The Importance of Continuous Glucose Monitoring in Managing Diabetes Mellitus| Chapter 13 | Medical Science: Updates and Prospects Vol. 2

 

Background: Continuous Glucose Monitoring (CGM) is arguably the most important technological advance in diabetes management over the past 15 years. It gives patients and healthcare providers real-time data on blood glucose trends. Most research on CGM has been done in specialised clinics, and there is little awareness of studies using CGM in a general internal medicine residency clinic.

 

Aim: This study aimed to assess whether continuous glucose monitoring (CGM) can be safely integrated into an Internal Medicine Residency Clinic.

 

Methodology: This is a 4-year retrospective extension study conducted in an Internal Medicine Residency Clinic, not solely in a specialised Endocrine clinic managing Diabetes Mellitus Type 1 and Type 2 in patients using 3-4 insulin injections daily and self-monitoring their blood glucose (SMBG) four times a day. The study was extended by an additional year to increase the sample size and statistical power and to evaluate whether longer-term CGM use results in a sustainable reduction in HbA1c, which also functions as a glucose management indicator. Initially, 51 patients were followed for 3 years, and now the study includes an extra year of data. Subsequently, 40 more patients were added. Additionally, the reduction in the glucose management indicator (GMI) was assessed. In total, 91 patients were monitored. Internal medicine and transitional year residents transitioned patients from SMBG to CGM devices to improve blood glucose monitoring due to uncontrolled diabetes. Each patient was assigned to a specific resident, who was initially trained by an endocrinologist to interpret CGM data and adjust insulin treatments accordingly. These residents contacted their assigned patients by phone every two weeks to adjust treatment as needed.

 

Results: Shapiro-Wilk's test indicated that the post-intervention data did not violate the normality assumption (p = .063), while the pre-intervention data did (p = .003). Participants’ A1c levels before the intervention were higher (M = 10.29, SD = 2.22) compared to after the intervention (M = 7.04, SD = 1.11). Levene’s test showed equal variances between pre- and post-intervention periods (p = .07). Regarding participants’ blood glucose levels, a significant mean decrease of 89.62, 95% CI [-102.76, -76.48], t(91) = -13.547, p < .001, d = 1.83 was observed. To summarise the findings, the mean HbA1c (GMI) decreased by 3.24%, the average blood sugar dropped by 89 mg/dL, and the mean Time in Range (TIR) increased by 45%.

 

Conclusion: The study highlights the potential of CGM to enhance medical residents’ education, a potential that larger prospective trials will further investigate. Expanding CGM use across US residency programs could raise the standard of diabetes care nationwide.

 

 

Author(s) Details

A. Manov
Department of Internal Medicine and Transitional Year, Mountain View Hospital, Sunrise Health GME Consortium, Las Vegas, Nevada, United States.

 

K. Mefferd
Department of Internal Medicine and Transitional Year, Mountain View Hospital, Sunrise Health GME Consortium, Las Vegas, Nevada, United States.

 

Y. Badi
Department of Internal Medicine and Transitional Year, Mountain View Hospital, Sunrise Health GME Consortium, Las Vegas, Nevada, United States.

 

R. Haddadin
Department of Internal Medicine and Transitional Year, Mountain View Hospital, Sunrise Health GME Consortium, Las Vegas, Nevada, United States.

 

V. Milan
Department of Internal Medicine and Transitional Year, Mountain View Hospital, Sunrise Health GME Consortium, Las Vegas, Nevada, United States.

 

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