Improvement of mild and more serious hypoglycemia in patients with DM type 1 and type 2 after introduction of Continuous Glucose monitoring in Internal Medicine Residency Clinic
Authors: A Manov  , J House  , S Antonio  , M Banal  , J Nazha  
Published: March 2023

We are describing our experience of introducing Continuous Glucose Monitoring (CGM) for the first time as far as we know not in specialized endocrine clinic, but in Internal Medicine Residency Clinic in USA. The 25- patients we included in the trial were with type 2 Diabetes Mellitus (DM 2) -85% and Type 1 DM (DM1)-15%. They were treated with multiple injections of Insulin per day and were self-Monitoring their blood glucose (SMBG) 4 times a day. Their HbA1c was in the beginning of the trial was 9.5-to 14%. Before the introduction of the CGM the patients were spending 1 hour and 14 minutes a day having mild hypoglycemia- between 69-54 mg/dl-4.75% and more significant hypoglycemia- less than 54 mg/dl 29 min a day-3.01%. The CGM was started in the Clinic by the CGM team. In the CGM team were actively participating a10- Internal medicine and Transitional Year Residents under the supervision of board-Certified Endocrinologist who was a member of the clinic also. The CGM used was Dexcom G6. The goal of the project was to show that not only in specialized centers, but in General Internal Medicine Residency clinic we can not only improve the control of DM type 1 and type 2 in those 25- patients but most importantly reduce the time they had hypoglycemia. The Internal Medicine and Transitional year Residents were actively involved in the project. They were educating the patients before starting the CGM on their die and how to adjust their Insulin at home based on written instruction materials and treat their low blood sugar. The patients were called at least once a week by Internal Medicine Clinic representative of the CGM team with instructions how to adjust their Insulin, treat their hypoglycemia and to counsel them about their diet and physical activity. The patients had scheduled appointment to the clinic once a month. After the glucotoxicity from the initial high blood sugar was overcomed by using the appropriate dose of Insulin the control of the diabetes was achieved with reduction of HbA1c to 7.04% mean from 11.21% before the introduction of the CGM. With the help of the CGM the time spent by the patients with BS less than 70 mg/dl decreased from 1 hour and 14 minutes per day-4.75% to 11 minutes per day-0.78% and the time spend with blood sugar less than 54 mg/dl per day decreased from 29 minutes-3.01% to 3 minute per day-0.25%. Both values after the introduction of CGM were within the American Diabetic Association (ADA) standards- mild hypoglycemia goal of less than 4 % and more significant hypoglycemia goal of less than 1 % per day. Four of the patients were able to have excellent control of their DM 2 without any low blood glucose only on per oral antidiabetic medications and or GLP1-RAG. Our experience showed that introduction of CGM instead of SMBG in General Internal Medicine residency Clinic can help a lot of patients with DM type 1 and type 2 on multiple injections of insulin per day to reduce mild and more serious hypoglycemia and improve their blood sugar control with Insulin. Also, we showed that this can be done safely in General Internal Residency clinic and not only in specialized endocrine clinics which can be adopted in other Internal Medicine residency Clinics in USA. This also significantly improves the education and experience with the CGM devise of our Internal Medicine and Transitional Year Medical Residents.