Issue 40 Februay 2012
1. Acceptance of Continuing Glucose Monitoring(CGM) as a Routine Investigation in Diabetes

This research presented at Spain, was carried out by a multi disciplinary team led by Dr. Jothydev Kesavadev and included Dr. Arun Shankar, Dr. Pradeep Babu.S.Pilllai, Gopika Krishnan, Geethu Sanal, Jayasree Lally and Sunitha Jothydev. This research paper presented at ATTD February,2012 Barcelona, Spain assesses the level of acceptance of Continuous Glucose Monitoring (CGM) as a routine investigation in diabetes.

Eight years back, CGM used to be a selective investigation in Jothydev’s Diabetes Research Center, confined to insulin pump users. With the advancements in technology, ease of using and interpreting the results of CGM have developed at a rapid pace. Since 2008, we have been using CGM in pre-diabetes, type 2 and type 1 diabetes with the aim of changing the therapeutic regimen, making intelligent decisions on diet, exercise etc. CGM has now evolved as part of routine clinical care in selected subjects. Despite being relatively expensive, the acceptance of this technology among the diabetes patients has been overwhelming. This study looks at the comfort and convenience of patients and our nurse educators and the influence of a multitude of factors on the practical use of various CGM devices available in India.

We conducted cross sectional survey among patients and nurse educators who performed CGM at our center to evaluate its acceptability. Questionnaires were administered to patients to assess level of acceptance of performing a CGM and the appreciation of glycemic trends. Separate questionnaires were administered to nurse educators to analyze the improvement in CGM technology.

Of 107 patients interviewed, 88% were male. The subjects had type 2 diabetes (n=93, duration= 15 ±8.3 years), type 1 diabetes (n=14, duration= 8.6 ± 7.5 years), or pre-diabetes (n=1). The most commonly used CGM devices were Paradigm 722 (68%) and ipro2 (30%).Among these, the prevalence of breaks in continuous recordings was least in ipro2 (13%) vs. Paradigm 722 (52%).Unusable data was got only with two readings. When asked whether they were fearful of CGM testing, 79% subjects were unafraid both before and afterwards the test, 16% were afraid before but not afterwards, 4% said they were afraid both before and afterwards, and 1% turned fearful after the CGM recording. Negative feedback also included high cost (29%) and inconvenience (27%). Positive feedback included those on utility of being shown glycemic trends, such as wide-glycemic excursions (76%) and patterns related to diet and exercise (74%), which helped changed lifestyle, diet, and exercise (93%). 94% of subjects also had had their medication s changed following CGM. Only 3% expressed unwillingness to undergo CGM again, with the remaining 97% giving an average of 6 ± 1 days as their preferred duration of CGM.

The profound impact of CGM data on diet, exercise and drugs has made it highly acceptable as a routine investigation in diabetes. Emergence of new generation devices resolving the existing limitations facilitated the use of CGM as a routine investigation in diabetes. This study conducted among 107 subjects and nurse educators establishes the utility of CGM irrespective of the type of diabetes or therapeutic regimen.

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