Clinical Value and Evidence of Continuous Glucose Monitoring

Transcription

1 Clinical Value and Evidence of Continuous Glucose Monitoring

2 Objective To review the clinical value and the recent clinical evidence for Professional and Personal CGM Key Points CGM reveals insights beyond A1C and fingerstick testing CGM reduces A1C while improving hypoglycemia detection Personal CGM reduces A1C while decreasing glycemic variability Continuous use of Personal CGM is associated with significant improvement in A1C

3 CGM Reveals Insights Beyond Fingerstick Testing 300 Glucose mg/dl Target Zone Fingersticks Alone Continuous Glucose Monitoring 3AM 6AM 9AM 12PM 3PM 6PM 9PM Time of Day

4 Blood Glucose Variability Standard of Care? Greater Frequency and Magnitude of Glycemic Variability Increased Oxidative Stress via Reactive Oxygen Species Despite comparable A1C, conventionally treated patients had markedly higher risk of progression to retinopathy than those treated intensively DCCT finding Glucose Variability, considered in combination with A1C, is a more reliable indicator of blood glucose control and the risk of long-term complications than mean A1C alone Hirsch et al., Journal of Diab and Its Complications 19 (2005)

5 CGM Reveals Glycemic Variability Masked by A1C 9 type 1 insulin pump patients treated with Lispro Patients placed on CGMS for 24 hours Professional CGM revealed excessive glucose variability in well controlled patients Glucose Concentration (mg/dl) Mean A1C 6.7% 12AM 4AM 8AM 12PM 4PM 8PM 12AM A normal to low A1C may be the result of hypoglycemic events Levetan C, et al. Diabetes Care 2003; 26:1-8

6 CGM Completes the Picture Fingerstick Testing A1C CGM Modern Diabetes Management Requires a Comprehensive Approach

7 Customize Diabetes Management Based Upon the Needs of Your Practice and Patients Continuous Glucose Monitoring Professional CGM Personal CGM Continuous glucose monitoring for healthcare providers Continuous glucose monitoring for patients Professional CGM reveals insights not possible with fingerstick testing alone

8 Professional CGM Reveals Postprandial Hyperglycemia Hidden with Fingersticks 56 type 1 pediatric patients with A1C 7.7% and near target pre-meal glucose 90% experienced glucose levels of > 180 mg/dl after meals Almost 50% experienced glucose levels of > 300 mg/dl after meals CGM is particularly valuable in detecting unrecognized postprandial hyperglycemia Boland E, et al. Diabetes Care 2001;24: Adapted from AACE Diabetes Mellitus Guidelines. Endocr Pract. 2007;13(Suppl 1):3-68.

9 Professional CGM Leads to a Reduction in Severe Hypoglycemic Events 10 patients with a history of severe hypoglycemia CGM profiles reviewed and therapy adjustments made No Change in A1C (7.2 +/- 0.8) No Change in total daily insulin dose Sabbah et al., Diabetes, (suppl. 2):1877-PO.

10 Professional CGM Decreases Hypoglycemic Events in Type 1 Pediatric Patients 27 type 1 pediatric patients (6 13 yrs), with a mean A1C of 7.6% on MDI therapy CGM profiles reviewed and therapy adjustments made Hypoglycemia defined at 55 mg/dl CGM is particularly valuable in detecting unrecognized nocturnal hypoglycemia Adapted from Schiaffini et al., Diabetes Metab Res Rev 2002; 18: Adapted from AACE Diabetes Mellitus Guidelines. Endocr Pract. 2007;13(Suppl 1):3-68.

11 Professional CGM Reduces A1C while Improving Hypoglycemia Detection Conventional (SMBG) or CGM therapy for 3 months Both groups received intensive treatment Therapy adjustments were made as required Chase et al., Pediatrics 2001, 107:

12 Customize Diabetes Management Based Upon the Needs of Your Practice and Patients Continuous Glucose Monitoring Professional CGM Personal CGM Continuous glucose monitoring for healthcare providers Continuous glucose monitoring for patients Personal CGM Increases Time in Target Zone Garg S., et al, Diabetes Care 2006

13 Continuous Use of Personal CGM is Associated with Significant A1C Improvement 162 type 1 Patients randomized to 3 arms in a 3 month study A1C of 8.1% or above MDI 52% Insulin pump 48% Adults 81 / Peds 81 1% A1C Reduction 26% of these patients had a 2 % A1C reduction Deiss et al., Diabetes Care 2006 Vol. 29

14 Personal CGM Reduces Duration of Hypoglycemic Excursions 71 type 1 patients wore sensors over a 12 day period Multi-center RCT where patients were randomized to: Alert Group Alerts On 50% Alerts Off 50% Control Group Alerts Off Patient Response to REAL-Time alarms Improve Glycemic Control Bode B., et al. Diabetes Technology and Therapeutics. Volume 6, Number 2, 2004

15 Continuous Use of Personal CGM Increases Time in Target Zone 91 insulin dependent patients wore a glucose sensor for 3 consecutive 72 hour periods Patients were randomized into a control group or a display group Garg S., et al, Diabetes Care 2006

16 Clinical Guidelines for Continuous Glucose Monitoring Arrange for continuous glucose monitoring for patients with Type 1 Diabetes with unstable glucose control and for patients unable to achieve an acceptable A1C level; continuous glucose monitoring is particularly valuable in detecting both unrecognized nocturnal hypoglycemia and postprandial hyperglycemia AACE Medical Guidelines for Clinical Practice, 2007

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