Issue 68 June 2014
1. Detecting undetected hypos with CGM- enhances treatment confidence in diabetes

This original research from Jothydev’s Diabetes Research Centre was presented by Dr.Jothydev Kesavadev at the 74th American Diabetes Association Scientific Sessions at San Francisco, California.

Benefits of intensive glycemic control in preventing vascular complications of diabetes & as a cost effective modality is largely offset by episodes/fear of hypoglycemia with fatal consequences. Despite limitations & higher costs, CGM detects glucose trends not revealed by SMBG. We analysed data of 432 T2D (male 243, female 189), aged 52.2 (15.04) on professional CGM over 6-7 days in past 1 year. CGM revealed low glucose trends undetected with 4 point SMBG. Nocturnal hypoglycemia (11.86%), hypoglycemia unawareness (10.32%) & Somogyi (2.50%) were detected in CGM. Therapeutic & lifestyle modifications were carried out (Table 1) & A1c reassessed (Table 2). After therapeutic and lifestyle modifications post CGM, hypoglycemic episodes were reduced- hypoglycemia (2.48%), hypoglycemia unawareness (3.76%) & Somogyi (0.20%). Cost effectiveness was analysed as incremental Cost/QALY gained.

CGM was projected to reduce lifetime probability of hypoglycemic episodes & may be recommended as routine in T2D to achieve safe A1c targets with confidence.

Modifications After CGM.

Modifications

% of patients

Diet and exercise

88.50

OHA

30.00

Shift to different regimen

10.50

Change in time of insulin

13.50

Change in dose of insulin

41.21

Change in insulin

7.00

Recommended CSII

21.00


Table 1

The Difference in Means of HbA1c at 0 and 3 Months.

Regimen

Percentage of patients on various regimens

Mean HbA1c ± SD
(at 0 months)

Mean HbA1c ± SD
(at 3 months)

Basal

10.63

7.89 ± 1.218

6.97 ± 1.419

Basal Bolus

21.35

8.64 ± 1.354

7.35 ± 1.379

Basal Plus

2.08

8.41 ± 0.910

7.01 ± 0.866

Biphasic

21.88

9.46 ± 1.238

7.21 ± 1.485

Insulin Pump

39.06

8.41 ± 1.446

7.10 ± 1.526

OHA

5

6.89 ± 1.667

6.07 ± 1.611


Table 2

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