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The revolutionary discovery of insulin in 1921 has saved millions of lives worldwide over the last century. Since that breakthrough year, scientific gains have emerged at a moderate pace. More recently, the rate and impact of change has increased.

“In the last decade or so, progress in the area of diabetes has dramatically accelerated,” says Dr. Akshay Jain, a clinical and research endocrinologist in Vancouver.

“It used to be that every few years a new medication in an existing class or a new low-tech device would appear, and the benefits to people with diabetes slowly tracked upwards. That progress graph has now sped up to become a rising steep slope.”

One advancement has been the development of entirely new classes of more effective diabetes medications, says Dr. Jain. The other defining breakthrough has been the technological revolution – with novel technologies now applied to the task of diabetes management.

“The marriage between technology and medicine has flourished in the last decade, and that has produced exciting new developments on the device side – most notably, the introduction of non-invasive glucose monitoring techniques and continuous glucose monitoring (CGM),” says Dr. Jain. “This technology has truly boosted our arsenal for treating people with diabetes.”

Easing the challenge of managing glucose levels

Once insulin became available as an injectable treatment, people could now live with diabetes, while tackling the complexities of managing their glucose levels, which meant measuring those levels and taking action to keep them from going too high or too low.

Until the 1960s, people with diabetes had to rely on urine tests to measure their glucose. Then a new approach to test blood came on the scene, first with test strips (introduced in 1964) and then with a glucometer, developed in 1970. Individuals would stick their fingers to draw blood for testing, multiple times daily.

It used to be that every few years a new medication in an existing class or a new low-tech device would appear, and the benefits to people with diabetes slowly tracked upwards. That progress graph has now sped up to become a rising steep slope.

Dr. Akshay Jain
Clinical and Research Endocrinologist

“Using a finger stick and taking blood glucose measures was the best technology we had for about 40 years, before the development of CGM,” says Laura Endres, senior vice president and general manager of Dexcom Canada, which manufactures the Dexcom G6 CGM System. “But there were limitations that made it difficult to manage the disease to avoid acute and long-term health complications.”

Frequent finger sticking is painful and disruptive, says Ms. Endres, and the test result provides only a snapshot of the individual’s sugars at a specific moment in time.

“Getting a static reading doesn’t reveal glucose trends, and you don’t know if your sugars are heading high or low. That’s important to know because you need to treat those two conditions differently.”

Insights to improve health

“Being able to continuously monitor the ups and downs of sugars is a true game changer,” says Ms. Endres. “The greater insights provided by this technology represent a huge leap forward that truly empowers people with diabetes to manage their condition.”

Studies have shown that use of Dexcom CGM significantly lowers A1C, 1,2 (average blood glucose levels over the previous 90 days) and reduces time spent in hypoglycemia (extreme low sugars).1,2

The CGM data can be downloaded and reviewed by patients and physicians to assess trends and make decisions about adjusting treatment as needed.* The data also show time in range – the percentage of time where glucose levels are in a target range.

Data indicate an inverse association between the amount of time an individual with diabetes spends in their target range and the likelihood that they will develop certain diabetes complications.3 This fall, the Diabetes Canada Clinical Practice Guidelines were updated to say that real-time CGM, like the Dexcom G6 CGM System, should be used by individuals with type 1 diabetes to reduce A1C and increase time in range, reduce duration and incidence of hypoglycemia and, in adults, improve quality of life.4

“Time in range is a very crucial parameter,” says Dr. Jain. “We have been relying on A1C for decades, and it’s a very good metric for assessing glycemic control. However, it’s an average that doesn’t capture the daily ups and downs of sugars.

“I believe time in range will be the key diabetes metric of the future,” he says. “It provides information that allows health-care providers to focus on helping their patients live with good sugars for the longest duration. And that gives us the potential to reduce diabetes complications and support patients to live healthierlives.”

1Beck RW, Riddlesworth T, Ruedy K, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: The DIAMOND randomized clinical trial. JAMA 2017;317(4):371-8.

2Welsh JB, Gao P, Derdzinski M, et al. Accuracy, Utilization, and Effectiveness Comparisons of Different Continuous Glucose Monitoring Systems. Diabetes Technol Ther 2019;21(3):128-32.

3Šoupal J, Petruželková J, Grunberger G, et al. Glycemic Outcomes in Adults with T1D Are Impacted More by Continuous Glucose Monitoring Than by Insulin Delivery Method: 3 Years of Follow-Up from The COMISAIR Study. Diabetes Care 2019 Sep; dc190888.

4Cheng AYY, Feig DS, Ho J, et al. Blood glucose monitoring in adults and children with diabetes: update 2021. Canadian Journal of Diabetes. 2021;45(7):580-587.

*To view a list of compatible devices, go to Internet connectivity required for data sharing.

Advertising feature produced by Randall Anthony Communications with Diabetes Canada. The Globe’s editorial department was not involved.

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