This article provides a comprehensive overview of monitoring strategies for effective diabetes management. It highlights the role of various technologies & recommendations from healthcare guidelines in optimising diabetes care & reducing long-term complications.

Monitoring is a crucial aspect of managing diabetes effectively. It helps individuals with diabetes and their healthcare providers (HCPs) make informed decisions about treatment and lifestyle adjustments. This article deals with some key aspects of monitoring diabetes.

Inadequate monitoring has been associated with the progression of microvascular as well as macrovascular complications associated with the poor control of blood glucose levels.

1. Blood Glucose Monitoring (BGM)

The only way to get a “snapshot” of blood glucose level is by monitoring through a glucometer or continuous glucose sensor (CGM).

Self-Monitoring of Blood Glucose (SMBG): Regular testing of blood glucose levels using a glucometer allows individuals to track their blood sugar throughout the day. This helps in understanding how food, physical activity, and medications impact blood sugar levels.

Continuous Glucose Monitoring (CGM): CGM devices provide real-time information on glucose levels throughout the day and night. Most CGMs report blood sugar levels every five minutes; that’s a total of 288 readings per day. These systems use a small sensor inserted under the skin to measure glucose levels and transmit data to a receiver or smartphone. Newer technology empowers patients to manage their diabetes effectively.

Non-invasive glucose monitoring: It refers to methods of measuring blood glucose levels without the need for traditional methods like fingerstick blood sampling. The aim is to provide a less invasive and more convenient way for individuals with diabetes to monitor their glucose levels. While several technologies have been explored, achieving accurate and reliable non-invasive glucose monitoring has proven to be a significant challenge.

2. A1C testing

1. The A1C test provides an average of blood glucose levels over the past 2-3 months. It is a valuable tool for assessing long-term glycemic control.
2. The target A1C level varies based on individual health and the recommendations of healthcare providers.
3. Factors like pregnancy, heavy blood loss, recent blood transfusion, anaemia, haemoglobinopathies, and Chronic kidney disease can affect the reading of A1C. An alternative test to the A1c is the fructosamine test, as it reflects the average blood glucose only over a 2-3-week period.

3. Ketones monitoring

In patients with type 1 diabetes, blood or urine ketone monitoring is advised in times of stress or illness and patients are advised to take immediate medical care to avoid the complications associated with diabetic ketoacidosis.

4. Blood pressure monitoring

People with diabetes are at an increased risk of cardiovascular complications. Regular monitoring of blood pressure is essential to manage this risk. Blood pressure should be kept within the recommended target range.

ADA and AACE guidelines on monitoring

1. As per recommendation, people who are taking insulin and using BGM should be encouraged to check their blood glucose levels when appropriate based on their insulin therapy.
2. As per recommendation, blood glucose monitoring (BGM) in people on non-insulin therapies has not consistently shown clinically significant reduction in A1C levels.
3. HCP should be aware of interfering substances like vitamin C, acetaminophen, galactose, uric acid, Xlylose and other factors that can interfere with the meter accuracy and provide clinical management as indicated.
4. HbA1c should be measured at least semi-annually in all persons with DM and at least quarterly in person, not at glycemic target.
5. CGM is recommended for persons with T2D who are treated with insulin therapy or who have a high risk of hypoglycaemia and/or hypoglycaemia unawareness.
6. CGM should be offered for diabetes management in youth with Type 1 diabetes and adults with t2 diabetes on MDI and insulin infusion pumps.
7. When used as an adjunct to pre-prandial and postprandial BGM, CGM can help to achieve A1C targets in diabetes and pregnancy.

Observational and real-world data analysis provide valuable insights into the effectiveness of rtCGM devices, demonstrating the reduction in A1 c levels, increased time in range as well as an increase in tight target range and episode of hypoglycaemia.

A database study of almost 27,000 children and adolescents with type 1 diabetes showed that, after adjusting for multiple confounders, increased daily frequency of BGM was significantly associated with lower A1C and fewer acute complications.

Good monitoring has been associated with reducing long-term complications like neuropathy by 30%, retinopathy by 25%, and CVD by 20%.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr. Hitesh Saraogi is a diabetologist, physician and an obesity specialist at Dhanvantari Hospital, Raj Nagar Extension, Ghaziabad.