Finger Pricks To Continuous Glucose Monitors: Exploring Modern Diabetes Diagnostics
Finger Pricks To Continuous Glucose Monitors : Diabetes mellitus has now become a rising epidemic globally, further increasing the socio-economic burden in all countries. Diabetes mellitus is increased plasma glucose levels associated with microvascular and macrovascular (mainly cardiovascular) complications. An illness that once used to be diagnosed in elderly individuals has now become a common phenomenon in all age groups, including children, adolescents, and pregnant women. Dr V Kavita, AVP Lab Operations TN & APT, Metropolis Healthcare Limited, shares the diagnostic modalities for diabetes mellitus have evolved from a simple finger prick, plasma glucose estimation, and glycosylated haemoglobin levels(HbA1C) to continuous glucose monitoring.
Hypoglycaemic Drugs And Insulin
Self-monitoring capillary blood glucose levels using the finger prick technique at the convenience of our homes is a popular method to monitor blood glucose levels. However, plasma glucose levels at the laboratory differ by 10-15 % from those obtained in self-monitoring devices. Hence, healthcare providers must evaluate the technique used at home and calibrate the values considering the variance before adjusting the dosage of oral hypoglycaemic drugs and insulin. For hospitalised patients, titrating the daily insulin dose can be difficult with repeated venepunctures. Hence, repetitive capillary glucose level estimation by finger prick devices is advisable.
Continuous Glucose Monitoring
Glycosylated haemoglobin (HbA1C) levels provide an average estimate of plasma glucose levels over the past eight weeks. This value helps monitor long-term plasma glucose level control and evaluate the risk of developing diabetes complications.
- Glycated serum protein estimation has become popular in scenarios where HbA1c levels, such as hemolytic anaemia, cannot be done. Glycated serum protein and glycated albumin levels provide an index for monitoring glucose levels over 1-2 weeks. This helps assess the response to treatment over a short period. However, evaluating glycated serum protein levels should not be equated to HbA1c levels because they only provide information on glycaemic status over a short period.
- Two conditions, ketoacidosis and hyperosmolar hyperglycaemia, become important in uncontrolled diabetes. The initial laboratory workup for these complications includes plasma glucose levels, urine and blood ketone levels, serum electrolytes, urine osmolality, and renal function tests. Based on the results, patients are hospitalised and diagnostic modalities developed until now might not provide real-time plasma glucose levels. Continuous glucose monitoring (CGM) refers to real-time plasma glucose level monitoring throughout the day and night. This is done by implanting biosensors beneath the skin.
- The sensor has a transmitter that sends the information to software that provides real-time glucose values. The sensors need to be replaced at regular intervals. The continuous monitoring devices provide glucose level monitoring, low glucose critical emergency alerts, and frequent finger pricks.
On the other hand, sensors have limited stability, which mandates replacing them on time. A few patients might experience minor skin irritation or allergy following biosensor implantation. Nevertheless, this has been very useful for monitoring diabetes and titrating insulin dosage in patients. Technology and medical developments have made it feasible to diagnose and monitor plasma glucose levels in diabetic patients. Once diagnosed, action must be taken to prevent the complications of diabetes.