Diabetes management is complex because of the interaction of diet, activity, stress, medications, illness, and hormonal changes. The gold standard for self-management of diabetes is periodic blood glucose checks, requiring a finger prick and a blood glucose meter. This approach has two disadvantages: Individuals dislike making multiple finger pricks per day, and the blood glucose level is a snapshot in time. Even when devices allow alternative locations, such as the arm, palm, or thigh, intermittent blood glucose checks in these samples may not be as accurate as samples from the fingertip if glucose levels are rapidly changing (Mayo Clinic, 2021).
Several new approaches to tracking glucose levels are already on the market or are in a clinical trial phase. This article explores emerging glucose monitoring technologies and provides implications for nursing education.
INVASIVE CONTINUOUS GLUCOSE MONITORING
Invasive continuous glucose monitoring (CGM) devices, such as FreeStyle Libre or Dexcom, offer systems with more flexibility than checking blood glucose levels multiple times per day with a finger stick (Haider, 2020). Although not yet on the market, the K'Watch Glucose uses technology similar to FreeStyle Libre or Dexcom but looks like a watch (PK Vitality, 2022). Each of these devices has a sensor with microneedles placed on the skin of the arm or abdomen to measure glucose in the interstitial spaces (Funtanilla et al., 2019). Glucose monitoring occurs throughout the day and night, alerting individuals if their glucose readings are above or below the recommended levels. Some CGMs send data to smartphones, where data on diet, physical activity, and medications can be synchronized (Haider, 2020).
Individuals who use a CGM system are more informed about fluctuations in glucose levels and the association with diet and exercise. This information empowers individuals with actionable information to hold their glucose levels in tight control. Several disadvantages of invasive CGMs include the cost of replacing sensors every 3 to 14 days, depending on the model, and the need to check blood glucose levels with a traditional meter to confirm the accuracy of readings at least every 12 hours (Mayo Clinic, 2021).
NONINVASIVE CGM
Research and development of noninvasive CGM is a high priority to improve diabetes self-management. No single approach has been found superior to others (Delbeck et al., 2019). For example, developers are creating devices such as watches to shine light through the skin into the blood. The wavelengths create a phenomenon called Raman scattering, which indicates the concentration of glucose molecules in the blood (Hutson, 2021). Know Labs is developing another approach. The company created a finger sensor called the KnowU and a wrist band called the UBand using Body Radio Frequency Identification (Bio-RFID) technology. These devices emit radio waves through the skin to measure the molecular signature of glucose in the blood with spectroscopy (Park, 2021). Another promising approach uses electrical bioimpedance analysis (Pedro et al., 2020). Regardless of the technology, the Food and Drug Administration requires 95 percent of sensor values within 15 percent of blood glucose levels for approval as a medical device (Delbeck et al., 2019).
IMPLICATIONS FOR NURSING EDUCATION
Advanced practice nursing students need to understand the complexities of diabetes management and the CGM technologies used for self-management. Diabetes management continues to be a challenge, and these new technologies offer hope for unobtrusive, noninvasive CGM. Advanced practice nursing students should be able to read scientific literature to make informed decisions about the accuracy of different types of noninvasive devices and consider individuals' adherence to such devices.
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