Jothydev Kesavadev1, Robert Vigersky2, John Shin3, Pradeep Babu Sadasivan Pillai4, Arun Shankar4, Geethu Sanal4, Gopika Krishnan4, Sunitha Jothydev4. 1. Jothydev's Diabetes Research Centre, Konkalam Road, Mudavanmugal, Trivandrum, Kerala, 695032, India. jothydev@gmail.com. 2. Medtronic Diabetes, 950 F St. NW, Washington, DC, 20004, USA. 3. Medtronic MiniMed Inc., 18000 Devonshire St., Northridge, CA, 91325, USA. 4. Jothydev's Diabetes Research Centre, Konkalam Road, Mudavanmugal, Trivandrum, Kerala, 695032, India.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: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. CONCLUSIONS: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.
Authors: John Furler; David Norman O'Neal; Jane Speight; Irene Blackberry; Jo-Anne Manski-Nankervis; Sharmala Thuraisingam; Katie de La Rue; Louise Ginnivan; Jessica Lea Browne; Elizabeth Holmes-Truscott; Kamlesh Khunti; Kim Dalziel; Jason Chiang; Ralph Audehm; Mark Kennedy; Malcolm Clark; Alicia Josephine Jenkins; Danny Liew; Philip Clarke; James Best Journal: BMJ Open Date: 2018-07-17 Impact factor: 2.692