Assessing the Therapeutic Utility of Professional Continuous Glucose Monitoring in Type 2 Diabetes Across Various Therapies: A Retrospective Evaluation
There have been few large studies that have analyzed the effect of professional (masked) continuous glucose monitoring (P-CGM) on glycemic control in patients with type 2 diabetes (T2DM) who were on a broad spectrum of baseline therapies.
We performed a retrospective, blinded evaluation of glycemic control in 296 T2DM adults for 6 months following a 6- to 7-day study of their glycemic profile using masked P-CGM. At baseline, 91% of the patients were on some form of insulin treatment with oral hypoglycemic agents (OHA), while 7% were on one or more OHAs without insulin, and the remaining 2% were on GLP-1RAs. On the basis of the masked CGM profile, patients were counselled on diet and exercise change(s) in their baseline diabetes therapy by our professionally trained diabetes team. They also continued to receive regular treatment advice and dose titrations through our Diabetes Tele-Management System (DTMS®). The baseline changes in hemoglobin A1C (A1C) observed in these patients after 6 months of undergoing P-CGM was compared to a matched control group.
P-CGM revealed that the predominant pattern of hyperglycemia was postprandial while previously unknown hypoglycemia was found in 38% of the patients; over half of the cases of hypoglycemia were nocturnal. The mean A1C of the P-CGM group dropped from 7.5 ± 1.4% at baseline vs. 7.0 ± 0.9% at 6 months (p < 0.0001). The frequency of performing self-monitoring of blood glucose (SMBG) was also found to be significantly increased in these patients from the baseline. Meanwhile, no significant improvement in A1C was noted in the control group during the same time frame (7.7 ± 1.1% at baseline vs. 7.4 ± 1.1% at 6 months; p = 0.0663) and frequency of SMBG remained almost unchanged.
P-CGM can provide actionable data and motivate patients for diabetes self-care practices, resulting in an improvement in glycemic control over a wide range of baseline therapies.
KeywordsA1C Continuous glucose monitoring Hypoglycemia Postprandial hyperglycemia Therapy change Type 2 diabetes
No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. Jothydev Kesavadev conceived the idea, researched data, contributed to the discussion and drafted the manuscript; Robert Vigersky contributed to the discussion and edited the manuscript; John Shin reviewed the data analysis; Pradeep Babu Sadasivan Pillai researched data; Arun Shankar reviewed the manuscript; Geethu Sanal contributed to the discussion; Gopika Krishnan contributed to the discussion and edited the manuscript; Sunitha Jothydev contributed to the discussion. Jothydev Kesavadev is the guarantor of this work, and, as such, had full access to all the data in the study and takes responsibility for the integrity of data and the accuracy of data analysis.
Robert Vigersky is a full-time employee of Medtronic Diabetes. John Shin is a full-time employee of Medtronic Diabetes. Jothydev Kesavadev, Pradeep Babu Sadasivan Pillai, Arun Shankar, Geethu Sanal, Gopika Krishnan and Sunitha Jothydev have nothing to disclose.
Compliance with Ethics Guidelines
Since this was a retrospective study, it was not registered as a trial. All procedures followed were in accordance with the ethical standards of the institutional review board and ethics committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2013. A waiver of patient consent was obtained from the institutional ethics committee for this retrospective, minimal risk study and all patient identifiers were removed before data analysis.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
- 3.Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140–9.CrossRefPubMedGoogle Scholar
- 4.Continuous Glucose Monitoring Summit - American Association of Diabetes Educators. 2015. https://www.diabeteseducator.org/docs/default-source/default-document-library/aade-2015-cgm-summit-white-paper-final.pdf?sfvrsn=0. Accessed 24 June 2017.
- 10.Garg SK. The future of glucose monitoring. Diabetes Technol Ther. 2016;18(Suppl 2):S2-iv-S.Google Scholar
- 18.Kesavadev J, Shankar A, Pillai PBS, Krishnan G, Jothydev S. Cost-effective use of telemedicine and self-monitoring of blood glucose via Diabetes Tele Management System (DTMS) to achieve target glycosylated hemoglobin values without serious symptomatic hypoglycemia in 1,000 subjects with Type 2 diabetes mellitus—a retrospective study. Diabetes Technol Ther. 2012;14(9):772–6.CrossRefPubMedGoogle Scholar
- 20.Blackberry ID, Furler JS, Ginnivan LE, et al. An exploratory trial of basal and prandial insulin initiation and titration for type 2 diabetes in primary care with adjunct retrospective continuous glucose monitoring: INITIATION study. Diabetes Res Clin Pract. 2014;106(2):247–55.CrossRefPubMedGoogle Scholar