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Technology for the Masses: The Promise of Flash Glucose Monitoring

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Technological advances in glucose monitoring have improved patient safety parameters over time. "Flash" Glucose Monitoring (FGM), not referring to the DC Superhero but to the marvelous swiping technology for reading blood glucose levels, is the newest trend in effective outcomes-driven diabetes management. Real time glucose monitoring has enabled precision glycemic control and enhanced patient safety. These latest technologies have opened avenues in controlling chronic disease at a global level, more optimally.

Dr. Ames discovered the glucometer in the 1970s. The Ames meter was a reflectographic meter and involved multistep detection processes with a color chart. In the 1980s, home glucometers became available, which marked the advent of tighter glucose control with home glucose monitoring. The Continuous Glucose Monitoring (CGM) systems monitor interstitial glucose levels. The Flash Glucose Monitoring (FGM) systems also monitor the interstitial fluid glucose levels, but they do so on demand. There is a time lag of 10-20 minutes between the blood glucose levels and the interstitial fluid glucose. CGM can provide more detailed information on glycemic control as compared to self-monitoring blood glucose.

Biosensor: The FGM prototype, Freestylelibre, is the first factory-calibrated sensor system. The pre-set calibration is a user-friendly feature. The sensor needs 12 hours to warm up before it's ready to use; following that it will function seamlessly for its 10-day life. The pre-set calibration is an excellent feature for the technologically challenged population. This prototype is also programmed to handle timezone changes and retain the data for retroactive review (scan option-8 hours). Freestylelibre is not compatible with MRI testing, but can be used on flights when other radio activities are turned off (or in airplane mode).

Safety Outcomes: The treatment of diabetes necessitates a two-fold strategy: adequate glycemic control and avoiding life-threatening side effects. In addition to satisfactory glycemic control, FGM monitors adverse outcomes, such as hypoglycemia and time spent in hypoglycemia. The monitoring devices have a niche patient population amongst Type 1 and Type 2 diabetics.

Alternate Uses: The provider can switch CGM to FGM once the patient achieves target levels. Once the patient-physician team has accurately studied trends with CGM, patients might discover that removing alarm notifications is more conducive to their personal or professional lifestyle. FGM has novel uses other than in patients with diabetes, like in individuals who are on a diet to check their metabolic state. When used with correct interpretation and physician guidance, FGM can give individuals insight into the effects of specific foods on blood sugars.

Technology Benefits: CGM and FGM use wireless communication between devices (Bluetooth and Near Field Communications (NFC) technology, respectively). Bluetooth has a range of 30 feet; NFC technology requires a proximity of 4 centimeters. Bluetooth has a greater range as compared to NFC technology; however, there is a loss of specificity due to interference caused by the proximity of other devices. Bluetooth requires technological knowhow to manually set up connections, while NFC's automatically set up. NFC reduces the handling effort, which has generated more interest.

Diabetes is a chronic metabolic disease with severe end-organ damage and a staggering burden on population health. The WHO and the International Diabetes Federation (IDF) recognize November 14th as World Diabetes Day for social advocacy of this global health problem. In rural areas, mobile healthcare and internet access is quite inaccessible. Although FGM might not be accessible easily in these places, Freestylelibre, with the use of NFC technology, can be utilized in remote areas without other broadband access. Meaningful use of FGM technology, by virtue of its easy handling and factory-set calibration, makes it the choice of wearable to monitor glucose. FGM has the potential to impact diabetes control and act as "technology for the masses."

Nita K. Thingalaya, MD, is an internal medicine hospitalist with over 15 years' experience as a practicing physician. She is currently Medical Director in Healthcare Utilization with experience in clinical research and informatics. The article is independent of her affiliations past or present.

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