Flash glucose monitoring system in special situations

Abstract

The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.

Keywords: Diabetes mellitus; blood glucose self-monitoring; liver cirrhosis; pregnancy; renal dialysis.

Figure 1. Example of an ambulatory glucose profile report, a standardized single-page report developed by the International Diabetes Center and adopted by most of the CGM device manufacturers, including 14 days of data. The middle graph shows the median glucose over 24 hours and its variation (5^th, 25^th, 75^th, and 95^th percentile), while the bottom graph shows daily glucose profiles. The stacked bar graph at the top right corner displays the percentage of time spent within, below, and above the target range. The additional table at the top left corner describes glucose statistics and targets.