Continuous Glucose Monitoring

Visit the link below to download the full version of this book:

https://medipdf.com/product/continuous-glucose-monitoring/

Click Download Now

Editor
Weiping Jia
Department of Endocrinology and Metabolism
Shanghai Clinical Center for Diabetes
Shanghai Diabetes Institute
Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
Shanghai
China

ISBN 978-981-10-7073-0    ISBN 978-981-10-7074-7 (eBook)

https://doi.org/10.1007/978-981-10-7074-7

Library of Congress Control Number: 2018945466

© Springer Nature Singapore Pte Ltd. and Shanghai Scientific and Technical Publishers 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Printed on acid-free paper

This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore
189721, Singapore
Foreword 1

Since Banting and Best won the Nobel Prize for their discovery of insulin,
there have been many small, iterative advances in diabetes management.
However, there have been only a few major breakthroughs that have revolu-
tionized our ability to better control glucose over that same period of time.
One of those is continuous glucose monitoring (CGM). Whether used in
masked (professional) or real-time (personal) mode, CGM permits the health-
care professional and patient to understand the relationship among the three
key elements of metabolic control, i.e., behavior (meals, exercise, stress,
etc.), medication (injectable or oral), and glucose levels, in ways not possible
with meter-based blood glucose monitoring. CGM is both an educational tool
for the patient and healthcare provider (HCP) and a management tool for the
HCP regardless of whether the patient has type 1 or type 2 diabetes.
Numerous studies have shown that masked (professional) CGM—essen-
tially a Holter monitor for glucose—adds significant value in the manage-
ment in both type 1 and type 2 diabetes regardless of whether or not the
patient is taking insulin. In addition, it is critical in evaluating the efficacy and
safety of not only new pharmaceuticals but also psycho-educational interven-
tions. By the data being masked from the patient the true, real-world effect of
the intervention can be determined. Real-time (personal) CGM provides sig-
nificant information to the patient whether they are receiving insulin by injec-
tion or pump. It also has been shown to benefit those with type 2 diabetes not
on insulin where it acts as a behavior modification tool.
The future of CGM is discussed in the last chapter. I foresee four major
directions in CGM use:

1. CGM will be a bridge to an era when we will use actual glucose metrics
(mean, standard deviation, severity of hypo- and hyperglycemia, and
times-in-ranges) rather than a surrogate marker (A1C) to evaluate diabetes
control. It is well known that there are many problems with using A1C, not
the least of which is that there is a wide range of mean blood glucose for
a given A1C, e.g., for an A1C of 8% the mean can be from 120 to 200 mg/
dL (6.7-11.1 mmol/L) because of different glycation rates, red cell turn-
over, and other as yet undefined genetic factors. While A1C will remain a
touchstone for our understanding of how it correlates with diabetes com-
plications, CGM-derived metrics will permit healthcare providers to make
changes between the typical quarterly A1C determination.

v
vi Foreword 1

2. There will continue to be iterative improvements in CGM accuracy, lon-

gevity, and footprint with the use of optical, fluorescence, and hydrogel
technologies that permit miniaturization and prolongation of sensor life by
months to years.
3. CGM drives artificial pancreas systems. Indeed, we have just entered that
era with the US FDA’s approval of the MiniMed Medtronic Hybrid Closed
Loop system (670G), which automates basal insulin delivery and sus-
pends insulin delivery based on CGM data. Many groups around the world
are actively investigating novel algorithms as well as ways to incorporate
other relevant hormones like glucagon, pramlintide, and exenatide into
artificial pancreas systems.
4. CGM will be used to assess dysglycemia in patients without diabetes
including those with prediabetes and obesity, and it is possible that CGM-­
derived criteria for the diagnosis of these metabolic disorders will be cre-
ated to supplement the traditional criteria. CGM is likely to be used to
educate nondiabetic yet dysglycemic patients about how to modify their
lifestyle behaviors. It is also reasonable to think that CGM will be used in
wellness efforts by a wide spectrum of individuals without metabolic
abnormalities.

