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Glucose Monitoring in Diabetes

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Glucose Monitoring in Diabetes

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Dr Roger Mazze explains why monitoring is indispensible for better
managing the glucose levels.

Ambulatory glucose profile
explained

Glucose Monitoring in Diabetes

When self-monitoring was first introduced
way back in the 1980s, I developed a way of capturing the
glucose values and then representing them to find any
underlying patterns. However, self-monitoring is done primarily
during the day time. It is intermittent and many individuals
forget to timely monitor or do so only when they are feeling
sick. But the data from Self-monitoring of Blood Glucose (SMBG)
does not give a full picture. Continuous Glucose Monitoring
(CGM) introduced in 2001 made it possible to take continuous
measurements and to find the underlying patterns.

Ambulatory Glucose Profile (AGP) aggregates
about two weeks of glucose levels and helps the physician look
for patterns that would show hypoglycaemia, excess glucose
exposure, significant glucose variability and all the
characteristics that help understand the blood sugar trends of
a person with Diabetes.

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At present, AGP seeks to find ways to use it
to quickly detect the problems that a patient might face or
better yet, anticipate problems. For instance, since we can now
identify the risk of overnight hypoglycaemia, we know that if
blood sugar levels are lowered during the day time, the
overnight glucose values also have to be recorded. Intervention
should involve reducing fluctuation blood glucose levels then
improving glucose stability and then manage glucose exposure.
This helps prevent hypoglycaemia. Understanding how and why
glucose levels fluctuate can help to anticipate and avoid
hypoglycaemia.

Ambulatory glucose profile is a graphic
program that shows glucose patterns. The most important
component of it is the ability to see the glucose patterns, to
see where it is hypoglycaemic, where it is hyperglycaemic and
to see the variability and the excess exposure. The patterns
are also quantifiable and it does report out values. What is to
be looked for is that AGP becomes a standard for reporting
continuous glucose monitoring.

Benefits of AGP

A person with Type 1 Diabetes even with
continuous monitoring looks at individual values. They do not
see an underlying pattern. So for them to learn and to get
feedback, the most important thing to see is when their glucose
levels tend to rise. So once you have the pattern, it begins to
get you to think about what things you need to do. It gives
excellent feedback. The only way you are going to determine
whether your glucose go up or stabilises or in fact not move at
all is by seeing a repetition in the pattern. AGP is meant to
show patterns. One of the fundamentals of medicine
is pattern recognition.

A person with Type 2 Diabetes can use AGP
for immediate feedback and to highlight a trend. Food,
exercise, stress, sleep and activity all of these affect
glucose levels just the way insulin does. Knowing what is
happening with regards to sugar levels guides in making
corrections in your lifestyle or report back to the doctor
whether a therapy is working.

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AGP is useful for people with prediabetes to
see whether an intervention in lifestyle, adding exercise or
losing weight would, in fact, change their profile.

AGP and gestational Diabetes

AGP is recommended for
gestational Diabetes. Observing glucose levels is of paramount
importance in gestational Diabetes as it can put the mother and
the child at risk. Low levels are considered to be better as
high levels may lead to poor outcome. Diabetes during
pregnancy, either GDM or pre-GDM, requires underlying
predictive patterns to be checked to initiate immediate
intervention. So what is required is the tightest control
possible. Continuous glucose monitoring helps analyse
underlying patterns and not just single glucose value to
determine how best to manage it.

CGM and children

CGM works wonders for children. For one
thing, it helps parents to sleep through the night because if
the child is hypoglycaemic, with alarm systems and other means
they are awakened rather than staying up all night watching the
child. CGM has been used in children, very safely, with no
significant problems.

To conclude

Devices like CGM or flash glucose monitoring
or SMBG will only make a difference when the physician is
properly trained to use the information. Any device’s true
benefit only comes when the information it produces gets used
by the clinician to make a productive clinical decision that
helps the patient. Simply giving it to the patient and
expecting better outcomes doesn’t work. The patient has to be
educated, the physician has to be educated and that applies
to even the simplest devices such as SMBG to the
most complex devices such as CGM and insulin pumps. Education
is the basis for everyone – the physician, the patient, the
nurse member of the team and the dietician member of the team.
All have to be able to understand how to collect the data, look
at it, analyse it and use it.

Bio:

Dr Roger Mazze

Dr Roger Mazze is the senior
Vice-president of the International Diabetes Centre, USA. He is
credited with the development of first
standardised report with SMBG and CGM. In 2014 Dr
Mazze had started the AGP Clinical Academy at Portsmouth
Hospitals, NHST (UK) in collaboration with Dr Iain
Cranston and the Centre for Diabetes and Endocrinology. He had
assisted in building directing the first WHO Collaborating
Centre devoted to advanced technologies in Diabetes. He has
also served as an advisor to the WHO, United States Centres for
Disease Control and Prevention, the US Public Health Service
and Indian Health Service Program in Diabetes.

 

 

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