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Patients with hypercholesterolaemia with unchanging LDL-cholesterol levels after 6 weeks of statin treatment should be actively assessed for either statin intolerance or resistance, says an expert at the 7th Malaysian Endocrine and Metabolic Society (MEMS) Annual Congress.

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This case scenario was presented at a grand round in the Department of Medicine, The University of Hong Kong. Unlike traditional grand rounds that directly or indirectly deal with clinical challenges posed by patients, this one was equally about doctors and how they care for their charges. All doctors who tend patients dread being implicated on the receiving end of medico-legal proceedings. This topic is therefore intimately linked to the professionalism of doctors, their standing in the community, and the ethical aspects of how they interact with patients and relatives.

CGM adoption reduces frequency of SMBG tests without compromising glucose control

Jairia Dela Cruz
18 Sep 2017

Use of continuous glucose monitoring (CGM) in the management of diabetes may lead to performance of fewer self-monitoring blood glucose (SMBG) tests, without any deleterious impact on glycaemic control, according to a study presented at the 53rd Annual Meeting of the European Association for the Study of Diabetes (EASD 2017).

The findings support the recent REPLACE-BG trial reporting that the use of CGM without regular confirmatory blood glucose monitoring (BGM) measurements is as safe and effective as using CGM with BGM in well-controlled type 1 diabetes (T1D) patients, the investigators said. [Diabetes Care 2017;40;538-545]

In the current study, the investigators used data from the DIAMOND trial to examine the glycaemic outcomes of reducing the frequency of SMBG measurements among CGM users. They found that the mean SMBG frequency decreased by 30 percent, from 4.7/day at baseline to 3.3/day after 24 weeks of regular CGM use. This decrease occurred alongside a 0.9-percent average reduction in A1C (from 8.6 percent at baseline to 7.7 percent at week 24). [EASD 2017, abstract 706]

The observed reductions in A1C were consistent across all subgroups of patients: those who reduced their SMBG frequency by >1 test/day (n=75) vs those who did by ≤1 test/day (n=100; 0.9 percentage points in both; p=0.36), and those in the top quartile of SMBG reduction (mean decrease of ≥2.2 measurements/day) vs those in the lowest quartile (mean decrease of ≤0.4 measurements/day; 0.9 percentage points in both; p=0.56).

In terms of safety, one episode of severe hypoglycaemia occurred each in the SMBG frequency reduction subgroups (>1 and ≤1 test/day).

The analysis included 99 patients with T1D and 76 with type 2 diabetes (T2D) who used multiple daily insulin injections. Mean age of the cohort was 52 years, and all patients had SMBG data available at baseline and follow-up. Results did not significantly differ between T1D and T2D patients (p=0.39).

According to the investigators, the present data reinforce the scientific foundation for CGM.

Current CGM monitoring technology touts improved accuracy and reliability. Such technology advances include needle size reduction to minimize the foreign body response, improved manufacturing processes to reduce batch-to-batch variability, better sensor membrane chemistry to eliminate the effects of interfering compounds, and advanced signalling processing to reduce delay and filter out noise and compression artefacts. [J Diabetes Sci Technol 2017;doi:10.1177/193229681770444]

The improved accuracy and reliability will likely stimulate greater trust in—and therefore greater use of—the CGM device, the investigators said.

To date, there is only one US Food and Drug Administration-approved CGM system indicated for use in routine diabetes management decisions without a confirmatory SMBG test.

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Most Read Articles
01 Jun 2015
Long-term oral testosterone undecanoate significantly improved IPSS quality of life scores in a 1-year, randomised, multicentre, double-blind trial among aging hypogonadal men.
Rachel Soon, 01 Jun 2016

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Rachel Soon, 01 Jun 2016

Patients with hypercholesterolaemia with unchanging LDL-cholesterol levels after 6 weeks of statin treatment should be actively assessed for either statin intolerance or resistance, says an expert at the 7th Malaysian Endocrine and Metabolic Society (MEMS) Annual Congress.

Prof. Cyrus Rustam Kumana, 07 Jul 2016

This case scenario was presented at a grand round in the Department of Medicine, The University of Hong Kong. Unlike traditional grand rounds that directly or indirectly deal with clinical challenges posed by patients, this one was equally about doctors and how they care for their charges. All doctors who tend patients dread being implicated on the receiving end of medico-legal proceedings. This topic is therefore intimately linked to the professionalism of doctors, their standing in the community, and the ethical aspects of how they interact with patients and relatives.