Utility of Continuous Glucose Monitoring in Type 2 Diabetes Mellitus Patients at Kenyatta National Hospital

Abstract

Background: Intensive diabetes therapy goal is to avert diabetes related complications, improve quality of life and reduce health cost burden. Local diabetic population have poor glycemic control with at least one diabetes related complication. Diabetes technology, Professional Continuous Glucose Monitoring (P-CGM), provides useful data on glucose trends and variability to be used in conjunction with the traditional glycemic control measures, can potentially revolutionize diabetes management. Locally there is a lacuna of data on the feasibility and acceptability of CGM use in our Type 2 Diabetes Mellitus (T2DM) population. Objective: To determine the utility of P-CGM in T2DM patients attending The Kenyatta National Hospital (KNH) Diabetes Outpatient Clinic. Design: Cross sectional design. Setting and duration: KNH Diabetes Outpatient Clinic and the study duration was 3 months. Population: Ambulatory T2DM patients on follow up at the KNH Diabetes Outpatient Clinic. Methods: 25 eligible T2DM patients were conveniently recruited. Consenting patients were fitted with the iProTM2 P-CGM by the PI and underwent 72-hours of blinded glucose recordings. We analyzed the 72-hour iProTM2 P-CGM recordings and a pre-defined criterion for feasibility and acceptability. Analysis: Data was analyzed using STATA version 13SE. Exploratory data analysis approach was used to identify and describe patterns in the data. Frequencies and proportions of subjects with specific outcomes to feasibility and acceptability were expressed in percentages. The glycemic variability and proportions of time were expressed in percentages. Results: 24 out of 25 ambulatory T2DM patients completed 72-hour continuous glucose monitoring period. 52% of the patients were aged 40-59 years and 64% were female. 95.8% of the patients had complete CGM data logs, the paired CGM and SBGM readings ≥2 /day was 100%, mean absolute difference < 28% was seen in all 24 patients (100%), 1 patient had premature removal of the sensor. Only 1 patient reported pain at the insertion site (4%), no other local reaction at the insertion site was reported. None of the patients experienced sleep disturbances or routine activity restriction. All 25 patients would wear the device again. 83% (n=24) of the participants had stable glucose with %CV of <36%, hypoglycemic and hyperglycemic excursions were reported in 20% and 65% of the patients respectively. The time in glycemic ranges, percentage of time spent in target was 58.4%, percentage of time spent above target was 36.3% and time spent below target was 5.3%. Conclusion: P-CGM using ipro2 device is feasible and acceptable to T2DM patients and there were no overt adverse reactions reported by participants. CGM data was useful in identifying previously unknown glycemic trends.