Hi-R-Ed Online

Introduction

This course examines the use of continuous glucose monitors in type-2 diabetes. We will focus on why their use is recommended in certain patients, the benefits they provide, and how to use them. Their success is well documented, and they are fairly straightforward to use, and we will review some clinical literature that will help to illustrate why their use has become so popular today.

Learning Objectives

The learning objectives for this program are listed below.

Upon completion of this course you should be able to:

1. List at least three justifications for the use of continuous glucose monitors (CGMs).

2. Define three benefits of CGM use.

3. Describe the three types of data CGMs provide.

4. Describe two ways CGMs can help to optimize outcomes.

Background

Fifteen years after Diabetes Control and Complications Trial (DCCT) was published, we still have not managed to achieve glucose control within recommended guidelines. Here a few statistics to give you an idea of how serious this problem is:

Only 37% of patients with diabetes obtain the levels of glucose control recommended by the American Diabetes Association.1

The care of patients with diabetes is costly.

1 in 5 healthcare dollars is being spent on diabetes.2

However, all the data obtained to date indicate that tight glucose control is the standard of care.3

This has proven to be most challenging for patients using insulin therapy, due to fear and incidence of hypoglycemia.

Beyond clinical measures the quality of life of patients with diabetes is key to treatment success and reducing anxiety tied to severe hypoglycemia and cute hyperglycemia can relieve the burden of care and improve quality of life.

Proven Need

This data illustrates that there is room for improvement in clinical glycemic control in children, as we can see an average daily excursion above target range of more than 19 hours per day. And, of course, with SMBG (only) we can only see a tiny portion of this time represented.

30 children wearing a CGM device for 3 months*

Fox L, et al. Presented at: American Diabetes Association 66th Scientific Sessions; June 9-13, 2006; Washington, DC. Abstract 391-P.

*Average HbA1c of 6.8%.

Glucose Threshold	Average Hours Each Day Above Threshold
180 mg/dL (10 mmol)	8.7
200 mg/dL (11 mmol)	6.6
250 mg/dL (14 mmol)	2.8
300 mg/dL (17 mmol)	0.9

And far more impactful in our pediatric population is time spent in a potentially hazardous or even life threatening hypoglycemic range with children spending, on average an hour of each day below target range, the impacts of quality of life, social and academic development and even brain development can be marked.

30 children wearing a CGM device for 3 months*

Fox L, et al. Presented at: American Diabetes Association 66th Scientific Sessions; June 9-13, 2006; Washington, DC. Abstract 391-P.

*Average HbA1c of 6.8%.

Glucose Threshold	Average Minutes Each Day Below Threshold
70 mg/dL (3.9 mmol)	71
60 mg/dL (3.3 mmol)	34
50 mg/dL (2.8 mmol)	14
40 mg/dL (2.2 mmol)	5