Dr. Anna Zaccariello graduated in nursing at the University of Campania “L. Vanvitelli” disserting the thesis entitled “Nursing assistance to patients with diabetes mellitus: Self Monitoring Blood Glucose vs Flash Monitoring Glucose”
Abstract
Diabetes is a chronic disease characterized by the presence of high levels of glucose in the blood (hyperglycemia) and due to an altered amount or function of insulin. Insulin is the hormone produced by the pancreas, which allows glucose to enter cells and be used as an energy source.
When this mechanism is impaired, glucose builds up in the blood. The main varieties of diabetes are: type 1 diabetes mellitus, also called insulin-dependent and type 2 diabetes mellitus, also called non-insulin dependent. These are two very different pathologies, both in terms of the modalities of onset, and in terms of therapy and the impact on the patients’ lives. Type 1 diabetes can hardly be prevented, as the risk factors that interact with the genetic predisposition and trigger the autoimmune reaction are still unclear.
Type 2 diabetes is partly preventable by changing the lifestyles of those at risk, particularly as regards nutrition and physical activity. Therefore the main objective of treatment, for people with diabetes, is to obtain normal glucose concentrations and through monitoring systems they are able to detect and monitor their glycemic value. The devices most used to measure the concentration of glucose in the blood are SMBG devices, i.e. self-monitoring blood glucose, which use as a sample a drop of venous, arterial or more commonly capillary blood from a finger prick made with a finger prick. and placed on a suitable test strip.
Self-monitoring of blood sugar is recognized as a therapeutic approach aimed at improving glycemic control and reducing hypoglycaemic events since it enables the diabetic patient to modify the dose of drug taken and correct the diet.
In recent years for glycemic determination, alongside SMBG systems, systems for continuous glycemia control have been developed, capable of measuring glucose levels in the interstitial fluid, through the use of a subcutaneous sensor. Among the sensors, some provide real-time indications, such as CGM sensors, continuous glucose monitoring, while other simpler ones provide intermittent glucose monitoring, such as FGM devices, flash glucose monitoring.
In CGM systems the glucose values are measured continuously and through these systems it is possible to detect in real time the glucose levels in the interstitial fluid in adult subjects with diabetes, for the entire operating life of the sensor.
While in FGM systems the glucose values are displayed when the user scans the sensor through a reader or smartphone, thanks to a specific dedicated APP. The FreeStyle Libre Flash Glucose Monitoring System has two main components: a handheld reader and a disposable body-applied sensor.
The reader is used for wireless sensor scanning and obtaining glucose readings. The aim of this study is to clarify which system, between SMBG and FGM, is more effective and accurate for detecting blood glucose value and monitoring blood glucose in patients with type 1 diabetes and patients with type 2 diabetes.
Materials and methods. To achieve the objective, an in-depth search was conducted on the best biomedical databases, scientific journals and websites, selecting the articles pertinent to the topic considered in the study. Subsequently, the results obtained from the bibliographic research relating to the database consulted, the search strategies used and the number of articles found were summarized and reported in a table.
Results
The responses provided by the studies carried out highlight the effectiveness and accuracy of an FGM system for monitoring flash glucose compared to SMBG self-monitoring of glucose.
Studies have shown that flash glucose monitoring, FreeStyle Libre can be used as a replacement for SMBG capillary glucose monitoring in patients with type 1 diabetes mellitus and in patients with type 2 diabetes mellitus.
Use of the FreeStyle Libre device has been shown to reduce hypoglycemia events and improve blood glucose levels glycated hemoglobin because it provides information about current and past glucose levels, indicates the direction, and therefore the trend, towards which it is changing and the rate of change of the glucose level, thus providing precise information to prevent sudden changes in blood sugar, unlike the system of SMBG self-monitoring which provides blood glucose value only. The use of flash monitoring glucose allows the estimation of parameters, in particular the Time in Range (TIR) which integrates the glycated hemoglobin data for the evaluation of glyco-metabolic control.
Conclusions
Using flash glucose monitoring is useful for good glycemic control, to improve glycated hemoglobin and to improve the management of home glucose monitoring, in order to have an indication necessary for adjusting drug therapy or for changes to be made in diet and physical activity. In the event of anomalous values, it is important to associate monitoring with capillary glycemia detection. Additionally, since hypoglycemia or hyperglycemia events cannot be detected with capillary monitoring alone, many FGM systems provide the ability to activate alarms that trigger in the event of hypoglycemia or hyperglycemia; in fact, flash monitoring has been shown to be useful for improving glucose monitoring adherence and detecting hypoglycemia (daytime and nighttime) in children and adolescents with type 1 diabetes.
Dr. Anna Zaccariello
BIBLIOGRAPHY
- Agency for Quality and Accreditation in Health Care and Social Welfare (AAZ), Main Association of Austrian Social Security Institutions (HVB), The Norwegian Institute of Public Health (NIPHNO). Continuous glucose monitoring (CGM real-time) and flash glucose monitoring (FGM) as personal, standalone systems in patients with diabetes mellitus treated with insulin. Joint Assessment. Zagreb: EUnetHTA; 2018.
- Chen WY, Gao Y, Xu X, Zhou M,. Effects of flash glucose monitoring on glycemic control in participants with diabetes mellitus: A meta-analysis of randomized controlled trials. J Diabetes Complications. 2022 Nov;36(11)
- Chen M, Lee KO, Li H, Liu B, Ma J, Shen Y, Su X, Sun X, Yan R, Ye L,. Flash Glucose Monitoring Improves Glucose Control in People with Type 2 Diabetes Mellitus Receiving Anti-diabetic Drug Medication. Exp Clin Endocrinol Diabetes. 2021 Dec;129(12):857-863
- Berard L, Glennie JL, Levrat-Guillen F. Sensor-Based Technology: Bringing Value to People with Diabetes and the Healthcare System in an Evolving World. Clinicoecon Outcomes Res. 2022 Feb 10;14:75-90.
- Abdulrahman L, Al Qahtani N, Al Suwaidi H, Artan I, Attia S, Deeb A, Nagelkerke N, Suliman S, Tomy M, Yousef H. Novel ambulatory glucose-sensing technology improves hypoglycemia detection and patient monitoring adherence in children and adolescents with type 1 diabetes. J Diabetes Metab Disord. 2019 May 9;18(1)
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