We performed a retrospective observational cohort study
between 2020-2023 in 26 patients with type-1 and type-2 Diabetes Mellitus (DM)
who were using 3-4 injections per day of Insulin and were monitored by
continuous glucose monitoring (CGM). The goal was to compare the patient’s
glycosylated hemoglobin (HbA1c) taken during their clinic visit by phlebotomy
as a marker for diabetic control with estimated HbA1c glucose management
indicator (GMI) derived from the 30-day CGM readings. The purpose of the study
was to see if there is a correlation between those two values taken within 30-
days of each other. To find if there is a correlation is extremely important in
assuring that GMI received from the CGM can be used instead of HbA1c in
patients on multiple daily injections of Insulin and be incorporated into the
American Diabetic Association goals for achieving Diabetes control. Also
finding such a correlation can help in reporting the control of diabetes
mellitus to other healthcare organizations like Medicare etc. by using CGM data
rather than HbA1c. The methodology we used was to compare CGM-derived GMI
obtained within 30 – days with HbA1c which has been shown to best correlate
with each other. To assess if this
difference between GMI and HbA1c was significant, a paired samples t-test was
conducted. This comparison is important because of the widespread use of
continuous glucose monitoring in patients with Type -1 and Type -2 Diabetes
Mellitus on multiple injections of insulin to make treatment decisions. The
patients with known factors that can interfere with the accurate measurement of
HbA1c like anemia, and liver and kidney diseases were excluded from the study.
We concluded the measured HbA1c was 0.34%(4 mmol/mol) higher than the
CGM-derived GMI which was the conclusion of several other studies as well. The
difference although numerically higher in favor of HbA1c was statistically
non-significant. As the use of CGM
continues to grow, addressing differences between laboratory-measured HbA1c and
CGM-derived GMI is critical. This can affect how we interpret the GMI in
patients with CGM compared to HbA1c as well and it can be taken into
consideration by different medical organizations while determining the goals of
control and reporting of patients with Diabetes mellitus using CGM. Another
very important part of the study was that the project was primarily driven by
Internal Medicine residents in their clinic and not in a specialized endocrine
clinic.
Author(s)details:-
A. Manov
Internal Medicine and Transitional Year Residency Program, Sunrise Health
GME Consortium, Mountain View Hospital, Las Vegas, Nevada, US.
Y. Badi
Internal Medicine and Transitional Year Residency Program, Sunrise Health
GME Consortium, Mountain View Hospital, Las Vegas, Nevada, US.
A. Donepudi
Internal Medicine and Transitional Year Residency Program, Sunrise Health
GME Consortium, Mountain View Hospital, Las Vegas, Nevada, US.
N. Holt
Internal Medicine and Transitional Year Residency Program, Sunrise Health
GME Consortium, Mountain View Hospital, Las Vegas, Nevada, US
M. Sharaf
Internal Medicine and Transitional Year Residency Program, Sunrise Health
GME Consortium, Mountain View Hospital, Las Vegas, Nevada, US.
R. Rivera
Internal Medicine and Transitional Year Residency Program, Sunrise Health
GME Consortium, Mountain View Hospital, Las Vegas, Nevada, US.
A. Daliwal
Internal Medicine and Transitional Year Residency Program, Sunrise Health
GME Consortium, Mountain View Hospital, Las Vegas, Nevada, US.
R. Haddadin
Internal Medicine and Transitional Year Residency Program, Sunrise Health
GME Consortium, Mountain View Hospital, Las Vegas, Nevada, US.
I. Quadir
Internal Medicine and Transitional Year Residency Program, Sunrise Health
GME Consortium, Mountain View Hospital, Las Vegas, Nevada, US.
K. Mefferd
Internal Medicine and Transitional Year Residency Program, Sunrise Health
GME Consortium, Mountain View Hospital, Las Vegas, Nevada, US.
Please See the book
here :- https://doi.org/10.9734/bpi/mria/v4/503
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