COMMENTARY

EASD: Flash Monitoring or CGM as a Diagnostic Tool?

Prof Kamlesh KhuntI, MD, PhD

Disclosures

October 04, 2018

Hi, my name is Kamlesh Khunti, I'm professor of primary care diabetes and vascular medicine at the University of Leicester in the UK.

I'm here at the EASD in Berlin and thought I'd share with you some of the highlights that we've seen so far.

Hypo-RESOLVE

We had a really exciting full day on Hypo-RESOLVE. This is a new initiative of partner organisations that includes industry, JDRF, EASD, and the European Union. This is a big initiative of €28 million, where there's a programme looking to see if we can harmonise data for all the studies from various companies on hypoglycaemia, and then develop tools to reduce the risk of hypoglycaemia in our patients. And then finally, some work around regulatory authorities to see what kind of data they would like to see for regulatory approval. So that's quite an exciting initiative, and we should be hearing quite a lot over the next 4 years about that

Flash and CGM Glucose Monitoring

There's been a lot of data on flash and CGM glucose monitoring. Again, a very, very exciting area, as we all know. Most of the time it’s being used for people with type 1 diabetes and we know it has really transformed the lives of people with type 1 diabetes, and even more so for carers of people with type 1 diabetes, and particularly the children whose parents were really, really worried about hypoglycaemia. Now they feel that they’re in more control with their children.

Another concept that we've talked about here about the CGM and flash glucose monitoring is not as a therapeutic option but as a possibly diagnostic option. Because we know there are a lot of people in the community, especially the elderly living alone, people in nursing homes, who may be getting hypoglycaemia and we're not aware of it. All we know is they have a fall and suddenly they are admitted to hospital costing huge amounts to the health services.

And so similar to how we use 24-hour blood pressure monitoring, or Holter monitoring, we can use flash glucose monitoring, or CGM, as a diagnostic tool, attaching this for a 2-week period to see if these patients are having hypoglycaemia, which they're not aware of. And then depending on that, changing the therapy options. For example, if a patient's on high doses of insulin that could be changed. If a patient's on a sulphonylurea one may consider stopping the sulphonylurea and changing that therapy to a low-risk of hypoglycaemia therapy.

And indeed, in some patients, we may have the targets too low. For example, an elderly frail patient who's HbA1c is below 7%, we do see that in clinical practice, if we're seeing hypoglycaemia then one of the things we can do [is] stop therapy, because that would not only save funding on avoiding the falls, but also on the therapy options.

Elderly Care Position Statement

On that light, tomorrow, we are presenting the position statement from the Primary Care Diabetes Europe (PCDE), on how to manage the elderly, and the therapeutic options that we have for the elderly, and in terms of what targets we may wish to follow for the fit elderly all the way down to frail elderly, and those people at the end of life care, when we may think about not thinking about the therapeutic options, not thinking about targets, but making sure there is no symptomatic hyper or hypoglycaemia.

CVD-REAL

But overall, I think there's a lot of excitement. There's some new data being presented. I'm also involved in the CVD-REAL study, which as a lot of people know has had a lot of attention at numerous conferences showing that real world data replicated in a decent way and done properly can replicate what's been shown in randomised control trials, giving us that assurance that what we've seen in randomised control trials is applicable to the real world setting. So there's been a lot of studies like this that have been presented, seeing a randomised control trial and seeing what happens in the real world setting when those therapies are taken on board.

Thank you very much for joining me for this short session.

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