Professor Jia and her colleagues have been international leaders in the use
of CGM. Their multiple publications in leading scientific journals have pro-
vided important insights about diabetes both in China and internationally.
Importantly, they have used CGM to establish norms for the population and
published one of the first guidelines in how CGM can be used to benefit
patients with diabetes and related conditions. This book provides a compre-
hensive description of the science and clinical use of CGM by one of the
world’s experts in CGM and is essential reading for anyone treating patients
with diabetes.

Robert A. Vigersky
Washington D.C.
United States of America
Foreword 2

Various types of diabetes with different etiologies or pathogenesis share a

common pathophysiological feature, that is, the elevation of blood glucose
levels. For more than half a century, measurement of venous or capillary glu-
cose levels or glycated hemoglobin has been the major methods to monitor
impaired glucose metabolism. Recent years have witnessed the rapid devel-
opment of continuous glucose monitoring (CGM) technology, which detects
glucose in subcutaneous interstitial fluid through a specialized sensor. As is
known to all, blood flows from the capillaries to the veins, and interstitial
fluid acts as a bridge in the diffusion of glucose between capillaries and cells
of the tissue. Elevation of glucose levels in interstitial fluid, due to impaired
glucose uptake or excessive glucose release into the interstitial fluid, repre-
sents the basic pathogenesis of the increased plasma glucose concentration in
diabetes mellitus. Therefore, understanding intraday and interday trends of
interstitial fluid glucose is the stepping stone to in-depth comprehension of
normal or impaired glucose metabolism and the metabolism of glucose-
related substances. From a hundred years ago when urine glucose testing was
initially performed to now, the feasible means for daily routine monitoring of
abnormal glucose metabolism remain imperfect and are still in progress.
The evaluation of the accuracy of CGM shows that the technology can
reflect the trend in blood glucose fluctuations. Thus, in China, CGM was once
referred to as dynamic glucose monitoring technology. CGM helps to under-
stand the trend in glucose fluctuations, as well as to detect occult hyperglyce-
mia and hypoglycemia, which are usually not detected by traditional glucose
monitoring methods. Therefore, CGM allows more precise management of
diabetes by controlling hyperglycemia, reducing hypoglycemia events,
decreasing glucose fluctuations, and finally preventing the occurrence and
development of diabetes complications that jeopardize the health and life
span of patients.
The technology of CGM is among the great achievements of glucose mon-
itoring technologies for diabetes. Since 1999 when the retrospective CGM
system was first launched, CGM technology has played a positive role in
promoting progress in diabetes management. In order to expand the knowl-
edge of CGM technology and to facilitate the scientific, standardized, and
reasonable use of CGM technology, the authors compiled this book based on
their long-term original researches and clinical experience, as well as the
scientific findings from domestic and international counterparts.

vii
viii Foreword 2

The authors of this book introduced their initial work on the establishment
of the normal reference ranges for CGM parameters in Chinese population.
Indeed, the definition of the "normal" value is the key to judging "abnormali-
ties." In the early years of clinical application of CGM technology, there was
a lack of normal reference values for CGM parameters and the reference
range of finger-stick glucose value was apparently not suitable to CGM mea-
surements. These limitations significantly hindered the interpretation of
CGM results and the clinical application of this technology. Previously, the
authors carried out a multicenter study and obtained large amounts of normal
CGM data and established the CGM normal reference range for the first time
worldwide. In the book, the authors introduce their innovative work and com-
pare and analyze similar findings from domestic and international counter-
parts in different ethnic groups. These studies lay the foundation for scientific
application of CGM and rational explanation for CGM results, and solve the
key problems in making the best use of CGM technology in clinical
practice.
Moreover, the authors introduce their CGM reporting and management
system in details, which was developed independently with intellectual prop-
erty rights. Scientific interpretation of CGM data and its graphical display are
important to the clinical use of the technology as are the presentation of a
comprehensive display of glucose metrics and standardized reports. By illus-
trating clinical cases, the authors introduce their CGM reporting system and
explain how to interpret or analyze CGM profiles. Their reporting system
includes an analysis software, which can calculate CGM-derived metrics and
generate a standardized CGM report automatically. All these efforts enable
clinicians to understand the trend of blood glucose fluctuations in patients.
Furthermore, the clinical significance and application of CGM metrics
proposed by domestic and international scholars are reviewed in the book.
The authors also summarize the advantages and concerns of several parame-
ters based on the clinical trials conducted by themselves.
In the book, the current clinical application of CGM technology is dis-
cussed in detail. The book also demonstrates the use of CGM measurements
in various situations of abnormal glucose metabolism, as well as the role of
CGM in evaluating the efficacy of different hypoglycemic therapies.
I would like to thank my colleagues in Shanghai Clinical Center for
Diabetes who have engaged in glucose monitoring studies and related clinical
work for their persistent devotion and efforts to promote the development of
CGM in China. It is expected that this book will help all the readers gain a
comprehensive understanding of the CGM system and promote the standard-
ized and wide application of CGM in clinical practice, thereby contributing
to the improvement of diabetes management in China.

