International Diabetes Center at Park Nicollet, HealthPartners Institute, Minneapolis, MN, USA.
J Diabetes Sci Technol. 2021 May;15(3):539-545. doi: 10.1177/1932296821998724. Epub 2021 Mar 10.
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.
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.
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, =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.
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.
关于连续血糖监测（CGM）在 2 型糖尿病（T2D）的初级保健管理中的影响，数据很少。我们在一个大型医疗保健系统中启动了一个质量改进（QI）项目，以确定专业 CGM（pCGM）对血糖管理的影响。我们评估了 MD 和 RN/认证糖尿病护理和教育专家（CDCES）的护理模式。
参与者患有 T2D 超过 1 年，A1C≥7.0%至<11.0%，使用任何 T2D 治疗方案且愿意使用 pCGM。收集基线 A1C，参与者佩戴 pCGM（Libre Pro）长达 2 周，然后由 MD 或 RN/CDCES 进行访问，以查看 CGM 数据，包括动态血糖图谱（AGP）报告。共同决策用于修改生活方式和药物治疗。3 至 6 个月的临床随访包括 A1C，在亚组中，重复使用 pCGM。
68 名参与者平均年龄 61.6 岁，T2D 平均病程 15 年，平均 A1C 8.8%。与 pCGM 相关，A1C 从 8.8%±1.2%降至 8.2%±1.3%（n=68，=0.006）。在佩戴第二个 pCGM 的 37 名参与者中，TIR 和高血糖时间有所改善，同时低血糖时间也有所增加。血糖改善归因于生活方式咨询（68%的参与者）和治疗强化（65%的参与者），而不是添加药物。
在初级保健中使用 pCGM，与 MD 或 RN/CDCES 护理模式相结合，可有效降低 A1C，增加 TIR，减少高血糖时间，而无需额外使用药物。
