Glycosylated hemoglobin (HbA1c) and SMBG have been traditionally used as indicators of glycemic control in type 2 diabetes. However, both have their limitations, which affect the management. HbA1c denotes the average glucose over the preceding 3 months and not the daily fluctuations in the blood glucose levels. Self-monitoring of blood glucose (SMBG) is patient dependent. Again, it measures blood glucose only at that point of time and does not reflect the daily glycemic variability. Continuous glucose monitoring (CGM), on the other hand provides real-time data representing glycemic trends such as impending hypoglycemia or rapid excursions.¹ Intermittently scanned continuous glucose monitoring (isCGM) has been effectively used in type 1 diabetes.

The SPOT FIRST study has demonstrated the utility of isCGM in patients with type 2 diabetes and states. One-time use of isCGM before consulting an endocrinologist had a favorable impact on glucose control, according to the study, which was presented at ATTD 2023, the 16th International Conference on Advanced Technologies & Treatments for Diabetes held in Berlin last month. The findings were simultaneously published in the journal Diabetes Technology & Therapeutics.²

Ninety-four patients with poorly controlled type 2 diabetes who had been using capillary blood glucose tests to track their glycemic status were enrolled in this study. None of them had ever used continuous glucose monitoring; 55 were given an isCGM device to use one time, 14 days before their first consultation with an endocrinologist, while the remaining 39 continued with SMBG prior to their specialist appointment. Then both the intervention and the control groups went back to capillary blood glucose tests. Based on the data obtained through capillary blood glucose testing or isCGM, modifications were made to their current treatment. The data was used by investigators aimed to find out if isCGM data at the first consultation improved treatment outcomes compared to data obtained from capillary blood glucose testing.

Reduction in HbA1c was significant among patients in the isCGM group, from 8.3% at the time of the first consultation (baseline) to 7.4% at the first follow-up visit after 133 days (average) without increase in hypoglycemia. Conversely, HbA1c showed only a small decline from 8.4% to 8.2% in the control group. In the isCGM group, the reduction in HbA1c was seen to persist at the second follow-up visit after an average of 165 days compared to the control group; 7.6% versus 8.2%, respectively, even though the patients had stopped using isCGM and were self-monitoring their blood glucose levels.

This study highlights the salutary effect of having isCGM data prior to the first consultation on glycemic control in patients with poorly controlled type 2 diabetes. The beneficial effect was sustained after the second follow-up visit.

References

1. Edelman SV, et al. Clinical implications of real-time and intermittently scanned continuous glucose monitoring. Diabetes Care. 2018 Nov;41(11):2265-2274. doi: 10.2337/dc18-1150.
2. Jain A, et al. OP052 / #366. Extended outcomes with intermittently scanned CGM (isCGM) used prior to first appointment with an endocrinologist, compared to capillary blood glucose (CBG) monitoring (SPOT‐FIRST study). Diabetes Technol Ther. 2023 Feb.;25(Suppl 2):A-61. DOI: 10.1089/dia.2023.2525.abstracts.