Shanghai, China Kunsan Xiang

Preface

Blood glucose monitoring is an important part of diabetes management. It

plays an essential role in the assessment of glucose metabolism disorders,
thereby guiding the optimization of the magagement of diabetes. As blood
glucose level changes continuously, neither the glucose values at certain time
points nor glycated hemoglobin reflects the dynamic fluctuations in blood
glucose throughout the day. Indeed, the capture of continuous glucose moni-
toring has always been a dream pursued by both patients and clinicians for a
long time. As in the early 1960s, Clark and Lyons first put forward the con-
cept of a glucose sensor. The designed sensor consisted of a thin layer of
glucose oxidase (GOD), an oxygen electrode, an inner oxygen semiperme-
able membrane, and an outer dialysis membrane. The glucose concentration
could be calculated by measuring the change in the local oxygen concentra-
tions. In 1967, Updike and Hicks further improved the detection assay and
measured glucose concentrations in biological fluids of an animal model for
the first time. Subsequently, continuous glucose monitoring (CGM) technol-
ogy has become increasingly sophisticated and accurate and has been gradu-
ally promoted from the experimental monitoring to clinical application.
In 1999, a CGM system was approved by the US Food and Drug
Administration (FDA) for clinical use, allowing a convenient, panoramic
view of all-day changes in blood glucose for the first time. Since 2005, the
real-time CGM system has been applied in clinical practice. In addition to
real-time display of monitoring results, it integrates alarm and predictive alert
features, providing a guarantee for the safety of treatment. At the same time,
the development of CGM technology promotes the creation of algorithms
that can modify the rate of continuous insulin infusion. Moreover, with the
application of CGM technology, investigators have been able to study the
normal patterns of glucose variation and how they differ under different clini-
cal circumstances.
In 2001, we started to apply CGM in clinical practice in China for the first
time. We found some challenges that need to be addressed. For example, the
lack of normal reference range for CGM parameters, the absence of standard-
ized interpretation methods for CGM graphs, and the complex and time-­
consuming process of CGM data analysis. In addition, little experience exists
regarding the clinical indications for this new technique, the methods for
assessing the accuracy of CGM data, and how the data should be used to
guide decisions in clinical practice. To address these challenges, we estab-
lished the normal reference values of CGM parameters by a national multi-

