Professional flash continuous glucose monitoring as a supplement to A1C in primary care

ABSTRACT

Decreasing glycated hemoglobin (A1C) is the primary goal of current diabetes management due to intervention studies in type 1 and type 2 diabetes associating levels <7.0% (53 mmol/mol) with lower complication risk. Strategic self-monitoring of blood glucose (SMBG) is also recommended to achieve greater time in range, with fewer extremes of hypo- or hyperglycemia. Unlike A1C, SMBG can distinguish among fasting, prandial, and postprandial hyperglycemia; uncover glycemic variability, including potentially dangerous hypoglycemia; and provide feedback to patients about the effects of behavior and medication on glycemic control. However, it has the drawback of capturing only static glucose readings and users are often dependent on time-pressed clinicians to interpret numerous data points. A novel flash continuous glucose monitoring (FCGM) device used for a single 2-week period with a readily interpretable data report know as the ambulatory glucose profile (AGP) has the potential to overcome limitations of conventional technologies, with less cost and greater convenience. This review summarizes the rationale for using intermittent FCGM as a supplement to A1C in primary care, and provides a stepwise approach to interpreting the AGP visual display for efficient individualized therapy.

KEYWORDS:

• Diabetes
• self-monitoring of blood glucose
• flash continuous glucose monitoring
• hyperglycemia
• hypoglycemia
• glycemic variability

Acknowledgments

The author wishes to thank Carol A. Verderese for assistance with the writing of this manuscript.

Declaration of Interest

I Hirsch author is a consultant for Adocia, Abbott, Roche, Intarcia, BigFoot. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This project has been made possible by an unrestricted educational grant from Abbott Diabetes Care to the Diabetes Education Group (TDEG).