Andre Manov*, Elizabeth Benge, Samera Baig and Sukhjinder Chauhan
Diabetes mellitus affects more than 34 million and pre- diabetes mellitus affects 88-million Americans and the prevalence is rising. The disease leads to micro and macro vascular complications if uncontrolled. Diabetes Mellitus is the number one cause of blindness, non-traumatic amputation and ESRD in the USA. In our study, we retrospectively looked at patients in which as a standard of care Continuous Glucose Monitoring (CGM) with Dexcom G6 Device was started in Internal Medicine Residency Continuity Community clinic in Mountain View Hospital, Las Vegas, Nevada in 11-patients with type- I and type- II diabetes mellitus uncontrolled on 3-4 injections of Insulin per day who were self- monitoring their blood glucose 4- times a day (SMBG). The CGM was initiated by internal medicine residents through a remote portal, and the subsequent titration of the insulin dose was done by the residents under the supervision of a board-certified endocrinologist who was also a member of the clinic. The goal of the present study was to demonstrate improvement of patients? HbA1c measured by a glucose management indicator, a decrement of mild, defined as less than 70 mg/dl hypoglycemia and severe- defined as less than 54 mg/dl hypoglycemia to less than 4% and 1% respectively, achievement of time in range between 70- 180 mg/dl blood sugar in 24-hour period of 50-70% of the time based on the patient?s age and have glucose variability less than 36%. The HbA1c was reduced in 3- months after introduction of the CGM from 10.5% to 7.47%, the mild hypoglycemia with blood sugar less than 70 mg/dl happened on average 7- minutes a day (less than 4%) from 27- minutes and severe hypoglycemia happened 3- min a day (less than 1%) from 7 minutes while the patients were using SMBG. These were the goals with the use of CGM. Time in range we achieved was 62% which was between 50 and 70%. Based on the average age of the patient of 53- years this is compatible with the goals using CGM. The glucose variability was 29% below the goal of 36% which is excellent. The patient satisfaction with the device measured by the CGM Quality of life questionnaire was very good. The unique feature of this study is that it demonstrates the successful introduction of the CGM was done by Internal Medicine Residents under the supervision of a Board-Certified Endocrinologist who was also a member of the clinic which we are not aware that it was done before.
