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.
Please see the book here :- https://doi.org/10.9734/bpi/msup/v2/6644
