Abstract | November 13, 2020

Clinical Benefits of Continuous Glucose Monitoring in the Real-World Practice

Presenting Author: Nathan Anthony Gilreath, B.S., MS4, College of Medicine, Medical University of South Carolina - AnMed Health Regional Campus, Anderson, South Carolina

Co-authors: David Geurkink, MS3, MUSC-AnMed, Anderson, South Carolina; Elizabeth Zipprer, MD, General Surgery Resident PGY-1, Des Moines, Iowa; Ravi Kant, MBBS, MD, Department of Endocrinology, AnMed Health, Anderson, South Carolina; Vipin Verma, MBBS, MD, Department of Internal Medicine, AnMed Health, Anderson, South Carolina; Rashmi Chandra, MD, Department of Internal Medicine, Anderson, South Carolina

Learning Objectives

  1. Upon completion of this lecture, learners should be better prepared to 1) Discuss the clinical benefits of CGM for patients with diabetes mellitus.

Background: Diabetes mellitus (DM) is currently the 7th leading cause of death in the United States of America (US) and affects roughly 10% of the US population. Despite the advent of newer hypoglycemic medications, only 30% of patients with DM are meeting the A1C goal set forth by the American Diabetes Association. Continuous glucose monitoring (CGM) is a relatively new technology that provides patients with DM the insight needed to achieve and maintain glycemic control. This study assesses the clinical benefits of personal CGM.

Methods: In this retrospective study, our cohort contained 91 patients with type 1 and type 2 DM who were initiated on the personal CGM for management of their DM. User-blinded diagnostic CGM was used to assess the patient’s average glucose and time spent in severe hypoglycemia (<54 mg/dl), hypoglycemia (<70 mg/dl), hyperglycemia (>180 mg/dl), and severe hyperglycemia (>250 mg/dl). These values were used as the patient’s baseline and compared to values found after 3 months of personal CGM. In addition, hemoglobin A1c (HbA1C) data before and after the initiation of personal CGM was collected and compared.

Results: Among the 91 subjects (median age 61 years, BMI 29.1 kg/m2, and 56% female), 31 participants had more than 3 months of personal CGM data and user-blinded diagnostic CGM data prior to the personal CGM use. In addition, 87 subjects had HbA1c done before and 3-6 months after personal CGM application. Paired t-test showed significant reduction in HbA1c after personal CGM application (Mean HbA1c 8.11 vs 7.63; P =0.002). Subgroup analysis of 31 patients with CGM data showed a 7.87% reduction in time spent in hypoglycemia (glucose &lt; 70 mg/dl) and a 4.3% reduction in time spent in severe hypoglycemia (glucose <54 mg/dl) with p <0.001. There was not a significant change in average glucose or the amount of time spent in hyperglycemia.

Discussion: Among adults with both type I and type II DM, the use of personal CGM for &gt; 3 months in a real-world clinical setting resulted in a significant reduction in HbA1c, decrease in hypoglycemia as well as severe hypoglycemia compared with pre-CGM initiation parameters. These results suggest the potential for personal CGM to further increase the percentage of patients able to reach their A1c goal as well as decrease health care expenditure associated with hypoglycemic episodes. Further research should be done to assess longer term effectiveness, as well as a detailed cost benefit analysis to assess the potential for insurance expansion of coverage for personal CGM.

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