Intermediate Intervention With FGM Improves Glycemic Control

Akshay B. Jain, MD;  Mark Harmel, MPH 


September 27, 2018

One of the challenges that clinicians face when managing type 2 diabetes is the lack of reliable self-monitoring of blood glucose. In India, we have noticed that a lot of patients arrive at their doctor's appointments without enough blood glucose [data from] self-monitoring using fingerstick checks at home, so all we have to work with are laboratory estimations of their fasting and post-lunch sugar levels.

The advent of flash glucose monitoring has somewhat improved this. Unfortunately, the blinded flash glucose monitoring available in India only looks at data from a retrospective point of view, wherein the sensor is evaluated after 14 days of use and glycemic trends are interpreted.

In my study, we looked at 105 consecutive patients with type 2 diabetes who had uncontrolled A1c levels over 7% and had previously undergone some type of lifestyle modification counseling, yet were not able to get their blood sugars under target range.[1]

At the time of their initial visit, we had these patients use a flash glucose monitoring system—the FreeStyle Libre Pro that is available in India—and asked them to keep a log of their food intake along with the time and quantity of food that they ate. We made no changes to their pharmacotherapy at the initial visit.

[Within a week, all patients returned for] an intermediate intervention where we downloaded the data from the sensors while the patients were still wearing them. We discussed the glycemic trends and correlated the trends with their food logs, explaining how certain food choices made unfavorable or favorable changes to their glycemic target.

On the basis of these glycemic trends, we also made changes to their pharmacotherapy. An individualized dietary and pharmacotherapy modification plan was developed at this second visit, with the benefit of having a few more days if the patient chose to come back for a follow-up visit on the same sensor to see the impact of this intervention on their glycemic targets.

We saw some very encouraging results whereby, using this intermediate approach, we were able to decrease the time above target range from 56% to 18%. Furthermore, we were able to decrease the daily average glucose levels from 197 mg/dL to 130 mg/dL. There was also a significant decline in hypoglycemia from 6% to 1.5%.

The most important result was that we doubled the time in target range (between 70 and 180 mg/dL) from 40% to 84%. We were also able to identify patients with recurrent hypoglycemia. Using this intervention technique, we reduced the time in hypoglycemia from 21% to 1.9% without causing any rebound hyperglycemia.

Patients loved that they could correlate certain food choices with that excursion of blood sugars, and clinicians loved that, without spending too much time, they could employ targeted dietary and pharmacotherapy modification plans using this approach.

This is a very simple approach that can be replicated across the world, from a primary care or diabetes educator office to an endocrinologist office setting, and significant improvements in glycemic control from both a lifestyle and individualized pharmacotherapy modification point of view can be seen.


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