Potential Advantages of Continuous Glucose Monitoring(CGM) in Commencing and Titrating Insulin in Primary Care: Two Case Reports from the INITATION Study. — ASN Events
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Potential Advantages of Continuous Glucose Monitoring(CGM) in Commencing and Titrating Insulin in Primary Care: Two Case Reports from the INITATION Study. (#35)

Hanan Derraz 1 2 , Louise Ginnivan 3 , John Furler 3 , Irene Blackberry 3 , Neale Cohen 2 , James D Best 4 , Doris Young 3 , Alicia A Jenkins 4 , Daniel Liew 4 , Glenn Ward 5 , David O'Neal 4
  1. Primary care Research Unit,Department of General Practice, University of Melbourne, Melbourne, Vic, Australia
  2. Baker IDI Heart & Diabetes Institute, Melbourne, VIC, Australia
  3. Primary care Research Unit,Department of General Practice, University of Melbourne, Melbourne, Vic, Australia
  4. Dept of Medicine-St Vincents Hospital, University of Melbourne, Melbourne, VIC, Australia
  5. Dept of Endocrinolgy and Diabetes, St Vincents Hospital, Melbourne, VIC, Australia

The INITIATION study aims to evaluate a structured protocol on the safe and efficient commencement of a basal/prandial insulin regimen for people with type 2 Diabetes (T2D) by general practitioners (GPs) and practice nurses (PNs) with CDE-RN support. The study also examines the utility, efficacy and outcomes of retrospective Continuous Glucose Monitoring (CGM) versus Self-Monitoring Blood Glucose (SMBG). Aim: To illustrate the potential advantages of retrospective CGM in insulin initiation and titration in primary care based on two case reports. Methods: Two matched study participants (male, 65 years of age, sub-optimally controlled T2D of 8 years diabetes duration and HbA1c=10.3%) were randomized to SMBG (Optium Xceed™; Abbott) and CGM (iPro™2; Medtronic). Participants were followed for 24 weeks post insulin glargine (Sanofi) initiation, during which doses were titrated according to the study algorithm, based on scheduled data uploads from either SMBG meter or CGM. Insulin glulisine (Sanofi) could be added at any time after 4 weeks at the discretion of the GP. Masked CGM was undertaken for participants in the SMBG arm at baseline, 12 and 24 weeks for comparison with the CGM arm. Results: While having similar levels of glycaemia, the differences between the two patients are of interest. In comparison to the SBGM patient, the CGM patient a) commenced on a short acting analogue; b) on a lower total dose of insulin per Kg body-weight; and c) did not gain weight despite the SMBG patient prescribed a greater dose of metformin and a DPP4 inhibitor. Conclusions: The introduction of CGM in insulin initiation may produce additional advantages as compared to SMBG. The potential of CGM data in influencing current practice, clinical decisions and supporting GPs and PNs to utilize CGM data will be discussed.