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Diabetes Blood Glucose Monitoring Future Perspectives in Glucose Monitoring Sensors Giulio Frontino, Franco Meschi, Riccardo Bonfanti, Andrea Rigamonti, Roseila Battaglino, Valeria Favalli, Clara Bonura, Giusy Ferro and Giuseppe Chiumello Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy. Abstract The prevalence of diabetes is increasing. Improved glucose control is fundamental to reduce both long-term micro- and macrovascular complications and short-term complications, such as diabetic ketoacidosis and severe hypoglycaemia. Frequent blood glucose monitoring is an essential part of diabetes management. However, almost all available blood glucose monitoring devices are invasive. This determines a reduced patient compliance, which in turn reflects negatively on glucose control. Therefore, there is a need to develop non-invasive glucose monitoring devices that will reduce the need of invasive procedures, thus increasing patient compliance and consequently improving quality of life and health of patients with diabetes. Keywords Diabetes, continuous glucose monitoring, non-invasive glucose monitoring, HbA1c Disclosure: The authors have no conflicts of interest to declare. Received: 21 January 2013 Accepted: 14 February 2013 Citation: European Endocrinology, 2013:9(1);6–11 Correspondence: Giulio Frontino, San Raffaele Scientific Institute, Department of Pediatrics, Diabetes Unit, Via Olgettina 60, 20132 Milano, Italy. E: frontino.giulio@hsr.it Blood glucose monitoring is fundamental in the management of diabetes and is essential to optimise glycaemic control. Achieving optimal glucose control is important in reducing the risk of significant long-term microvascular (nephropathy, retinopathy) and macrovascular (cardiovascular disease) complications, as well as neuropathy. Intensive insulin therapy and frequent blood glucose determinations are recommended to achieve glucose objectives in Type 1 diabetes patients. 1 Self-monitoring of blood glucose (SMBG) is performed by obtaining a capillary blood sample by means of a lancing device and then measuring the blood glucose employing a glucose meter. The obtained result represents the blood glucose at the moment when the blood was drawn. This method provides an accurate determination the glucose levels; however, significant oscillations in blood glucose may be ignored, hindering the achievement of an optimal glycaemic control. 2 Furthermore, SMBG entails a significant number of daily punctures that many patients find uncomfortable and painful. who patients who showed low or no sensor usage. 4 Furthermore, a recent consensus statement from the European Society for Pediatric Endocrinology, the Pediatric Endocrine Society and the International Society for Pediatric and Adolescent Diabetes declared that the use of RT-CGM may be appropriate for motivated children and youth of all ages provided that appropriate support personnel are available. 6 CGM therefore provides detailed information on glucose oscillations and trends. This allows patients to manage their diabetes more successfully. Several CGM systems are commercially available. Two types of CGM systems can be identified according to the way information is delivered: • • Continuous glucose monitoring (CGM) systems measure interstitial fluid glucose levels providing continuous information reflecting blood glucose levels. This continuous monitoring may recognise glucose oscillations that may otherwise remain unidentified with SMBG alone. Currently, the use of CGM is not common practice. 3 CGM is considered to be particularly useful for children (to reduce the often very high number of finger punctures in this group), for patients with poorly controlled diabetes, for pregnant women in whom tight glucose control is essential with respect to the outcome of pregnancy and for patients with hypoglycaemia unawareness (to prevent dangerous episodes of hypoglycaemia). 4,5 A recent meta-analysis by Langendam et al. 4 shows that there is limited evidence for the effectiveness of real-time CGM (RT-CGM) on glycaemic control. However the reduction in HbA1c levels seems to be related to actual CGM use. After 12 months, those patients who used their CGM frequently had a significantly lower HbA1c level compared 6 Retrospective systems that measure the glucose concentration during a certain time span: the information is stored in a monitor and can be downloaded in a second moment. RT systems that continuously provide the actual interstitial glucose concentration and trend on a display. CGM devices can be further classified into three categories: invasive, minimally invasive and non-invasive. Sensor placement/invasiveness depends on the its transduction mechanism. 7,8 Current (Invasive) Continuous Glucose Monitoring Systems There are four RT-CGM devices approved by the US Food and Drug Administration (FDA) and clinically used: DexCom® SEVEN® PLUS (San Diego, California, US), Medtronic MiniMed Paradigm® and Guardian® REAL-Time (Minneapolis, Minnesota, US) and Abbott Diabetes Care FreeStyle Navigator (Maidenhead, Berkshire, UK). Each system consists of a glucose oxidase-based electrochemical sensor, which is placed subcutaneously. Interstitial glucose measurements are then sent continuously from the sensor to a receiver through wireless technology. © Tou ch ME dic a l ME dia 2013