Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care

2021 ◽  
pp. 193229682199872
Author(s):  
Gregg D. Simonson ◽  
Richard M. Bergenstal ◽  
Mary L. Johnson ◽  
Janet L. Davidson ◽  
Thomas W. Martens
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Glucose Monitoring ◽  
Care Model ◽  
Time In Range ◽  
Glucose Management ◽  
The Impact ◽  
Primary Care Management

Background: Little data exists regarding the impact of continuous glucose monitoring (CGM) in the primary care management of type 2 diabetes (T2D). We initiated a quality improvement (QI) project in a large healthcare system to determine the effect of professional CGM (pCGM) on glucose management. We evaluated both an MD and RN/Certified Diabetes Care and Education Specialist (CDCES) Care Model. Methods: Participants with T2D for >1 yr., A1C ≥7.0% to <11.0%, managed with any T2D regimen and willing to use pCGM were included. Baseline A1C was collected and participants wore a pCGM (Libre Pro) for up to 2 weeks, followed by a visit with an MD or RN/CDCES to review CGM data including Ambulatory Glucose Profile (AGP) Report. Shared-decision making was used to modify lifestyle and medications. Clinic follow-up in 3 to 6 months included an A1C and, in a subset, a repeat pCGM. Results: Sixty-eight participants average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8% ± 1.2% to 8.2% ± 1.3% (n=68, P=0.006). The time in range (TIR) and time in hyperglycemia improved along with more hypoglycemia in the subset of 37 participants who wore a second pCGM. Glycemic improvement was due to lifestyle counseling (68% of participants) and intensification of therapy (65% of participants), rather than addition of medications. Conclusions: Using pCGM in primary care, with an MD or RN/CDCES Care Model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia without necessarily requiring additional medications.

scholarly journals Impact of COVID-19 Vaccination on Glycemia in Individuals With Type 1 and Type 2 Diabetes: Substudy of the COVAC-DM Study

2022 ◽  
Author(s):  
Felix Aberer ◽  
Othmar Moser ◽  
Faisal Aziz ◽  
Caren Sourij ◽  
Haris Ziko ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Immune Response ◽  
Type 1 Diabetes ◽  
Side Effects ◽  
Glucose Monitoring ◽  
Time In Range ◽  
The Mean ◽  
Glucose Management

Vaccination and potentially related side effects might impact glucose management in people with diabetes. In this study, we investigated effects of COVID-19 vaccination on glycemia assessed by continuous glucose monitoring (CGM) in people with type 1 and type 2 diabetes. <br> 74 participants of the ongoing multicenter prospective COVAC-DM-study, investigating the immune response to COVID-19 vaccines in people with diabetes, were willing to participate in this CGM sub-study. Time spent in glycemic ranges (time in range [TIR] 70-180 mg/dL; time below range [TBR] <70 mg/dL and time above range [TAR] >180 mg/dL) was assessed daily from two days prior to three days after the first COVID-19 vaccination. Participants were asked to document side effects in response to vaccination, insulin injections, and carbohydrate intake.<br> 58 participants with type 1 (27 female, mean age 39.5 years, HbA1c 57 ± 12 mmol/mol) and 16 with type 2 diabetes (9 females, mean age 60.6 years, HbA1c 63 ± 11mmol/mol) were included in this study. The mean TIR did not change on the day of the vaccination and the following 3 days (p>0.05). In people with type 1 diabetes, the TIR (p=0.033) and the TAR (p= 0.043) deteriorated on days with side effects as compared to those without. <br> Side effects occurring after COVID-19 vaccination significantly reduce the TIR and increase the TAR in people with type 1 diabetes, while no impact was observed in people with type 2 diabetes.

scholarly journals Impact of COVID-19 Vaccination on Glycemia in Individuals With Type 1 and Type 2 Diabetes: Substudy of the COVAC-DM Study

2022 ◽  
Author(s):  
Felix Aberer ◽  
Othmar Moser ◽  
Faisal Aziz ◽  
Caren Sourij ◽  
Haris Ziko ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Immune Response ◽  
Type 1 Diabetes ◽  
Side Effects ◽  
Glucose Monitoring ◽  
Time In Range ◽  
The Mean ◽  
Glucose Management

