For years, managing diabetes has meant finger-prick tests, sore fingertips and one-off numbers that only tell part of the story.
Nowadays, we have Continuous Glucose Monitoring (CGM), a technology that’s giving people a clearer, gentler and more dynamic way to understand their blood sugar.
“In very simple terms, conventional finger-prick tests provide a single blood glucose value at a point in time, so they are like a polaroid photograph that captures one photo at a time but cannot provide context beyond that one photo,” described Consultant Endocrinologist at University Malaya Medical Centre and UM Specialist Centre Professor Dr Lim Lee Ling.
“A CGM device is designed to keep reading glucose values from the interstitial fluid just under the skin every minute or every few minutes.
“If the finger-prick is a polaroid, then the CGM is a full-length movie providing rich context about how glucose levels are fluctuating throughout the day and how they are impacted by factors such as activity, food and medication,” said Dr Lim.
How CGM Works
A finger-prick draws blood every time, so it’s painful and can lead to sore fingers. A CGM, by contrast, uses a tiny microfilament inserted just under the skin with an applicator.
“A CGM reads glucose levels every minute or few minutes over 10-15 days, depending on the brand of CGM used, before it needs to be replaced,” Dr Lim said.
That means continuous tracking allows you to see how food, activity, stress and medication shape your glucose levels across the day.
A lifestyle tool, not just a medical device
Dr Lim emphasises that CGM works best as part of holistic diabetes care.
“Using CGM as part of holistic diabetes care, which incorporates diabetes-specific nutrition and lifestyle modifications, helps users to manage their glucose levels. This informs them about the impact of activity and diet, the levels of insulin they need and the dosage of oral medications,” she said.
The result from this is that people don’t just track their condition, they understand it with comprehensive reports that reveal the impact of their daily routines.
“Consistent use of CGM over time with actions taken to address high and low glucose can lead to a reduction in HbA1c levels, indicating long-term glucose control,” she said.
Who should use CGM?
Currently in Malaysia, CGMs are indicated for people living with diabetes. But around the world, the technology is expanding.
“As presently indicated in Malaysia, CGMs are meant to be used for people living with diabetes, both type 1 and type 2 diabetes.
“Globally, there are devices that are based on the CGM technology that have been introduced for use by people who are not living with diabetes as a health and lifestyle tool.
“For example, Lingo is a popular technology that is now available in the US and UK,” she said.
Backed by research
CGMs are more than just convenient as studies show they help prevent dangerous complications like hypoglycemia and hyperglycemia.
“There’s significant data from CGMs in general that underlines their ability to improve diabetes management,” Dr Lim said.
She referred to clinical trials and real-world data showing better blood glucose control, reduced time in hyperglycemia and hypoglycemia, reduced hospitalisations and lower HbA1c levels.
For instance, Swedish national data showed people with Type 1 and Type 2 diabetes significantly reduced their HbA1c after using the FreeStyle Libre system for three to nine months.
The bigger picture
While CGMs can’t yet track stress or diagnose insulin resistance directly, their potential keeps expanding. Pregnant women with diabetes have used them safely to adjust insulin, while elite athletes abroad are experimenting with CGM-inspired devices for performance monitoring.
“Some companies are now looking to add metabolites such as ketones to the CGM sensor, which can be of great clinical utility.
“CGM data now integrates with data from other wearables, ‘smart’ rings for instance, giving users a never-before window into what’s happening inside their bodies, and an ability to manage health better,” Dr Lim said.