CGM is expected to improve IRR and reduce the risk of hypoglycemia

Obesity and type 2 diabetes are closely related because they share an insulin resistance mechanism. According to the Obesity Fact Sheet 2021 in Korea, the incidence of type 2 diabetes was 2.6 times higher in obese patients overall, with more than 30 kg / m2. At this year’s International Conference on Obesity and Metabolic Syndrome (ICOMES 2022), effective management strategies for patients with obesity and type 2 diabetes were discussed as a major topic. Name of the Emory University that gave the lectureProfessor Ye (Western Sydney Diabetes Prevention and Management Initiative) pointed out that continuous blood glucose measurement (CGM) is an effective strategy for the management of patients with obesity and type 2 diabetes.

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Clinical Benefits of CGM

Professor Maberly pointed out that CGM has a number of clinical benefits. First, he introduced, “CGM is a method of measuring blood glucose on the surface around subcutaneous cells without reaching the bloodstream.” Therefore, it is explained that it can replace the self-monitoring of blood glucose currently in use. Self-monitoring of blood glucose is necessary to control insulin dose, control low blood sugar, rapid blood sugar change, and calibrate diabetes management devices, but can be a burden on the patient. In this regard, CGM can reduce the burden on diabetic patients.

He also pointed out that CGM can compensate for the limits of glycated hemoglobin (A1C). A1C is widely used to control the average blood sugar level, but cannot confirm the incidence of hypoglycemia or the variability of blood glucose. Conversely, the CGM can check the evaluation period, sensor operating rate, mean glucose (mmol / L), glycemic management index (GMI), glucose variability, and rate within range target (TIR).

Furthermore, Professor Maberly noted that ‘it can help doctors and patients choose a better treatment strategy because it can confirm real eating patterns and can also be a good tool for lifestyle improvement.’

Improvement of the TIR by CGM

Above all, Professor Maberly placed great emphasis on the fact that TIR can be controlled and managed via CGM. He said, “The clinical role of IRR is emphasized in the American Diabetes Association (ADA) guidelines and has a significant correlation with clinical outcomes. For every 10% increase in IRR, A1C was found to decrease. 0.8%. ”He stressed that TIR management is the key.

In a related study, TIR was associated with microvascular complications, particularly retinopathy and microalbuminuria, and the risk of macrovascular complications decreased with increasing TIR ratio.

Examples of Freestyle Libre applications
– Male patient in his forties

Professor Maberly explained the effect of CGM on TIR control in patients with type 2 diabetes through the use of Freestyle Libre, a representative CGM device. First, we introduced a case of a male patient with type 2 diabetes mellitus for 6 years. At baseline, A1C was 13%, body weight was 160 kg, and BMI was 52.3 kg / m2.

As a result of evaluation with Freestyle Librero for 14 days, mean glucose was 12.3 mmol / L, GMI was 8.6% (or 71 mmol / mol), and blood glucose variability was 21.1% . In the TIR assessment, the appropriate interval ratio was 22% and the high ratio was 50%. When the management strategy was modified based on these data and evaluated after approximately 4 months, the mean blood glucose level was 7.3 mmol / l and body mass index improved to 6.5% (or 47 mmol / mol). IRR also improved the appropriate level ratio to 95%, 5% for high or very high and 0% for low or very low.

Examples of Freestyle Libre applications
– 70-year-old patients with long-term illness

The second case presented by Professor Meberly was an elderly patient in his 70s with type 2 diabetes. This patient had a history of acute myocardial infarction, kidney disease, chronic obstructive pulmonary disease (COPD), bladder cancer and peripheral neuropathy. Baseline A1C was 8.1%, eGFR was 35, fasting cholesterol was 3.2 mmol / l and body weight was 103 kg., BMI was 32.5 kg / m2.

As a result of evaluation with Freestyle Librero for 14 days, mean glucose was 12.8 mmol / mol, GMI was 8.8% (or 73 mmol / mol), and blood glucose variability was 27. , 6%. In the TIR assessment, the ratio maintained in the appropriate range was 18%, high 48% and very high 34% and there was neither low nor very low.

As a result of approximately 3 months follow-up with the diet, the mean blood glucose level was 9.4 mmol / mol and the GMI improved to 7.3% (or 57 mmol / mol). The very high IRR was 3%, the maximum 36%, the appropriate range was 59%, the minimum 2% and the minimum 0%.

Effective tools in COVID-19

Professor Maberly also noted that CGM is an effective tool for managing diabetes despite the current COVID-19 pandemic. He presented a study conducted at the beginning of the COVID-19 pandemic, when it was difficult to cope with patients, and explained that CGM has been shown to be effective in identifying real hypoglycemic patients.

This study involved 55 subjects. Thirty-two were male and the mean age was 59.9 years (34-86 years). 52 patients had type 2 diabetes and 93% were receiving insulin. The mean A1C was 9.4% (± 2.1%). As a result of controlling the incidence of hypoglycemia, 23 (39%) self-reported hypoglycemia, but 37 (63%) confirmed hypoglycemia by CGM.

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“Means of effective management as well as means of patient education”

Professor Maberly said: “CGM has been suggested as an effective method for appropriate multidose therapy or insulin pump treatment in patients with type 1 diabetes and is also widely used in patients with type 2 diabetes who use insulin “. diabetes management is growing settled there

Areas that can benefit in detail include improved clinical outcomes for diabetic patients, patient observation in hospitals during the COVID-19 pandemic, connectivity with general clinical information systems, and more accurate and convenient blood glucose monitoring for elderly patients and better behavioral habits, physical activity and daily living habits of pre-diabetic patients.

Also, regarding Freestyle Libre, a CGM representative, “it can be applied to patients with suspected hypoglycemia and eating problems because their blood glucose is not well controlled with insulin. In addition, it can be used as an intermittent diagnostic or educational tool and is highly preferred by patients as it can replace the existing self-monitoring blood glucose measurement. “

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