Manov Andrey, Haddadin Rakahn, Chauhan Sukhjinder, Benge Elizabeth
Internal Medicine, MountainView Hospital, Las Vegas, USA.
Cureus. 2024 Jul 15;16(7):e64594. doi: 10.7759/cureus.64594. eCollection 2024 Jul.
In this three-year retrospective study, data from 51 patients with type 1 or type 2 diabetes mellitus (DM), receiving a minimum of 3-4 insulin injections per day and self-monitoring their blood glucose (SMBG) four times a day, were derived from our internal medicine residency primary care clinic. The patients were equipped with a continuous glucose monitoring (CGM) device that shared 24-hour glucose data with the clinic. They were assigned to members of our CGM team, which included internal medicine or transitional year medical residents who functioned under the supervision of a board-certified endocrinologist. The residents, in consultation with our endocrinologist, assessed the patients' glucose management data and adjusted their treatment regimens biweekly by calling the patients, and monthly by seeing the patients in the clinic. Significant results from the study include a reduction in HbA1c from 9.9% to 7.6%, an average blood glucose decrement from 242 mg/dL to 169 mg/dL, a reduction in the incidence of mild hypoglycemia from below 70 mg/dL to 54 mg/dL, from 4.68% to 0.76% per day, and a more pronounced hypoglycemia with glucose less than 54 mg/dL from 3.1% per day to 0.2% per day. We observed a significant increase in the time in the range of the blood glucose from 33% to 67% per day. Furthermore, 9.5% of the patients in this study eventually discontinued their daily insulin injections and continued treatment with oral diabetic medications with or without the use of injectable GLP-1 receptors once a week. Our study affirms that CGM devices significantly improve glycemic control compared to SMBG, supporting its efficacy in optimizing glycemic control in real-world clinical practice. The results imply that this can be accomplished in internal medicine residency clinics and not exclusively in specialized endocrine clinics. As far as we know, this is the first study of its kind in a residency clinic in the USA. This study confirms the benefits of widening the application of CGM in DM, along with the challenges that must be overcome to realize the evidence-based benefits of this technology. CGM needs to become a part of routine monitoring for type 1 and type 2 DM.
在这项为期三年的回顾性研究中，数据来自我们内科住院医师初级保健诊所的51例1型或2型糖尿病（DM）患者，这些患者每天至少注射3 - 4次胰岛素，并每天进行4次自我血糖监测（SMBG）。患者配备了连续血糖监测（CGM）设备，该设备与诊所共享24小时血糖数据。他们被分配到我们的CGM团队成员中，该团队包括在内科认证内分泌专家监督下工作的内科或过渡年医学住院医师。住院医师与我们的内分泌专家协商，评估患者的血糖管理数据，并通过给患者打电话每两周调整一次治疗方案，每月在诊所看诊时调整一次。该研究的显著结果包括糖化血红蛋白（HbA1c）从9.9%降至7.6%，平均血糖从242mg/dL降至169mg/dL，轻度低血糖（血糖低于70mg/dL）的发生率从每天4.68%降至0.76%，以及更严重的低血糖（血糖低于54mg/dL）从每天3.1%降至0.2%。我们观察到血糖处于目标范围内的时间显著增加，从每天33%增至67%。此外，本研究中9.5%的患者最终停止了每日胰岛素注射，继续使用口服降糖药物治疗，部分患者每周使用或不使用注射用胰高血糖素样肽-1（GLP-1）受体激动剂。我们的研究证实，与自我血糖监测相比，连续血糖监测设备能显著改善血糖控制，支持其在现实临床实践中优化血糖控制的疗效。结果表明，这在内科住院医师诊所即可实现，并非仅在专门的内分泌诊所。据我们所知，这是美国住院医师诊所中首例此类研究。本研究证实了扩大连续血糖监测在糖尿病中应用的益处，以及实现该技术循证效益必须克服的挑战。连续血糖监测需要成为1型和2型糖尿病常规监测的一部分。
