Continuous Glucose Monitoring-Assisted Insulin Dose Titration in the Indian Outpatient Setting

Abstract

Context: Monitoring blood glucose levels is an important aspect in the overall management of an individual with diabetes mellitus. Continuous glucose monitoring (CGM) system is an effective tool that enables physicians to do so by way of regular automated checks of sensor glucose (SG). Aims: In this article, we discuss in detail on how CGM technology works, practical aspects of its application and how CGM data are interpreted. We describe the different glucose sensors available in India and suggest when and whom to use them. We also evaluate the effectiveness of CGM-assisted titration of insulin dose in our hyperglycemic patients and discuss the results. Settings and Design: This is a single-center retrospective observational study of insulin-treated patients with diabetes attending the endocrinology outpatient department, who opted for a CGM-assisted insulin dose titration. Subjects and Methods: Monitoring was done using the Freestyle libre pro™ CGM system and insulin doses were titrated on regular follow-ups every 3–4 days for a total of 2 weeks. Patients who had an average SG level of more than 250 mg/dl on day 1 of monitoring, and had CGM data for a minimum of 12 days were included (n = 73). Data were analyzed using CGM-specific glucometrics including average SG and estimated A1c (eA1c) reduction, and changes in the percentage time in range (TIR), time below range (TBR), and time above range (TAR). Statistical Analysis Used: Not applicable. Results: When compared to day 1, the last day (D12–14) of CGM-assisted insulin dose titration showed: 1. An average SG reduction of 164.1 mg/dl (321.34 mg/dl → 157.24 mg/dl). 2. An eA1c reduction of 4.98% (12.08% → 7.1%). 3. An average TIR improvement of 51.21% (3.8% → 55.01%). 4. An average TAR reduction of 62.06% (96.12% → 34.06%). 5. An average increase in TBR from 0% to 10.21%. Target TIR >70% was achieved by 31/73 patients on D12-14, compared to 0/73 on day 1. Target TAR <25% was achieved by 43/73 patients on D12-14, compared to 0/73 on day 1. Target TBR <5% was not achieved by 21/73 patients on D12-14 when compared to 0/73 on day 1. Conclusions: CGM is a novel, easy-to-use, useful technology easily available in India for all patients with diabetes. We have demonstrated that quick and effective glycemic reduction is possible with CGM-assisted insulin dose titration within a short period of 2 weeks.