Case Series on Implementation of Continuous Glucose Monitoring for Better Glycemic Control without Long-acting Insulin

Abstract

In our case series, we are describing 6 patients with uncontrolled, complicated type 2 Diabetes Mellitus (Type 2-DM). Although they were self-monitoring their blood glucose (SMBG) at least 4 times a day, they continued to have suboptimal glucose control. Continuous glucose monitoring (CGM) was started at our Internal medicine residency primary care clinic. The patients were educated on diet, lifestyle changes, and how to adjust their insulin regimen according to their blood glucose results from the CGM as the standard of care. They were called every two weeks by the representative of our CGM team to monitor and answer any queries regarding insulin adjustment, blood glucose monitoring, diet, physical activity, or lifestyle. The CGM team included Internal medicine and transitional year medical residents and a board-certified endocrinologist who was a member of our clinic. Moreover, the patients were seen at the clinic once every month by a member of the CGM team. Long and rapid-acting Insulins were started to achieve optimal glucose control initially. Eventually, Insulin dosage was gradually reduced, and the patients we described were started on alternate agents like oral antidiabetic agents with or without injectable glucagon-like peptide GLP-1 receptor agonists. The five-hour postprandial C-peptide was checked after discontinuation of insulin in all of our patients and was normal. Within a few months of CGM initiation, there was a significant improvement in the patients’ glucose control which was maintained after stopping the Insulin. Some patients were also able to lose weight. We concluded that CGM could be initiated safely in an internal medicine residency clinic not only at specialized endocrine clinics in a project that was managed primarily by internal medicine and transitional year residents under the supervision of a member of the clinic who was board certified in endocrinologists. We also demonstrated the introduction of CGM instead of SMBG in patients with Type 2-DM helped them to achieve better glycemic control with insulin, overcome glucose toxicity, and eventually stop the insulin and maintain excellent glucose control only with oral antidiabetic agents with or without injectable GLP 1 receptor agonist.