ix
x Preface

center study, which was the first reported evidence domestically and
internationally. We also analyzed the patterns of blood glucose fluctuations in
different metabolic disorders, carried out standardized protocols for CGM
graphs interpretation, and designed a series of supporting software and man-
agement systems independently to simplify the time-consuming data analysis
process. We have published more than 50 papers related to CGM in domestic
and international journals, established a CGM database containing more than
15,000 cases, and accumulated a wealth of clinical experience. In order to
further enhance the knowledge of CGM technology among professional med-
ical staff in the fields of endocrinology and metabolism, we have compiled
this book to facilitate the scientific, standardized, and proper utilization of
CGM technology.
The book firstly focuses on the basic knowledge of CGM technology, and
then introduces the advantages and applications of the CGM system with
clinical cases. In the book, we introduce the principles, the operation meth-
ods, the management procedures, and indications of CGM. Also, the alarms
settings and responses to the alarms, interpretation of CGM results, the analy-
sis of clinical cases, the relative researches and prospects are also discussed.
This book is edited mainly based on our original research results and specifi-
cally focuses on the clinical application. It illustrates CGM knowledge in the
form of clinical cases and graphs, with the aim of becoming a reference book
guiding the application of CGM technology in clinical practice and scientific
research.
All the clinical trials carried out by the authors in this book have been
reported to the Ethics Committee of Shanghai Jiao Tong University Affiliated
Sixth People’s Hospital already and were in accordance with the Good Clinical
Practice and Standards of China Association for Ethical Studies (approval num-
ber: 2007-45).
I would like to thank my colleagues in the Department of Endocrinology and
Metabolism and Shanghai Diabetes Institute who have engaged in the glucose
monitoring and clinical work for years for their continuous dedication. In addi-
tion, my colleague Jie Li and graduate students Xingxing He, Hang Su, Lingwen
Ying, Jiahui Peng, Lingli Cai, Yiming Si, Dongjun Dai, Yun Shen, and others
who have contributed in the careful editing and chart proofing. Specifically, my
mentor, the Chinese Academy of Engineering member, Professor Kunsan Xiang,
and the former president of the Endocrine Society, Professor Robert A. Vigersky,
wrote the foreword for this book. Also, many thanks to my editors Ling Wan,
Jianshe Zeng, Lujing Kong, et al. in the Shanghai Scientific and Technical
Publishers for their help and support.
There might be some inevitable shortcomings and omissions exist in the
book. We sincerely hope that readers will share their valuable advice and sug-
gestions for future improvements.

Shanghai, China Weiping Jia

Contents

1 Determination of Glucose and Continuous

Glucose Monitoring ����������������������������������������������������������������������    1
Y. F. Wang and W. Jia
2 Introduction of Continuous Glucose
Monitoring Technology������������������������������������������������������������������   13
J. Y. Lu and Y. Bao
3 Accuracy Assessment of Continuous Glucose
Monitoring Technology������������������������������������������������������������������   21
J. Zhou and W. Jia
4 Operation Standards for Continuous Glucose Monitoring�������   27
W. Lu and Y. Bao
5 Methods for Interpreting Continuous Glucose
Monitoring Graphs������������������������������������������������������������������������   35
M. Li and Y. Bao
6 Definition and Clinical Significance of Continuous
Glucose Monitoring Parameters��������������������������������������������������   47
Y. F. Mo and W. Jia
7 Reference Values for Continuous Glucose
Monitoring Parameters ����������������������������������������������������������������   65
J. Zhou and W. Jia
8 Clinical Applications of Continuous Glucose Monitoring
Reports and Management Systems����������������������������������������������   75
L. Zhang and W. Jia
9 Clinical Indications for Continuous Glucose Monitoring����������   87
W. Jia
10 Interpretation of the Chinese Clinical Guideline
for Continuous Glucose Monitoring��������������������������������������������   93
W. Jia
11 Continuous Glucose Monitoring and Glycemic Variability ������ 101
J. Zhou and W. Jia

xi
xii Contents

12 Continuous Glucose Monitoring and Antidiabetic

Therapies���������������������������������������������������������������������������������������� 111
J. Zhou and W. Jia
13 Using Continuous Glucose Monitoring for Patients
with Hypoglycemia������������������������������������������������������������������������ 121
X. J. Ma and J. Zhou
14 Using Continuous Glucose Monitoring for Patients
with Fasting Hyperglycemia �������������������������������������������������������� 129
J. Zhou
15 Using Continuous Glucose Monitoring for Patients
with Fulminant Type 1 Diabetes�������������������������������������������������� 143
J. Zhou
16 Using Continuous Glucose Monitoring for Diabetes
Mellitus in Pregnancy�������������������������������������������������������������������� 159
X. J. Ma and J. Zhou
17 Using Continuous Glucose Monitoring for Steroid-Induced
Diabetes������������������������������������������������������������������������������������������ 171
J. Y. Lu and W. Jia
18 Using Continuous Glucose Monitoring for Patients
with Insulinoma������������������������������������������������������������������������������ 183
J. F. Han and Y. Bao
19 Using Continuous Glucose Monitoring for Patients
Who Have Undergone Metabolic Surgery���������������������������������� 195
H. Y. Yu and Y. Bao
20 Perspectives on Continuous Glucose
Monitoring Technology������������������������������������������������������������������ 207
F. Gao and W. Jia
About the Editor and Associate Editors

