via our portal. This immediate feedback further drives patient engagement and education about glycemic variability and compliance.
Here the patient used our food logging function and added everything that she ate, the carbs the patient counted and the insulin dosage that was taken:
In addition, our nutritionist gave the patient feedback based the data received to learn correct carb counting:
Within a month the patient becoming proficient with carb counting and we optimized the patients Insulin to Carb Ratio (ICR):
Check out the TIR of 76% in just 30 days!
But that’s not all:
Real-time or near real-time patient engagement allows the care team to suggest corrective actions required based on the information received or trends observed (sleep hygiene, activity, food logging, glucose readings, compliance criteria, etc.).
Here are some examples how we can compare glucose with sleep or activity:
Glucose vs sleep Glucose vs activity
The GluCare team becomes part of the self-management process. We monitored the patient’s glucose levels all the time, and could correlate it to food intake, activity, and sleep patterns.
Hold on…. you can’t be tracking the patient all the time?
We track patients 24/7. GluCare uses both humans and machines to help monitor patients.
The human part:
Our coaches and clinic team are communicating with the patient when insights are seen and understood. This is data-driven personalized disease management.
Machines….what?
We are not only a team of humans. Our artificial intelligence platform continuously analyzes what the data received means. No human will ever understand what the risk to a patient is with so many changes in sleep, glucose, respiration rate, heart rate variability, weight, skin temperature, etc. daily.
Here is where the magic happens. Our machine learning algorithms use all the incoming data from digital devices (like CGM, blood pressure, weight scale and band data), EMR data and questionnaires to continuously assess stratified risk scores across multiple diseases.
With this information have the opportunity to start preventing other diseases closely related to diabetes and metabolic syndrome.
Summary
CGM has shown in many cases and studies to improve self-management of diabetes patients.
With GluCare’s model of diabetes management through the methodology of Integrated Continuous Monitoring (ICM) we are using CGM data as part of many other parameters to give continuous feedback to our patient on their self-management behaviors and are showing significant improvement of glucose time in range, HbA1c, and many other metabolic parameters (weight, LDL, Triglycerides, HDL, uric acid…).
GluCare is planning the release of own version of a CGM in the UAE within months and is expected to bring the cost of CGMs in use down significantly.
It is only a matter of time before glucose tracking becomes as widely available as activity trackers, and feeds in continuous data into your phone, providing everyone (including your care team) with insights on what is happening in real-time to your blood glucose levels.
And by the way
The patient is still in range 324 days later.
Reference
[1] Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes : a randomized clinical trial. Randomized Controlled Trial JAMA. 2020 Jun 16;323(23):2388-2396.
[2] Glycemic Targets: Standards of Medical Care in Diabetes—2021American Diabetes Association. Diabetes Care 2021 Jan; 44(Supplement 1): S73-S84.
[3] Diabetes Technology: Standards of Medical Care in Diabetes—2021 American Diabetes Association. Diabetes Care 2021 Jan; 44(Supplement 1): S85-S99.
[4] Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in Diabetes: A Systematic Review with Meta-analysis of Randomized Controlled Trials, Diabetes Care 2020 May; 43(5): 1146-1156.
