Research Series: Continuous Glucose Monitors

Research into Type 1 Diabetes has come on leaps and bounds in recent years. The introduction of insulin pumps and the huge steps forwards of continuous glucose monitoring devices have really made life changing alterations to the lives of those with Type 1 Diabetes everywhere. As a non-T1D I will be delivering this series of blogs which looks at a number of the current research projects into cures and management devices/medications across the world; starting with continuous glucose monitors which are a fairly new introduction into the UK healthcare market.

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The Continuous Glucose Monitor Factfile

What: a small device similar to that of an insulin pump that continually monitors the glucose level in your interstitial fluid via a sensor under the skin

Why: dramatically reduces the number of daily finger pricks, is good for brittle diabetics (who cannot sense their glucose levels dropping), good to show overall trends in glucose levels, most have an alarm system which is good for everyday use but particularly useful for hypos during the night

How: a sensor is placed under the skin, similar to that of the insulin pump, it is then worn for 5-7 days before replacement. It monitors the glucose level in your interstitial fluid (the liquid that comes out of cuts and grazes). It can be paired with insulin pump systems or just used with injections.

How can I get one?: 7 CGM systems available in the UK but current NICE guidelines do not require the NHS to fund CGMs yet but this could soon be changing as 2015 marks the first time CGMs have been mentioned in relation to T1D. Currently the only way you can definitely get one is by purchasing one yourself.

Cost: £1000-2000 for the monitor itself (£200 if you already have a recent Medatronic insulin pump), then £40-60 for each sensor

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CGMs are by no means new and research has been going on for many years now; a 2005 article in the Diabetes Care journal show that by 2004 five CGM systems were already approved by the FDA in the USA and the earliest CGM I can find dates back to 1999 with the GlucoWatch (although the first attempt at continuous glucose monitoring in animals occured way back in 1967). However as insulin pumps have become more prevalent, CGMs seem to have come more to the forefront of research both in the USA and here.

Research has shown that those who have used CGMs have lowered that HbA1c level by a fair amount compared to those who have not used CGMs One study in adults puts this at an average of 0.53% reduction in the level after six months. Another involving children put the reduction at an average of 0.8%. This is probably one of the strongest arguments for the useage of CGMs - in the long term lower HbA1c levels will mean a reduced risk of the side effects of Type 1 like nerve problems, feet issues and diabetic retinopathy. Secondly those anyone who is struggling with the control of Type 1 would find the CGM beneficial to see how their body is reacting to insulin after exercise or sleep as well as just generally throughout the day. In my personal opinion, I think that the best thing about CGMs is its warning system. If it sees your levels dropping, most systems will alert you to this to allow you to take action. This could be a lifesaver to the many unfortunate people who have passed away from "dead in the bed syndrome" - one of the most heartbreaking complications of Type 1.

However one of the downsides is that you would still need to do blood glucose tests at least once or twice a day to calibrate the system which, whilst an annoyance, will reduce the overall number of needle pricks you have to do a day and mean that finally your fingers can heal! Like insulin pumps, CGMs require a sensor to be place beneath the skin and so every 5-7 days (in current guidance) a new sensor is required to be put in place. It would appear that this is similar to the way that insulin pumps are attached to the body with a cannula-like device.

Another downside, although limited, is that due to the sensor testing the interstitial fluid there is a slight lag in real time glucose levels compared with blood glucose testing. This is only by five to ten minutes so unless your levels are falling or rising fast, I would hope that this is not too much of an issue.

Overall, hopefully continued research will mean that CGMs become more of an option for the management of Type 1 to allow both sufferers of Type 1 and parents of young children with Type 1 to have the opportunity to use these systems should they wish to. It's definitely something I would like for my sister! Yet I would also wait a couple more years to see how their usage in the UK progresses as they are still fairly new to us over here, then hopefully they will be much cheaper and positively advocated by the NHS as insulin pumps seems to be now.

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[*Disclaimer* the author of this post is not a medical professional- all information included in this post has been found via the internet and all opinions are her own.]

#diabetes #research #CGM #continuousglucosemonitor