Impact of Continuous Glucose Monitoring (CGM) Devices in Managing Uncontrolled Diabetes Mellitus: A Retrospective Observational Study

In the United States, there are around 90 million individuals affected by impaired glucose tolerance and impaired fasting blood glucose(pre-diabetes), with an additional 34 million diagnosed with diabetes mellitus (DM). Among those diagnosed, the majority (90-95%) have type 2 diabetes mellitus (T2DM), while 5-10% have type 1 diabetes mellitus (T1DM) or other rare forms of the disease. This retrospective study aimed to assess the effectiveness of continuous glucose monitoring (CGM) devices in managing uncontrolled diabetes mellitus (DM). The study cohort comprised 25 patients with uncontrolled diabetes who received treatment at an internal medicine resident clinic. The objective was to evaluate the impact of transitioning from self-monitoring of blood glucose (SMBG) to CGM devices on glycemic control, as measured by changes in hemoglobin A1c (HbA1c) levels, average blood glucose levels, hypoglycemic events, time spent within the target blood sugar range, and glucose variability. The main objective of the study was also to see if this can be done by Internal medicine residents in the Residency clinic after appropriate education by a Board Certified Endocrinologist. It is known that this is the first project of introduction of CGM in an Internal medicine clinic and not a specialized endocrine clinic in a project driven by Internal medicine residents. This can be introduced in other internal medicine residency programs in the United States to improve the quality of treatment of Diabetes and the quality of education of Internal medicine Residents. The findings indicated significant improvements in glycemic control with the adoption of CGM devices, highlighting their potential benefits for optimizing diabetes management. The mean HbA1c after transitioning from self-monitoring blood glucose (SMBG) to CGM decreased from 11.21% to 7.04% and average blood glucose decreased from 286 mg/dl to 158 mg/dl. Time in range increased after the transition to CGM from 18% to 74%, and mild hypoglycemia decreased from 4.75% to 0.78%. The dangerous more pronounced hypoglycemia of less than 54 mg/dl decreased after the switch from SMBG to CGM from 3.01% to 0.2%. All patients were using 3-4 injections of Insulin per day plus other injectable or peroral antidiabetic medications.

The study is fascinating because it was done in an internal medicine continuity clinic with the main participation of the internal medicine residents under the supervision of an endocrinologist. It was not done as the majority of the other studies used CGM in specialized endocrinology clinics.