Determination of Glucose and Continuous Glucose Monitoring

  • Y. F. Wang
  • W. JiaEmail author


Glucose is the main source of energy for human activities. Diabetes is a group of disorders characterized by chronic elevation of blood glucose. Thus, determination of blood glucose is a basic method for the diagnosis, treatment, and follow-up of diabetes. In addition to blood, many types of body fluids contain glucose. Continuous glucose monitoring (CGM) technology was first applied in clinical practice at the end of the twentieth century. It monitors the glucose concentrations in subcutaneous interstitial fluid through a glucose sensor and is able to provide continuous, comprehensive, and reliable all-day glucose profiles, thereby allowing for an understanding of the trends in blood glucose fluctuations, and to detect occult hyperglycemia and hypoglycemia that cannot be detected by traditional glucose monitoring methods. The detection equipment for measuring interstitial fluid glucose concentrations is mainly divided into two categories. One is minimally invasive technology in which interstitial glucose concentrations are continuously monitored with a subcutaneous glucose sensor, also known as the CGM system, which can be categorized as a retrospective CGM system or a real-time CGM system. The other is noninvasive technology, in which glucose is extracted across the skin for monitoring of glycemia using weak current electrodes close against the skin. This chapter will introduce the metabolism and regulation of glucose in the body, the detection of the interstitial glucose concentration and its clinical significance, as well as the principle of CGM technology.


Glucose Blood glucose measurement Interstitial glucose Continuous glucose monitoring 