Weiping Jia is a Chinese endocrinologist,

professor of medicine at Shanghai Jiao Tong
University, president of the Shanghai Sixth
People’s Hospital, director of the Shanghai
Clinical Center for Diabetes, and director of
Shanghai Diabetes Institute. Professor Jia
also serves as the president of Chinese
Diabetes Society, chief editor of the Chinese
Journal of Internal Medicine, associate edi-
tor of Diabetes Research and Clinical
Practice, as well as an editorial board mem-
ber of Lancet Diabetes Endocrinology. She
is the chief editor of the Chinese National Guideline for Prevention and
Treatment of Type 2 Diabetes Mellitus (2017 Edition) and the Chinese
National Guideline for Primary Healthcare of Diabetes (2018 Edition). Her
research interests include the diagnosis and monitoring of diabetes as well as
identification of genetic risk factors for diabetes. She established new diag-
nostic standards for diabetes and abdominal obesity, discovered novel T2DM
genetic susceptibility loci, and established normal reference values for con-
tinuous glucose monitoring in Chinese population. She has published over
100 research articles in international journals, including Diabetes, Diabetes
Care, Diabetologia, JCEM, BMJ, Lancet Diabetes Endocrinol, and JACC.
Her research has been funded by the Natural Science Foundation of China
(NSFC), the National Basic Research Program of China, and the European
Association for the Study of Diabetes (EASD). She is the Co-PI of research
projects funded by the US National Institute of Health (NIH). Since 2015, she
has been the PI of the Construction of Prevention and Treatment of Diabetes
Healthcare System in Shanghai, the largest community-based screening pro-
gram for complications of diabetes in China which covers over 200,000
patients.

xiii
xiv About the Editor and Associate Editors

Jian Zhou is the associated professor of

medicine at Shanghai Jiao Tong University
and the deputy director of the Department
of Endocrinology and Metabolism,
Shanghai Jiao Tong University Affiliated
Sixth People’s Hospital. He also serves as
the member of the Youth Committee of
Chinese Society of Endocrinology, the sec-
retary and committee member of Shanghai
Diabetes Society, an editorial board mem-
ber of Cardiovascular Diabetology, and the
corresponding editor of Chinese Medical
Journal, Chinese Journal of Endocrinology
and Metabolism, and Chinese Journal of
Diabetes. His career has focused on diabe-
tes and obesity, and he has taken the leading role in promoting the new tech-
nology of Continuous Glucose Monitoring in China. He was the first
researcher who proposed to establish the normal reference values of
Continuous Glucose Monitoring parameters and published the relevant
results in Chinese population on Diabetes Care. He has published more than
90 research articles (as first or corresponding author), among which 30 were
cited by international peer-reviewed journals.

Yuqian Bao is a Chinese endocrinologist,

professor of medicine at Shanghai Jiao Tong
University, the director of the Department
of Endocrinology and Metabolism,
Shanghai Jiao Tong University Affiliated
Sixth People’s Hospital, and the executive
deputy director of Shanghai Clinical Center
for Diabetes. She also serves as the vice
chairman of Specialty Subcommittee of
Diabetes Prevention and Control of Chinese
Preventive Medicine Association, member
of Chinese Society of Endocrinology, and
the president of Shanghai Diabetes Society. Her career has focused on obe-
sity, and she was professionally trained in key research areas.
Her team established the accurate diagnostic criteria of central obesity
(abdominal obesity) for the first time in Chinese population and defined the
corresponding waist circumference cutoffs, which were adopted by the “Criteria
of weight for adults” (WS/T 428-2013) issued by National Health and Family
Planning Commission of the People’s Republic of China in 2013. She was also
the first researcher who proposed to use glycated hemoglobin A1c as a supple-
mental index for the diagnosis of diabetes in Chinese population and published
the relevant results in the British Medical Journal. Moreover, she has estab-
lished the hyperglycemic clamp technique as the precise method to evaluate
pancreatic β-cell function in Chinese population. In recent years, her team has
founded a model of comprehensive management of metabolic surgery, also
called the “Shanghai Model” by local and international researchers.
Contributors

