Early Optimization of T2D Management with CGM

Provided by AAFP partner

Despite advancements and improved availability of therapeutic options in diabetes management, outcomes defined by hemoglobin A1C (A1C) have declined over the last two decades. Specifically, NHANES data indicate that the percentage of people with diabetes (PWD) with A1C values <7% has decreased from 57.4% in the 2007-2010 analysis to 50.5% in the 2015-2018 analysis.¹

Studies show that when glycemic goals are not met, the median time for a person to be prescribed an additional diabetes medication can range from one to seven years.^2,3 Delaying treatment intensification by just one year when glucose is above target has been associated with increased risk of myocardial infarction, heart failure, stroke, and composite cardiovascular events.⁴

Optimizing glycemic management to an A1C level <6.5% within the first year of a type 2 diabetes (T2D) diagnosis⁵ is fundamental to maximizing the protection against micro- and macrovascular complications.⁶

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A tool to accelerate positive outcomes

Continuous glucose monitoring (CGM) is proven to significantly improve A1C and time in range (TIR) among people with T2D regardless of insulin⁷ or non-insulin therapy,⁸ with positive outcomes demonstrated within three months.⁹

The American Diabetes Association states that diabetes devices, including CGM, should be offered to people with diabetes.¹⁰ While coverage for CGM has greatly expanded in recent years, less than half of PWD taking any kind of insulin are prescribed CGM to help manage their diabetes.¹¹

The opportunity to make a lasting impact for millions of PWD is monumental, and it is now. Watch this video to learn how a Findlay, Ohio-based family medicine doctor uses CGM as an early and primary prescription in the management of T2D, which has ignited change in local policy.

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Thomas Grace, MD, is a family medicine doctor in Findlay, Ohio. Dr. Grace is rated as a Distinguished doctor by MediFind in the treatment of type 2 diabetes (T2D). He is board certified in obesity medicine, and he is an active member of the American Diabetes Association and a Certified Diabetes Care and Education Specialist. Dr. Grace is an employee of Dexcom.

REFERENCES

Fang M, Wang D, Coresh J, Selvin E. Trends in Diabetes Treatment and Control in U.S. Adults, 1999-2018. N Engl J Med. 2021;384(23):2219-2228. doi:10.1056/NEJMsa2032271
Fu AZ, Qiu Y, Davies MJ, Radican L, Engel SS. Treatment intensification in patients with type 2 diabetes who failed metformin monotherapy. Diabetes Obes Metab. 2011;13(8):765-769. doi:10.1111/j.1463-1326.2011.01405.x
Khunti K, Wolden ML, Thorsted BL, Andersen M, Davies MJ. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care. 2013;36(11):3411-3417. doi:10.2337/dc13-0331
Paul SK, Klein K, Thorsted BL, Wolden ML, Khunti K. Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes. Cardiovasc Diabetol. 2015;14:100. doi:10.1186/s12933-015-0260-x
Laiteerapong N, Ham SA, Gao Y, et al. The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study). Diabetes Care. 2019;42(3):416-426. doi:10.2337/dc17-1144
Rodriguez P, San Martin VT, Pantalone KM. Therapeutic Inertia in the Management of Type 2 Diabetes: A Narrative Review. Diabetes Ther. Published online January 25, 2024. doi:10.1007/s13300-024-01530-9
Martens T, Beck RW, Bailey R, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin: A Randomized Clinical Trial. JAMA. 2021;325(22):2262–2272. doi:10.1001/jama.2021.7444
Shields S, Norman GJ, Thomas R, Ciemins EL. HbA1c Improvements After Initiation of Real-Time Continuous Glucose Monitoring in Primary Care Patients With Type 2 Diabetes. J Diabetes Sci Technol. 2023;17(5):1423-1424. doi:10.1177/19322968231171176
Grace T, Salyer J. Use of Real-Time Continuous Glucose Monitoring Improves Glycemic Control and Other Clinical Outcomes in Type 2 Diabetes Patients Treated with Less Intensive Therapy. Diabetes Technol Ther. 2022;24(1):26-31. doi:10.1089/dia.2021.0212
American Diabetes Association Professional Practice Committee. 7. Diabetes Technology: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S126-S144. doi:10.2337/dc24-S007
Seagrove Partners. 2023 Diabetes Blue Book.

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