  1. 1.
    Chinese Diabetes Society. Clinical application guide of blood glucose monitoring in China (Edition 2015). Chin J Diabetes. 2015;7:603–13. Scholar
  2. 2.
    Jansson PA, Fowelin J, Smith U, Lonnroth P. Characterization by microdialysis of intracellular glucose level in subcutaneous tissue in humans. Am J Phys. 1988;255:E218–20.Google Scholar
  3. 3.
    Dye L, Mansfield M, Lasikiewicz N, Mahawish L, Schnell R, Talbot D, Chauhan H, Croden F, Lawton C. Correspondence of continuous interstitial glucose measurement against arterialised and capillary glucose following an oral glucose tolerance test in healthy volunteers. Br J Nutr. 2010;103:134–40. Scholar
  4. 4.
    Boyne MS, Silver DM, Kaplan J, Saudek CD. Timing of changes in interstitial and venous blood glucose measured with a continuous subcutaneous glucose sensor. Diabetes. 2003;52:2790–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Cengiz E, Tamborlane WV. A tale of two compartments: interstitial versus blood glucose monitoring. Diabetes Technol Ther. 2009;11(Suppl 1):11–6. Scholar
  6. 6.
    Sternberg F, Meyerhoff C, Mennel FJ, Mayer H, Bischof F, Pfeiffer EF. Does fall in tissue glucose precede fall in blood glucose? Diabetologia. 1996;39:609–12.CrossRefPubMedGoogle Scholar
  7. 7.
    Zhou J, Jia WP, Yu M, Yu HY, Bao YQ, Ma XJ, Lu W, Hu C, Xiang KS. The reference values of glycemic parameters for continuous glucose monitoring and its clinical application. Zhong hua Nei Ke Za Zhi. 2007;46:189–92.Google Scholar
  8. 8.
    Zhou J, Li H, Ran X, Yang W, Li Q, Peng Y, Li Y, Gao X, Luan X, Wang W, Jia W. Reference values for continuous glucose monitoring in Chinese subjects. Diabetes Care. 2009;32:1188–93. Scholar
  9. 9.
    Kilpatrick ES, Rigby AS, Goode K, Atkin SL. Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycemia in type 1 diabetes. Diabetologia. 2007;50:2553–61. Scholar
  10. 10.
    Ji L, Guo X, Guo L, Ren Q, Yu N, Zhang J. A multicenter evaluation of the performance and usability of a novel glucose monitoring system in chinese adults with diabetes. J Diabetes Sci Technol. 2017;11:290–5. Scholar
  11. 11.
    Chase HP, Beck R, Tamborlane W, Buckingham B, Mauras N, Tsalikian E, Wysocki T, Weinzimer S, Kollman C, Ruedy K, Xing D. A randomized multicenter trial comparing the GlucoWatch biographer with standard glucose monitoring in children with type 1 diabetes. Diabetes Care. 2005;28:1101–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Zhou J, Lv X, Mu Y, Wang X, Li J, Zhang X, Wu J, Bao Y, Jia W. The accuracy and efficacy of real-time continuous glucose monitoring sensor in Chinese diabetes patients: a multicenter study. Diabetes Technol Ther. 2012;14:710–8. Scholar
  13. 13.
    Diabetes Research in Children Network (DirecNet) Study Group. Accuracy of the GlucoWatch G2 biographer and the continuous glucose monitoring system during hypoglycemia: experience of the diabetes research in children network. Diabetes Care. 2004;27:722–6.CrossRefGoogle Scholar
  14. 14.
    Corrie SR, Coffey JW, Islam J, Markey KA, Kendall MA. Blood, sweat, and tears: developing clinically relevant protein biosensors for integrated body fluid analysis. Analyst. 2015;140:4350–64. Scholar
  15. 15.
    Ma X, Hu X, Zhou J, Hao Y, Luo Y, Lu Z, Bao Y, Jia W. Glycated albumin is more closely correlated with coronary artery disease than 1,5-anhydroglucitol and glycated hemoglobin A1c. Cardiovasc Diabetol. 2015;14:16. Scholar
  16. 16.
    Vigersky RA. Glucose monitoring. In: Umpierrez GE, editor. Therapy for diabetes mellitus and related disorders. 6th ed. Alexandria: American Diabetes Association; 2014. p. 28–50.Google Scholar
  17. 17.
    Bennion N, Christensen NK, McGarraugh G. Alternate site glucose testing: a crossover design. Diabetes Technol Ther. 2002;4:25–33.CrossRefPubMedGoogle Scholar
  18. 18.
    Knapp PE, Showers KM, Phipps JC, Speckman JL, Sternthal E, Freund KM, Ash AS, Apovian CM. Self-monitoring of blood glucose with finger tip versus alternative site sampling: effect on glycemic control in insulin-using patients with type 2 diabetes. Diabetes Technol Ther. 2009;11:219–25.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Suzuki Y, Atsumi Y, Matusoka K. Alternative site testing increases compliance of SMBG (preliminary study of 3 years cohort trials). Diabetes Res Clin Pract. 2003;59:233–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Bina DM, Anderson RL, Johnson ML, Bergenstal RM, Kendall DM. Clinical impact of prandial state, exercise, and site preparation on the equivalence of alternative-site blood glucose testing. Diabetes Care. 2003;26:981–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Jungheim K, Koschinsky T. Glucose monitoring at the arm: risky delays of hypoglycemia and hyperglycemia detection. Diabetes Care. 2002;25:956–60.CrossRefPubMedGoogle Scholar
  22. 22.
    Tonyushkina K, Nichols JH. Glucose meters: a review of technical challenges to obtaining accurate results. J Diabetes Sci Technol. 2009;3:971–80. Scholar
  23. 23.
    Tang Z, Lee JH, Louie RF, Kost GJ. Effects of different hematocrit levels on glucose measurements with handheld meters for point-of-care testing. Arch Pathol Lab Med. 2000;124:1135–40.<1135:EODHLO>2.0.CO;2.CrossRefPubMedGoogle Scholar
  24. 24.
    Ginsberg BH. Factors affecting blood glucose monitoring: sources of errors in measurement. J Diabetes Sci Technol. 2009;3:903–13. Scholar
  25. 25.
    Belazi MA, Galli TA, Drakoulakos D, Fleva A, Papanayiotou PH. Salivary alterations in insulin-dependent diabetes mellitus. Int J Paediatr Dent. 1998;8:29–33.CrossRefPubMedGoogle Scholar
  26. 26.
    March WF, Mueller A, Herbrechtsmeier P. Clinical trial of a noninvasive contact lens glucose sensor. Diabetes Technol Ther. 2004;6:782–9. Scholar
  27. 27.
    Badugu R, Lakowicz JR, Geddes CD. A glucose-sensing contact lens: from bench top to patient. Curr Opin Biotechnol. 2005;16:100–7. Scholar
  28. 28.
    Su H, Ma X, Yin J, Wang Y, He X, Bao Y, Zhou J, Jia W. Serum 1,5-anhydroglucitol levels slightly increase rather than decrease after a glucose load in subjects with different glucose tolerance status. Acta Diabetol. 2017;54:463–70. Scholar

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© Springer Nature Singapore Pte Ltd. and Shanghai Scientific and Technical Publishers 2018

Authors and Affiliations

  1. 1.Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes InstituteShanghai Jiao Tong University, Affiliated Sixth People’s HospitalShanghaiChina

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