Continuous Glucose Monitoring in Clinical Practice: Ambulatory Glucose Profile and the Application of Advanced Glucose Sensing Technologies to Clinical Decision-Making

Abstract

Nothing is more fundamental in evidence-based clinical decision-making than understanding the diurnal glucose patterns that characterize dysglycemia, and nothing is more fundamental to obtaining diurnal glucose patterns than continuous glucose monitoring (CGM). The significance of CGM cannot be overstated, whether the treatment decisions are for type 1, type 2, or diabetes in pregnancy. Glucose control is unequivocally of significance, and although the evidence remains equivocal as to the precise mechanisms glucose control provides prevent or slow the progression of complications, there is no doubt that its importance remains paramount. The argument can be summed up by Ceriello’s observation after examining diurnal glucose patterns of individuals with normal glucose tolerance: “If the human body spends so much energy to maintain the blood glucose level within such a narrow range, it is because otherwise it would be deleterious.” (Ceriello and Ihnat Diabet Med. 27:862–7, 2010) It has been established that individuals with normal glucose metabolism have the lower risk of glucose-related macrovascular, microvascular, and maternal and fetal complications when compared to individuals with any degree of dysglycemia (Di Cianni, Diabetes Metab Res Rev. 19:259–70, 2003; Mazze et al., Diabetes Technol Ther. 11:11–8, 2009; Hoss et al., Sci Technol Sep. 7:1210–1219, 2013; Xing et al., Diab Tech Ther. 13:351–8, 2011; Mazze et al., Diabetes Technol Ther. 10:149–59, 2008).