Authors (including presenting author) :
Wong TW, Au KY, Chan SW, Chan WS, Chong YC, Kwok KP, Leung HT, Leung JYY, Wong WM
Department of Medicine and Geriatrics, Ruttonjee Hospital
Affiliation :
Department of Medicine and Geriatrics, Ruttonjee Hospital
Introduction :
Diabetic management based on HbA1c level alone with or without home blood sugar monitoring is often insufficient to guide optimal management in diabetic patients. With advance in technology, continuous glucose monitor system (CGMS) can over the limitation of HbA1c by providing a continuum of glucose data, and give information on glycaemic variability, the amount of time in hyperglycaemia or hypoglycaemia. These parameters allow a more personalized approach for professional to help direct changes in management including medication adjustment, dietary and lifestyle advice. A real-time CGMS also allows patient to view immediate glucose level and trend for taking immediate action.
Objectives :
The objective is to see whether offering a free real-time CGM device to diabetic patients in an outpatient setting, together with professional support and feedback, would improve glycaemic outcome.
Methodology :
It is a retrospective single center analysis of a 10-14 days of CGMS trial in type 1 or type 2 diabetic patients conducted in the diabetic clinic in Ruttonjee Hospital between August 2020 and November 2021. Patients were instructed to do a food diary during the trial period. Upon completion, the CGM report and food diary were reviewed by endocrinologist and DM nurse to give recommendation.
Result & Outcome :
A total of 135 eligible patients (35 Type 1DM; 100 Type 2DM) were included in the analysis. The mean age was 57.7 (±13.1) years old, with male to female ratio of 0.55:0.45. Insulin user comprised of 97% (n=127). The pre-intervention mean HbA1c was 8.38% (±1.33%). Overall, 73% of patients had improvement in HbA1c. There was a significant reduction in mean HbA1c of 0.49% (±1.04%) (p <0.001) overall. However, glycaemic improvement was seen only in type 2 diabetic patients with a 0.68% HbA1c reduction (p<0.001). Furthermore, those who participated between August 2020 and March 2021 (n=74) had greater HbA1c reduction than those who participated between April 2021 and November 2021 (n=61), with HbA1c reduction of 0.682% vs. 0.323% (p=0.046).
Conclusion
The use of a single real-time CGM device is worthwhile in outpatient clinic setting, given adequate professional support and guidance, in improving glycaemic control especially in patients requiring insulin.
