SAT-127 Hypoglycemic Episodes in Type 2 Diabetes Mellitus : Continuous Glucose Monitoring Versus Self Monitoring of Blood Glucose

Abstract

Introduction: Strict glycemic control with lifestyle modifications has been emphasized to prevent microvascular and macrovascular diabetic complications. However patients treated with intensive treatment often experienced more frequent episodes of hypoglycemia than did those treated with the standard treatment. Moreover, resent trials revealed that episodes of severe hypoglycemia were associated with an increased risk of subsequent mortality and morbidity. The use of CGM can detect both symptomatic and silent hypoglycaemia and can therefore prevent hypoglycaemia related morbidities and mortality. Aim: To detect occurrence of hypoglycaemic episodes by continuous glucose monitoring (CGM) and self monitoring of blood glucose (SMBG) in type 2 diabetic patients Methods: Ninety one type 2 diabetes mellitus patients who have Hb A1C ≤ 7.5 % and treated with insulin or insulin secretagogue (sulphonylureas and meglitinides) were included in this study. After making history taking and physical examination, they were instructed to record their food diary, medication history, to perform SMBG 4 times per day and to wear CGM for 72 hours period. At the end of 72 hours, CGM was removed from patient's body and data were submitted to Medtronic database. The report on continuous monitoring of patients’ blood glucose were downloaded from the database and interpreted for hypoglycemic episodes. Results: During study period, 16 patients (17.6 %) experienced symptomatic and 14 patients (15.4%) experienced silent hypoglycaemias which were detected by SMBG. In comparison, 16 patients (17.6%) experienced symptomatic whereas 17 patients (18.7%) experienced silent hypoglycaemiaby using CGM system. The accuracy of CGM had 93.4% sensitivity and 96.7% specificity in detection of hypoglycemia in study population. So it had overall accuracy of 95.6%. However, the numbers of hypoglycemic episodes detected by CGM were higher compared to SMBG (43 versus 107) within 72 hours of observation.Most of the hypoglycaemic episodes occurred in AM1 (00:00 AM to 6:00AM) ie,nocturnal followed by PM2 (18:01 PM 23:59 PM) ie, post dinner to bed time. Conclusion: We concluded that hypoglycemia is relatively common in fairly controlled type 2 diabetic patients. The accuracy of CGM was 95.6% in overall which is very good accuracy. With regards to the detection of number of hypoglycemic episodes, CGM is more reliable.