Authors (including presenting author) :
AU SKY(1), LAM YH(1), CHAN M(2), WONG YS(3), HUANG HY(1), HO SY(1), KWOK KP(2), CHEUNG SM(1), LIU A(1), CHAN W(2), WONG S(2), WONG WM(3), Dr. HUI G(3), Dr. LEUNG JYY(2), Dr. LAU EYF(1)
Affiliation :
Diabetes Centre (1)Pamela Youde Nethersole Eastern Hospital1 (2)Ruttonjee & Tang Shiu Kin Hospitals, (3)Tung Wah Eastern Hospital
Introduction :
Continuous Glucose Monitoring (CGM) automatically tracks the trend of interstitial glucose levels throughout the day. Visualizing blood glucose levels in real time helps monitor its changes with the type of food taken, physical activity and anti-diabetic medications, which in turn empowers patients to make decisions on diabetic self-care. Randomized control trials have demonstrated the effectiveness of CGM on improving glycaemic control and reducing the risk of hypoglycaemia in patients with diabetes (DM).
Objectives :
This study aims to evaluate whether changes in self-management behaviour during the CGM period can be sustained.
Methodology :
Patients with suboptimal DM control or high risk of hypoglycaemia were recruited from PYNEH, RTSKH & TWEH during the period from July 2020 to April 2021. Insulin Injection technique, diet control and management of hypoglycaemia were reinforced before application of the CGM sensor. Patients were instructed to record their food intake and insulin dosage during CGM. HbA1c were measured before and at 6, 12 and 18 months after CGM.
Result & Outcome :
There were 282 patients (Male: 52.5%; 20-88 years old; Mean age 56.1±14.1years old; Type 2: 75.5%; Pregnant women: 1.8%; Duration of living with diabetes: 0.2-68 years; Mean duration of DM: 17.5±10.5 years; Newly diagnosed: 5.3%) being recruited. Majority (89.7%) of the patients were insulin users. The target Time-in-Range (TIR) of interstitial glucose target was set between 3.9 to 10mmol/L. The percentage TIR of our patients ranges from 1.8% to 97.4%. 210 patients (74.7%) had hypoglycaemia documented by CGM, including nocturnal or fasting hypoglycaemia; with almost half of them (48.8%) experienced Level 2 hypoglycaemia (< 3.0mmol/L). More than 75% patients made adjustment on their treatment regimen, of which 25.5% of them reduced the dosage of insulin used. Their HbA1c improved progressively from 8.7±1.6% to 8.2±1.5%, 8.1±1.4% and 8.0±1.4% at 6, 12 and 18-months respectively (mean difference 0.7%, 95% CI: -0.44 to -0.96). More than 20% patients achieved HbA1c < 7% at 18-month compared with 9.2%, 15.5%, and 16.7% at 0, 6 & 12-month. The fasting blood glucose and LDL-Cholesterol had also improved, though not statistically significant. In average patients visited DM nurse for 5.7±5.2 times during the 18 months period in Nurse Clinic or via tele-consultation. 79.8% of them had CGM performed once; while the number of sensors used during the period was 1.3±0.7 sensors per patient and 16 patients documented continuous use of CGM on their own cost.
The utilization of CGM with real-time graphic display helps detect trends and patterns to provide a more complete picture of glycaemic control for better diabetes management. This study demonstrated that lifestyle changes with CGM use can be sustained. It allows ongoing collaborative communication between patients and health care professionals. Improvement in HbA1c continued to be observed over 18 months in this group of patients who had suboptimal glycaemic control.
