Everybody knows about diabetes at this point. It can cause serious damage to several of the body functions mainly marring the nervous and vascular systems. A 300% jump in number of diabetic patients was observed in less than 35 years (According to WHO) and as reported by International Diabetes Federation in 2021, roughly 540 million adults between age 20 – 80 are diabetic. Being incurable, the only and widely prescribed course of action to prevent mortality due to hyperglycemia is by managing blood sugar level. Diagnosis at prediabetic stage and controlling blood sugar levels early-on, greatly diminishes the possibility of advancements to Type 1 and Type 2 diabetes; and glucometer or glucose meter helps monitor blood glucose levels on a regular basis, aiding in maintaining sufficient concentration of sugar or glucose in the blood.
Controlling sugar intake and monitoring blood sugar level is must to manage diabetes.
As we are living in the era of COVID-19, managing diabetes is paramount. The symptoms and complications of COVID-19 are more severe in patients with hyperglycemia. Ill-managed glycemia with a viral infection may cause Diabetic Ketoacidosis, a life-threatening condition that occurs in the absence of insulin, leading to diabetic coma. In such scenarios, weekly monitoring of blood glucose is insufficient; hence the trend of Continuous Glucose Monitoring began.
Continuous Glucose Monitoring Systems
Continuous Glucose Monitoring or CGM measures and tracks glucose level continuously, enabling either the patient or the doctor or both, to gain understanding of the trends like spike and fluctuations. CGM supports people by letting them efficiently adapt to variations. It helps in accurate diabetes management and drug prescription for Type 1 and Type 2 diabetes. Lifestyle changes can be implemented effortlessly as well. CGM is facilitated by CGM System that fundamentally are constituted by sensors, transmitters and receivers.
But WHAT exactly is a CGM System?
It is an electronic medical device employed to continuously monitor blood glucose levels in the blood stream day and night, from anywhere between couple of days to couple of weeks. It is a home glucose monitor worn continuously for long durations. It relieves the patients’ trauma of repeatedly pricking their fingers. Traditionally the sensor and transmitter of the CGM system is packaged into a single unit that stays either on the abdomen or arm with adhesives; and the receiver is a handheld device to which the data is transmitted. CGM systems also notify the user instantly about hypoglycemia which is an important characteristic in order to regulate diet and insulin usage.
And HOW does it work?
A tiny sensor is placed right under the skin with the help of an applicator. Adhesives on the applicator holds the sensor in-place and prevents accidental dislodging. These sensors measure the concentration of sugar in the body fluids. Usually, the blood sugar level reading is taken every 5 minutes. The CGM sensors are non-reusable and requires replacement. The electronics in the CGM system relays the accumulated blood glucose data, mostly wirelessly, via transmitters to receivers in a handheld electronic device (like a smart watch, digital display or smart phones). Real-time data can also be fetched and displayed on the handheld device to better manage glycemia.
Image Source: Medtronic, shows how CGM Sensor obtains blood sugar level.
So WHICH one to choose?
As always, the market is flooded with variety of Continuous Glucose Monitors. It is always difficult to choose and trust one’s decision when it comes to medical devices and instruments. The digital device market for diabetes monitoring is eying to reach $12 billion which was $3billion 2018, by 2025. There are 4 distinct and famed continuous glucose monitors available, all having some distinct feature set making them stand apart.
- Abbott Freestyle Libre
Image Source: AbbottIt is 2nd generation continuous glucose monitor developed by Abbott laboratories. It was released in 2020 and addressed certain issues with Freestyle Libre such as interreference due to presence of Aspirin, absence of alarms & alerts and usage approval for only 18 years or older. It is one of the popular CGM system mainly due to its low cost. With Libre 3 on the horizon, thinner and sustainable option, which also claims to have the smallest sensor in the world, will be welcomed. In the last month itself Abbott Diabetes Care Inc. were granted more than 5 patents for CGM related technologies – An automatic sensor insertion device, Connectors for analyte sensor & associated systems and System displays for monitoring devices to name a few; which makes cogent the development of this CGM system is towards lesser inaccuracies. - Dexcom G6
Image Source: DexcomG6 is the next iteration of Dexcom G5. Improving on the newer version, the technological aspect has been given importance. Direct-to-mobile app technology eliminates the need of a separate reader. This also enables real-time monitoring of blood glucose levels. Data sharing capability allows the user to get immediate attention, if necessary. Analyte sensor are not impacted by any medication like acetaminophen or vitamin C. Above all, Dexcom G6 has an automatic sensor insertion applicator. It is also approved for children aged 2 years or more. Better deployment of sensors and Malady identification systems in the wake of COVID-19 are some research areas where patents have been granted to Dexcom, Inc. - Medtronic Guardian Sensor 3
Image Source: MedtronicDeveloped by Medtronic, being a stand-alone system, unrestricted usage and compatibility with insulin pumps, unchallenging sensor insertion and predictive alerts are some pros of Guardian sensor 3. But requiring extra adhesion, lack of user-friendly design of transmitter & involving many steps to set-up, calibration every 12-hours, 2 hours of warm-up time and comparative higher price point together with false reading reported by users, makes it the most unreliable and difficult to recommend CGM system. According to mean absolute relative difference or MARD (The lower the better) Guardian Sensor 3 landed in the range of 9 – 11 percent. - Eversense CGM System
- Image Source: Mobile Health NewsThe only, first-of-its-kind CGM system with implanted sensor, with a wear life of 90 days, eliminating the need to replace it very frequently. The transmitter is attached over the implant that can be removed as per the user without damaging the sensor; but which needs adhesive reapplication every 24 hours of continuous use. It has an excellent UI for the mobile app offering range of customizations including personalized sugar level fluctuation alert. The sensor implantation and retrieval require a surgical procedure. As per FDA, it requires calibration once a day and one-time 24 hours long warm-up Eversense 90-day received 8.5% to 9.6% MARD score.
Why DEXCOM G6 is the ultimate CGM?
- With a MARD score of 9%, and 9.3% for Freestyle Libre 2, Dexcom G6 is the most precise and accurate CGM system in the market. The lower priced Freestyle Libre 2 attracts potential users but data accuracy and reliability surpasses concerns of financial nature. The continuous fetching of data facilitated by a smartphone along with reported less sensor failures places it over its competition. The only reason users will shy away from Dexcom G6 will be its affordability, but technologically and pathologically it is the leading continuous glucose monitoring system.
FAQs
Q1) What is a CGM?
Continuous Glucose Monitoring or CGM measures and tracks glucose level continuously, enabling either the patient or the doctor or both, to gain understanding of the trends like spike and fluctuations. Continuous Glucose Monitor is an electronic medical device employed to continuously monitor blood glucose levels in the blood stream day and night, from anywhere between couple of days to couple of weeks. It is a home glucose monitor worn continuously for long durations.
Q2) What is the difference between BGM and CGM?
Blood Glucose Meter (BGM) is a conventional method of testing for blood sugar level by the means of a glucometer. BGM analyses blood obtained from the vascular system where as CGM measures blood sugar levels present in the interstitial fluids of the body. Unlike BGM, CGM monitors blood sugar level almost continuously.
Q3) Who can use CGM?
Even a prediabetic can use a CGM, but it’s mostly preferred for patients with Type 1 and Type 2 diabetes. People on a strict insulin intake require this to alter their dosage in case of any fluctuations caused by external factors. Including CGM in one’s lifestyle helps that person to track diet and food habit impacts and manage diabetes better.