Vaccination and potentially related side effects might impact glucose management in people with diabetes. In this study, we investigated effects of COVID-19 vaccination on glycemia assessed by continuous glucose monitoring (CGM) in people with type 1 and type 2 diabetes. <br> 74 participants of the ongoing multicenter prospective COVAC-DM-study, investigating the immune response to COVID-19 vaccines in people with diabetes, were willing to participate in this CGM sub-study. Time spent in glycemic ranges (time in range [TIR] 70-180 mg/dL; time below range [TBR] <70 mg/dL and time above range [TAR] >180 mg/dL) was assessed daily from two days prior to three days after the first COVID-19 vaccination. Participants were asked to document side effects in response to vaccination, insulin injections, and carbohydrate intake.<br> 58 participants with type 1 (27 female, mean age 39.5 years, HbA1c 57 ± 12 mmol/mol) and 16 with type 2 diabetes (9 females, mean age 60.6 years, HbA1c 63 ± 11mmol/mol) were included in this study. The mean TIR did not change on the day of the vaccination and the following 3 days (p>0.05). In people with type 1 diabetes, the TIR (p=0.033) and the TAR (p= 0.043) deteriorated on days with side effects as compared to those without. <br> Side effects occurring after COVID-19 vaccination significantly reduce the TIR and increase the TAR in people with type 1 diabetes, while no impact was observed in people with type 2 diabetes.

scholarly journals The Association Between Continuous Glucose Monitoring-derived Metrics, Including Time in Range, and Cardiovascular Autonomic Neuropathy in Outpatients With Type 2 Diabetes

2020 ◽  
Author(s):  
Min Young Kim ◽  
Gyuri Kim ◽  
Ji Yun Park ◽  
Min Sun Choi ◽  
Ji Eun Jun ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Autonomic Neuropathy ◽  
Autonomic Function ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Cardiovascular Autonomic Neuropathy ◽  
Inverse Association ◽  
International Consensus ◽  
Time In Range

Abstract BackgroundContinuous glucose monitoring (CGM)-derived metrics including time in range (TIR) are attracting attention as new indicators of glycemic control and diabetes complications beyond hemoglobin A1c. This study investigated the association between CGM-derived TIR, hyperglycemia, hypoglycemia metrics, and cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes.MethodsA total of 284 patients with type 2 diabetes who underwent CGM for three days and autonomic function tests within three months based on outpatient data were recruited. The definition of CGM-derived metrics was subject to the most recent international consensus. CAN was defined as an abnormal case in two or more parasympathetic and the severity of CAN was estimated as the sum of the scores of the five cardiovascular autonomic function tests.ResultsMultiple logistic regression analysis revealed that the odds ratio of definite CAN was 0.876 [95% confidence interval (CI): 0.79–0.98] per 10% increase in the TIR of 70 to 180 mg/dL, after adjusting for age, sex, diabetes duration, any medications, and glycemic variability. A 10% increase in TIR was significantly inversely associated with the presence of advanced CAN (OR: 0.89, 95% CI: 0.81–0.98). In addition, there was a strong inverse association between a 10% increase in the TIR and the total CAN score (p for trend = 0.001). Among the metrics of hyperglycemia, a time above range (TAR) of greater than 180 mg/dL was also independently correlated with the presence of definite CAN (OR: 1.013, 95% CI: 1.00–1.02) and advanced CAN (OR: 1.01, 95% CI: 1.00–1.02).ConclusionsA TIR value of 70 to 180 mg/dL and a TAR value of greater than 180 mg/dL were significantly associated with cardiovascular autonomic neuropathy in outpatients with type 2 diabetes.

scholarly journals Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs, and nurses in the East of England

2020 ◽  
Vol 70 (698) ◽  
pp. e668-e675
Author(s):  
Hajira Dambha-Miller ◽  
Simon J Griffin ◽  
Ann Louise Kinmonth ◽  
Jenni Burt
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Care Provision ◽  
Structured Interviews ◽  
High Quality ◽  
Face To Face ◽  
Healthcare Experiences ◽  
Provision Of Services ◽  
The Impact

BackgroundThere is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients, their GPs, and nurses.AimTo explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses.Design and settingA qualitative primary care interview study in the East of England.MethodSemi-structured interviews were conducted, between August 2017 and August 2018, with people who have type 2 diabetes along with their respective GPs and nurses. Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed.ResultsThe authors interviewed 24 patients and 15 GPs and nurses, identifying a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient responders wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes care provision. A reluctant acknowledgement surfaced among GPs, nurses, and their patients that only minimum care standards could be maintained, with aspirations for high-quality provision unlikely to be met.ConclusionType 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably by patients and providers, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed, and realistic, may be one way forward.

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