Continuous Glucose Monitors Offer Substantial Glucose Improvements in Patients with Poorly Controlled Diabetes

The traditional method of glucose monitoring in diabetic patients includes a blood glucose reading, also known as the fingerstick method. Although blood glucose monitors (BGMs) are the fastest, most accurate form of glucose measurement, non-adherence to the patient’s prescribed frequency is common.

Patients with BGMs may be unaware of sudden, drastic changes in glucose due to the single point-in-time measurements. A1c measurements are the gold standard for assessing the average glucose reading over a 3-month period but are not useful for daily readings or sudden changes in glucose.

Continuous glucose monitors (CGMs) benefit diabetic patients by continuously tracking glucose trends. CGMs eliminate the need for frequent fingerstick use and carrying BGM supplies.

In May 2022, the FDA cleared the next-generation FreeStyle Libre 3 system (Abbott) for use in patients 4 years of age or older living with diabetes. The device is about the size of 2 stacked US pennies and is worn on the back of the upper arm with a 1-piece applicator that allows for easy application.

The system is intended for use with the FreeStyle Libre 3 iOS and Android mobile apps, which allows users to view their glucose levels in real time, track their glucose history and trends, and set up optional alarms with notifications to alter the user of serious medical events, such as hypoglycemia.

CGM data are easily accessible to patients and providers through these smartphone applications or handheld monitors. In patients with a long history of diabetes, on intensive insulin therapy, and/or at an elevated risk for hypoglycemia, CGMs can provide life-saving alerts for quick action.

A retrospective study published in Clinical Diabetes evaluated pharmacists’ impact on glycemic outcomes using a flash CGM in 3 patients with poorly controlled diabetes. Researchers assessed areas of percent time in range (TIR), time below range (TBR), time above range (TAR), and the glucose management indicator (GMI).

CGM data informed clinicians and pharmacists of the frequency and degree of glucose fluctuations. Using up-to-date glucose readings, clinicians adjusted therapy promptly as needed based on patient-specific factors. Clinicians monitored therapy response remotely and followed up with patients through telehealth visits.

Patient glucose variability from 2 weeks to 3 months of CGM use decreased between 3% and 4.2%. Two patients increased their percent TIR by 6% and 17%. One patient retained the same percent TIR after 3 months of down-titration and discontinuation of their basal insulin.

Patients saw real-time impact of lifestyle changes and therapy on their TIR while reducing incidences of hypoglycemia. All patients improved their glycemic control, AGP, and dietary choices after CGM use.

CGMs allowed patients to understand their glucose metrics and apply this in therapy decisions and lifestyle modifications. Pharmacists used CGM data tracking to improve outcomes, education, and overall daily patient burden.

References

Siemens R. Remote Pharmacist-Assisted Flash Continuous Glucose Monitoring Improves Glycemic Outcomes in Patients With Poorly Controlled Diabetes: A Retrospective Case Series. Clin Diabetes. 2022;40(2):211-221.