The Evolution of Diabetes Management, with Linda Parks, RN

Linda Parks, RN

Credit: LinkedIn

Managing diabetes is a constant balancing act, with blood sugar levels fluctuating throughout the day due to factors like diet, exercise, stress and illness. For decades, people with diabetes relied on finger-stick tests for glucose monitoring — until continuous glucose monitors (CGMs) revolutionized care. In an interview with The Educated Patient, Linda Parks, RN, a diabetes educator with 40 years of experience, shares how CGM technology has transformed diabetes management, common misconceptions about glucose monitoring and what advancements are on the horizon.

What are some of the biggest challenges that people with diabetes face when managing their blood sugar levels?

Linda Parks, RN: That’s a great question because there are still many challenges. Over the last 40 years, I’ve seen a lot of changes in diabetes management. One of the biggest advancements has been glucose monitoring, which has significantly improved life for people living with diabetes.

Back in the 1980s and 1990s, blood glucose monitoring required finger pricks to obtain a drop of blood. The challenge with glucose levels is that they are constantly changing — every minute, they fluctuate based on factors such as food intake, exercise, stress and illness. In the past, we recommended checking blood glucose four times a day, which we considered frequent testing. However, since there are 1,440 minutes in a day, four checks provided very limited information.

With the advent of CGM, we can now see glucose levels every five minutes and track trends through directional arrows. This technology provides a more comprehensive view of glucose patterns, helping individuals make better-informed decisions about their management.

How can CGM help patients better control their diabetes?

LP: CGM has been a game changer. I had the opportunity to work with CGM companies in the early 2000s, just as the technology was emerging. As a diabetes educator, I knew this would revolutionize diabetes management.

One major benefit is that CGM eliminates the need to stop daily activities to check glucose levels. Many people dislike finger sticks, and CGM allows them to monitor their glucose painlessly. Additionally, CGM provides directional arrows, showing where glucose levels were 15 minutes ago and where they are headed. These extra data help individuals make proactive decisions about their diabetes management.

What are some common misconceptions about blood sugar management that you often hear from patients?

LP: One common misconception is that CGMs measure blood glucose, when in fact, they measure interstitial glucose. The sensor is placed just under the skin, making it easier to use than a direct blood glucose sensor.

There is a physiological lag of about 15 to 20 minutes between blood glucose and interstitial glucose. When glucose levels are stable, this difference is minimal. However, after eating, blood glucose rises quickly, while interstitial glucose takes longer to reflect the change. For example, if someone drinks a sugary soda, their blood glucose may spike to 160 milligrams per deciliter (mg/dL), while their CGM still shows 112 mg/dL with an upward arrow.

The lag is particularly important when glucose is dropping. If blood glucose falls to 62 mg/dL, the CGM may still display a safe 85 mg/dL, but a downward arrow indicates that levels are decreasing. In such cases, individuals should act to prevent low blood sugar.

How have CGMs evolved over time?

LP: The first CGM was introduced in 1999, and it was large, uncomfortable and not very accurate. Over the past 25 years, CGM technology has dramatically improved. Devices are now much smaller, more accurate and easier to use. Instead of requiring a separate receiver, most modern CGMs integrate with smartphones. Sensors are now all-in-one units, making insertion quick and nearly painless.

What key features should patients consider when choosing a CGM?

LP: First and foremost, cost is a major factor. Insurance coverage has improved, especially for people with type 1 diabetes, but some insurers still require specific criteria for coverage in type 2 diabetes, such as insulin use or a history of low blood sugar.

Other considerations include the following:

• Adhesive sensitivity: Each CGM has a different adhesive formula, and some may irritate the skin.
• Device compatibility: Some CGMs integrate with insulin pumps, while others work best with specific smartphones.
• Ease of use: Some sensors last seven days, while others last up to 15 days. Patients should consider how often they are willing to change their sensor.

How do you see diabetes management evolving over the next decade?

LP: I have high hopes for the future of diabetes management. Over the past 40 years, we have made incredible progress, particularly in reducing hypoglycemia in children. CGMs with alerts and alarms allow parents and caregivers to monitor glucose levels, providing peace of mind.

One exciting development is implantable CGMs. A company called GlucoTrack is working on a sensor implanted into a vein, similar to a pacemaker, with electronics placed just under the skin. This device could last for three years, eliminating the need for external sensors and reducing the inconvenience of replacing sensors regularly. Data would be transmitted directly to a smartphone, allowing for seamless glucose monitoring without any on-body wearables.

Beyond monitoring, we need improvements in insulin delivery. Faster-acting insulins would enhance diabetes management by allowing quicker responses to glucose fluctuations. My ultimate dream would be a system that seamlessly adjusts insulin delivery in real time.

Any final thoughts?

LP: Diabetes management has come a long way, and technology continues to make life easier for people with diabetes. While CGMs are an incredible tool, it’s important for users to understand how they work to make the best decisions for their health. As research advances, I am hopeful that we will continue to improve both the accuracy and convenience of diabetes technology, making daily management even more seamless.

This transcript was edited for clarity.