Examining the Role of Remote CGM in Diabetes Management
Two posters presented at the American Diabetes Association 84th Scientific Sessions looked at challenges of remote CGM in older populations and after discharge from the hospital.
Diabetes is the eighth leading cause of death in the United States and impacts nearly 39 million people in the country.1 Complications from the disease include cardiovascular disease, nephropathy, coronary heart disease, retinopathy, and neuropathy, making it critical to keep the disease under control.2
Examining the Role of Remote CGM in Diabetes Management / romaset - stock.adobe.com
Continuous glucose monitoring (CGM) technology has come to be regarded as the gold standard for monitoring glucose levels, as it allows patients to implement dietary or other lifestyle changes to regulate their glucose levels.3 At the American Diabetes Association 84th Scientific Sessions, held June 21 to 24 in Orlando, Florida, 2 posters examined the role that remote CGM can play in diabetes management.
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In the first poster, investigators conducted a study to assess the benefit and challenges older patients who are on multiple daily insulin injections face when initiating a virtual CGM platform.4 The study cohort included 24 patients who started a remote CGM service between January and December 2023. Of the patients, the mean age was 72 years, the mean duration of diabetes was 30 years, and 52% were female, 76% were white, and 52% had type 1 diabetes.
The researchers conducted interviews and found that 100% of the patients viewed the remote education, ease of scheduling, and overall value of remote CGM favorably. All of the patients maintained the CGM over the study period and 95% said they planned to continue using it when the study was over. However, the patients did note some challenges, including difficulty with the mobile application, annoyance with alarms, and concerns for Medicare coverage.
“The results of this qualitative analysis show that in our cohort, remote initiation of CGM in older adults was perceived positively, despite some challenges,” the authors concluded.
In the second poster, investigators conducted a prospective cohort study to examine the feasibility and efficacy of remote CGM versus manual CGM following discharge from the hospital.5 The study cohort included 100 patients with type 2 diabetes who had an A1c greater than 8% and were currently taking basil insulin. The investigators collected 14-day CGM reports 4 weeks after hospital discharge.
Investigators found that barriers to use in the manual group included incompatible cell phone, no smartphone, or other reasons. Median glucose in the remote group was 176, compared to 203 in the manual group. Median time in range was 53% in the remote group, compared to 40% in the manual group. For both groups, the percent of time at less than 70 mg/dl was less than 1%. Additionally, patients in the remote group tended to be younger, more likely to be employed, and had higher numeracy.
“Early findings suggest that CGM with remote monitoring is associated with higher time in range compared to CGM with manual downloads following hospitalization,” the authors concluded. “Overcoming technological barriers to remote monitoring may improve glycemic outcomes post-discharge.”
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References
1. National Diabetes Statistics Report. Report. CDC. May 15, 2024. Accessed June 27, 2024. https://www.cdc.gov/diabetes/php/data-research/index.html
2. Kidanie BB, Alem G, Zeleke H, et al. Determinants of Diabetic Complication Among Adult Diabetic Patients in Debre Markos Referral Hospital, Northwest Ethiopia, 2018: Unmatched Case Control Study. Diabetes Metab Syndr Obes. 2020 Feb 4;13:237-245. doi: 10.2147/DMSO.S237250. PMID: 32099430; PMCID: PMC7007775.
3. Reddy N, Verma N, Dungan K. Monitoring Technologies- Continuous Glucose Monitoring, Mobile Technology, Biomarkers of Glycemic Control. [Updated 2023 Jul 8]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279046/
4. Mahoney C, Slyne C, Munshi M, et al. Remote Initiation of Continuous Glucose Monitoring in Older Adults Using Insulin. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 1004-P.
5. Folk S, Sobol T, Gatti T, et al. Remote Continuous Glucose Monitoring following Hospital Discharge. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 1024-P.
