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INTENDED AUDIENCE
Diabetologists, Endocrinologists, Primary Care Physicians, Nurse Practitioners, Certified Diabetes Educators and other Health Care Professionals interested in the management of diabetes attending the respective 2017 AACE Annual Meeting.
STATEMENT OF NEED
Self-monitoring of blood glucose (SMBG) is a core component of a diabetic patient's management but only provides a measurement of blood glucose levels at a specific point in time, often missing trends, hyperglycemic or hypoglycemic excursions. HbA1c is even more limited and reports an average reading over 90 days; therefore incapable of alerting the patient of fluctuations in blood glucose at any point in time.
As Real Time (RT) Continuous Glucose Monitoring (CGM) continues to improve, treatment guidelines by leading societies have incorporated this technology to reduce glycemic excursions, episodes of dangerous hypoglycemic events, and reduce HbA1c. In 2011, The Endocrine Society recommended CGM use starting at 8 years of age for anyone with Type 1 diabetes (T1D) able to use it on a near-daily basis. More recently, the American Diabetes Association (ADA) added CGM to the 2014 Standards of Care, noting its potential benefits to lower HbA1c in adults ≥25 and preventing hypoglycemic events in all age groups. Multiple studies, however, indicate that the benefits of RT-CGM are only realized if it is used more than 70% of the time (≥5 days per week).
Other experts have focused on the use of CGM in the notification and prevention of hypoglycemic events, particularly in children, those who require supervision, and those with hypoglycemia unawareness. Despite the urgency of treating hypoglycemia, CGM is not commonly used in T1D children at this juncture. Reports show that <30% of children with T1D have an HbA1c <8%, and children experience episodes of severe hypoglycemia more frequently than adults. The ASPIRE trial of 247 patients showed that sensor augmented insulin pump therapy with a low glucose suspend significantly reduced nocturnal hypoglycemia, without increasing A1C levels for those >16 years of age.
CGM may also offer benefits for the Type 2 diabetes (T2D) adult. In addition to the potential to lower HbA1c and warn of hypoglycemic events and other glycemic excursions, the information provided can serve as an educational and motivational tool for these T2D patients by influencing their eating and exercise options.
Selection of an appropriate CGM device is important because improvements in accuracy and reliability are ongoing. RT-CGM is one cornerstone of optimal glycemic control. Each varies; relying on different sensing technology and requiring the traditional finger-stick for confirmation of alerts. The Mean Absolute Relative Difference (MARD) between sensor readings and reference glucose levels can vary by as much as 20% with worrisome discrepancies in the hypoglycemic range. But new generation devices have significantly improved MARD measurements. These devices have shorter lag times and improvements in accuracy. Many physicians are lacking the appropriate level of knowledge to employ CGM as part of their practices.
Significant improvements in accuracy of Continuous Glucose Monitoring (CGM) sensors and device algorithms have made CGM-based decisions a near-term possibility. These programs will evaluate the potential clinical application and use of CGM in diabetes management decisions and the importance of various aspects of CGM to guide treatment for those patients on multiple daily injections of insulin, as well as insulin pumps.
EDUCATIONAL OBJECTIVES
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Define the role of CGM in diabetes management treatment decisions for intensive insulin therapy patients
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Employ novel management strategies in personal and professional RT-CGM
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Identify patient types, via clinical case reports, that will most benefit from RT-CGM
ACCREDITATION AND CERTIFICATION
The American Association of Clinical Endocrinologists (AACE) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Association of Clinical Endocrinologists (AACE) designates this live activity for a maximum of 1.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Co-provided by AACE and
CogniMed Inc. This activity is supported by an independent educational grant provided by Dexcom.
© 2017 CogniMed Inc. All rights reserved. CGM19004 May 2017
