Work

Use of Continuous Glucose Monitoring and Glucagon-Like Peptide 1 Receptor Agonist Therapy to Achieve Individualized Treatment Goals in Insulin-Treated People With Type 2 Diabetes: A Case Series and Expert Opinion

Year: 2023

Type: article

Abstract: Case Presentation 1A 54-year-old man with a 5-year history of type 2 diabetes and hypertension presented to his primary care clinician for uncontrolled diabetes with a recent A1C of 10.3%.He had to take control of his diabetes (A1C <7.0%) before his clinician would perform surgery for a lumbar herniated disc.His current medications included metformin 1,000 mg twice daily, insulin detemir 52 units every evening, atorvastatin 40 mg daily, and lisinopril 20 mg daily.At the visit, the patient denied significant polyuria or weight loss but reported increased thirst.Glucose data were limited because the patient worked in landscaping and was unable to consistently wash his hands to perform fingerstick blood glucose monitoring checks.His blood pressure was 136/74 mmHg, and his weight was 81.8 kg (BMI 28 kg/m 2 ).An intermittently scanned continuous glucose monitoring (CGM) system was placed at the initial visit.A 2-week review of the CGM data showed a glucose management indicator (GMI) of 10.1% (mean glucose 284 mg/dL, coefficient of variation [%CV] 29.5%) (Figure 1A).The patient had spent 63% of the time with glucose levels >250 mg/dL, with only 10% time in range (TIR; 70-180 mg/dL) (Figure 1B and C).There was a consistent pattern of fasting hyperglycemia in the range of 180-200 mg/dL, with a >100 mg/dL decline in glucose overnight without hypoglycemia.The CGM report also revealed significant postprandial excursions.

Source: Clinical Diabetes

DOI: 10.2337/cd23-0047

Authors: Nicole M. Ehrhardt, Vanita R. Aroda, Rodolfo J. Galindo, Anne L. Peters, Jay H. Shubrook