1. Dr Zaranyika MBChB(Hons) UZ, MPH, FCP SA Department of Medicine UZ-CHS
Modern Advances in Glucose Monitoring and implications for clinical Practice
Dr Zaranyika
MBChB(Hons) UZ, MPH, FCP SA
Department of Medicine UZ-CHS

2. Quotation
“ Now for years we have written the numbers down in a log book, sometimes they are legible, sometimes they are not legible, some patients keep them very organized, others do them on the back of a napkin, but that is called a log book. You write the data down and then we try to make sense of it. Along came the electronic and digital age and now we can take a digital glucose meter, plug it in at an office visit and download the data and let the machine do a little bit of the work for us; then we can look for patterns in the download of the glucose data. That has been helpful, but again, you are still limited by the number of tests that the individual does, and if we get 4 a day we really feel lucky. What if we could get 288 blood sugars a day? That is what we are calling continuous glucose monitoring where there are devices now that can measure your blood sugar every 5 minutes, 288 times a day. If you put that together for a couple of weeks, you get an amazing profile, or pattern or picture, of the blood sugar for a given individual”

4. Moving Beyond HbA1c

5. Glycaemic variability
A study demonstrated that variability in glucose levels may be more damaging than a constant high concentration of glucose
examined apoptosis in human umbilical vein
endothelial cells in cell culture that were subjected to steady state and alternating glucose concentrations.
Am J Physiol Endocrinol Metab 2001; 281(5): E924-E930.

6. Questions
What are the clinical implications of modern technology for glucose monitoring?
Is there a role for the ambulatory glucose profile in clinical practice in Zimbabwe?
What are the differences between glucose monitoring options for self management of diabetes?

7. HBA1C

12. Continuous Glucose Monitoring
a small sensor under the skin that measures glucose levels in interstitial fluid
a transmitter that attaches to the sensor and transfers data
a receiver that displays glucose information and stores data.
CGM does require at least 1 fingerstick blood glucose reading every 12 hours to calibrate the CGM sensor
It is recommended that you calibrate CGM systems with fingersticks 3–4 times per day for optimal glucose sensor accuracy.

15. Ambulatory glucose profile- AGP
Assess current treatment and give feedback to patient
Guide and support behavioural change
Make decisions regarding advancing therapy
The AGP is really a practical, simple way to look at glucose values.
daily glucose data so that we can make the assessment
The AGP is 1 of those tools being put forward as an international standard of a way to look at glucose data.

19. AGP for Patients Monitoring Their Glucose Using SMBG

20. Insulin pump
Rapid- or short-acting insulin 24 hours a day through a catheter placed under the skin. insulin doses :
Basal rates
Bolus doses to cover carbohydrate in meals
Correction or supplemental dose

21. Insulin Pump

26. Thank You