W. Jia Department of Endocrinology and Metabolism, Shanghai Clinical

Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
J. Zhou Department of Endocrinology and Metabolism, Shanghai Clinical
Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
Y. Bao Department of Endocrinology and Metabolism, Shanghai Clinical
Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
X. J. Ma Department of Endocrinology and Metabolism, Shanghai Clinical
Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
Y. F. Mo Department of Endocrinology and Metabolism, Shanghai Clinical
Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
J. Y. Lu Department of Endocrinology and Metabolism, Shanghai Clinical
Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
Y. F. Wang Department of Endocrinology and Metabolism, Shanghai
Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao
Tong University Affiliated Sixth People’s Hospital, Shanghai, China
H. Y. Yu Department of Endocrinology and Metabolism, Shanghai Clinical
Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
L. Zhang Department of Endocrinology and Metabolism, Shanghai Clinical
Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
M. Li Department of Endocrinology and Metabolism, Shanghai Clinical
Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China

xv
xvi Contributors

J. F. Han Department of Endocrinology and Metabolism, Shanghai Clinical

Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
F. Gao Department of Endocrinology and Metabolism, Shanghai Clinical
Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
W. Lu Department of Endocrinology and Metabolism, Shanghai Clinical
Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong
University Affiliated Sixth People’s Hospital, Shanghai, China
 Determination of Glucose
and Continuous Glucose 1
Monitoring

Y. F. Wang and W. Jia

Glucose is the main source of energy for human trends in blood glucose fluctuations, and to detect
activities. Under normal circumstances, the blood occult hyperglycemia and hypoglycemia that
glucose level in the body is relatively constant, cannot be detected by traditional blood glucose
generally maintained at 3.9–6.1 mmol/L before monitoring methods [1]. This chapter introduces
meals and 7.8–8.3 mmol/L after meals. Diabetes the metabolism and regulation of glucose in the
is a group of disorders characterized by chronic body, explains the detection of interstitial fluid
elevation of blood glucose. Thus, determination glucose concentration, and analyzes the principle
of blood glucose is a basic method for the diag- of CGM technology and its differences from tra-
nosis, treatment, and follow-up of diabetes. Due ditional blood glucose monitoring methods, in
to the limitations of detection technologies, until order to help readers understand the CGM tech-
recent years, it was not possible to observe a pan- nology more comprehensively.
oramic view of subtle changes in blood glucose
and, thus, not possible to gain an in-depth under-
standing of the changes in blood glucose among 1.1 Metabolism and Regulation
diabetic patients. At present, a widely used tech- of Glucose
nology is continuous glucose monitoring (CGM)
technology, which monitors the glucose concen- 1.1.1 Glucose Metabolism
trations in subcutaneous tissue interstitial fluid
(referred to as interstitial fluid) through a glucose Glucose is a carbohydrate molecule composed
sensor. This technology is able to provide contin- of six carbon atoms. The chemical formula is
uous, comprehensive, and reliable all-day glucose C6H12O6; the molecular weight is 180.16; the den-
profiles, thereby allowing for an understanding of sity is 1.54 g/cm3; the melting point is 146 °C;
and it is easy to dissolve in water. Glucose is the
most extensively utilized and stored carbohydrate
molecule and also the basic carrier for energy sup-
ply and transportation in the body. Carbohydrates
Y. F. Wang (*) · W. Jia (*) are important sources of energy for the body, and
Department of Endocrinology and Metabolism, more than 70% of the energy needed is derived
Shanghai Clinical Center for Diabetes, Shanghai
from carbohydrates in food. Glucose is a diges-
Diabetes Institute, Shanghai Jiao Tong University
Affiliated Sixth People’s Hospital, Shanghai, China tive product of carbohydrates, and as smallest unit
e-mail: [email protected] of carbohydrate, it is absorbed into blood circula-

© Springer Nature Singapore Pte Ltd. and Shanghai Scientific and Technical Publishers 2018 1
W. Jia (ed.), Continuous Glucose Monitoring, https://doi.org/10.1007/978-981-10-7074-7_1