A multi-marker approach for improved glycemic management in diabetes mellitus

Tight glycemic control has been the goal of care for people with diabetes [1], as achieving near-normal glucose levels has been shown to reduce the risk of microvascular disease [2-4]. Traditionally, people with diabetes are instructed to check their glucose consistently using self-monitoring of blood glucose (SMBG) technologies and make appropriate modifications to their medical intervention according to experience, empirically derived algorithms, and lifestyle. However, there are many challenges throughout the process including an increased risk of hypoglycemia when attempting to reach tighter glucose control. In addition, there is also a lack of ability to effectively account for multiple simultaneous life-style choices (e.g., exercise, alcohol ingestion, accurate carbohydrate counting) when deciding insulin boluses. These challenges all contribute to variability and unpredictability of daily glucose control. Unfortunately, sporadic measurement of glucose alone is insufficient to reach the goal of tight glycemic control, as it is merely a biomarker that reflects a series of complicated metabolism process. Given the discussed limitations there is a continued effort to improve glycemic management. Continuous monitoring and multi-marker detection are instrumental in achieving better management of the condition.