Choosing the best glucose monitor to manage diabetes

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Diabetes is one of the fastest growing chronic diseases, with over 400 million people impacted across the world.1 According to the International Diabetes Federation, the prevalence of diabetes is estimated to surpass 700 million by the year 2045.1 This metabolic disorder can be classified into two main groups: type 1 and type 2.2 Both types are characterized by an increase in glucose, or blood sugar, due to impaired insulin functioning.2 Insulin is an enzyme secreted by the pancreas that is responsible for lowering the levels of glucose in blood after meals.3

If the body cannot produce insulin (type 1 diabetes) or becomes resistant to it (type 2 diabetes), the associated long-term increase in blood glucose can lead to increased thirst, vision complications, weight loss, amputation, stroke, coma, and even death.4 As a result, frequent measurements of glucose levels using monitors are critical for the management of diabetes. The best glucose monitor for diabetics may involve using a fingerstick or wearing a sensor.5 How can you choose the best glucose monitor for yourself?

What are normal blood sugar levels?

Before making your selection, understanding the range of glucose levels in healthy versus diabetic people is important. A study in the Journal of Diabetes Science and Technology found that glucose measurements spike to an average of 132 mg/dL about 45 minutes after a meal.6 Glucose levels are highly variable throughout the day and measurements can drop to about 80 mg/dL when fasting.6

When glucose levels do not fall within the healthy range between fasting and eating, diabetes can be confirmed using one of four main criteria.2 Patients must have one of the following approximate values: 

  • fasting plasma glucose level ≥ 126 mg/dL, 
  • 2-hour plasma glucose ≥ 200 mg/dL, 
  • glycated hemoglobin (HbA1C) ≥ 6.5%, or 
  • random plasma glucose ≥ 200 mg/dL.2

The use of HbA1C as a diagnostic criteria is to examine the average plasma glucose levels over the past three months. 

Types of glucose monitors

Glucose measurements can be taken using two types of monitors, specifically the blood glucose monitor (BGM) or continuous glucose monitor (CGM).5

1. Blood glucose monitors

A blood glucose monitor is the traditional method to assess glucose levels.5 With this glucometer, a fingerstick is used to lightly prick the skin to obtain a small sample of blood for analysis.5

While blood glucose monitors measure blood sugar levels at the moment of testing, it must be done at least four times a day.5 Blood glucose moitors are also portable and easy to use, however poking the skin with a needle multiple times daily may not be ideal for some people. 

2. Continuous glucose monitors

A continuous glucose monitor is more complex as it consists of a transmitter, receiver – or an application that can be downloaded onto a smartphone instead, and a sensor to be inserted under the skin.5

Due to advancements in monitoring technology, continuous glucose monitors have various features such as the ability to see trends in a person’s blood glucose readings over time and to set alerts if levels become too high or too low.7Continuous glucose monitors also automatically measure glucose levels throughout the day. However, they are not without problems since the sensors must be replaced weekly, the device requires regular calibrations, and not all users may understand recorded data without the help of a healthcare provider.5,7

Comparing between the two types of glucose monitors

Research studies that have compared user experiences with both types of monitors report improved control of glucose levels as well as greater satisfaction with individualized treatment and quality of life when using continuous glucose monitors compared to blood glucose monitors.5,7

So, what is the best glucose monitor then? The answer depends on specific needs and preferences. A relatively affordable and accessible way to take daily measurements is using the traditional blood glucose monitor.5 However, although they tend to be more expensive, continuous glucose monitors can be hidden under clothing and provide real-time access to more health information.5,7 While these factors should be considered before selecting a device, ensure that you communicate with your healthcare provider for medical advice before you pick the best glucose monitor for you.

The next step: Regulate blood sugar levels using an insulin pump

After measuring blood glucose levels, the next step is to address any increase using the right amount of insulin.8 This can be achieved using daily injections or an insulin pump, with the latter being generally favoured.8 When combined with continuous glucose monitors, insulin pumps can automatically and precisely adjust the dosage required in response to readings on the glucose monitor.8 Insulin pumps can also be used with blood glucose monitors, however blood glucose measurements must be manually entered.8

Importance of the right glucose monitor for diabetes self-management

In addition to being one of the fastest growing diseases around the world, diabetes is a leading cause of death.1 Diabetes also comes with a significant global financial burden with an estimated cost of over 700 billion dollars each year.1

To manage diabetes, regularly checking blood glucose levels is necessary. Measurements of glucose can be taken using the traditional blood glucose monitor that employs a fingerpick test or the more automated continuous glucose monitors that must be worn at all times.5 While the best glucose monitor will vary from person to person depending on considerations like cost, accessibility and features, both types allow diabetics to self-measure blood glucose levels. In doing so, a person may mitigate the risks associated with chronically elevated levels of glucose to potentially prevent serious health complications and organ damage.2

References

1.        Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. doi:10.1016/j.diabres.2019.107843

2.        Punthakee Z, Goldenberg R, Katz P. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Can J Diabetes. 2018;42:S10-S15. doi:10.1016/j.jcjd.2017.10.003

3.        Roh E, Song DK, Kim MS. Emerging role of the brain in the homeostatic regulation of energy and glucose metabolism. Exp Mol Med. 2016;48(3). doi:10.1038/emm.2016.4

4.        Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Fard HH, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: A systematic review and meta-analysis. Heal Promot Perspect. 2020;10(2):98-115. doi:10.34172/hpp.2020.18

5.        Laffel LM, Kanapka LG, Beck RW, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults with Type 1 Diabetes: A Randomized Clinical Trial. JAMA – J Am Med Assoc. 2020;323(23):2388-2396. doi:10.1001/jama.2020.6940

6.        Freckmann G, Hagenlocher S, Baumstark A, et al. Continuous glucose profiles in healthy subjects under everyday life conditions and after different meals. J Diabetes Sci Technol. 2007;1(5):695-703. doi:10.1177/193229680700100513

7.        Lawton J, Blackburn M, Allen J, et al. Patients’ and caregivers’ experiences of using continuous glucose monitoring to support diabetes self-management: Qualitative study. BMC Endocr Disord. 2018;18(1):1-10. doi:10.1186/s12902-018-0239-1

8.        Berget C, Messer LH, Forlenza GP. A clinical overview of insulin pump therapy for the management of diabetes: Past, present, and future of intensive therapy. Diabetes Spectr. 2019;32(3):194-204. doi:10.2337/ds18-0091

Photo by Artem Podrez from Pexels

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