DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20200032

Ambulatory glucose profile as an educational tool in the management of patients with type 2 diabetes mellitus

A. G. Unnikrishnan, Vedavati Bharat Purandare

Abstract


A 60-year-old male patient with Type 2 Diabetes Mellitus (T2DM) since the last two years was presented in the clinic with repeated falls. He was on dietary treatment and was also taking metformin 500 mg twice daily, on and off. His Fasting Plasma Glucose (FPG) was 116 mg/dL, Postprandial Glucose (PPG) was 140 mg/dL and Glycosylated Haemoglobin (HbA1c) was 6.4%. The complete glycaemic profile obtained from the first Ambulatory Glucose Profile (AGP) revealed that the patient was not having hypoglycaemia and has very minimal glucose fluctuations without any post-prandial excursions. The visual cue obtained from Continuous Glucose Monitoring (CGM) / AGP enabled physicians to better inform the patient on the effects of medication and lifestyle on diabetes, thereby allowing the patient to make informed treatment and lifestyle modifications. This case study sheds light on the need to recommend AGP in such cases to provide insights on the glucose trends, thereby improve patient’s confidence in the therapy, with lifestyle modification.


Keywords


Ambulatory glucose profile, Diabetes education, Hypoglycaemia, Type 2 diabetes mellitus

Full Text:

PDF

References


Little M, Humphries S, Patel K, Dodd W, Dewey C. Factors associated with glucose tolerance, pre-diabetes, and type 2 diabetes in a rural community of south India: a cross-sectional study. Diabetol Metab Synd. 2016 Dec;8(1):21.

Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, et al. Diabetes Epidemiology Study Group in India (DESI. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia. 2001 Sep 1;44(9):1094-101.

Barik A, Mazumdar S, Chowdhury A, Rai RK. Physiological and behavioral risk factors of type 2 diabetes mellitus in rural India. BMJ Open Diabe Res Care. 2016 Aug 1;4(1):e000255.

Tripathy JP, Thakur JS, Jeet G, Chawla S, Jain S, Pal A, et al. Prevalence and risk factors of diabetes in a large community-based study in North India: results from a STEPS survey in Punjab, India. Diabetol Metab Synd. 2017 Dec;9(1):8.

Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research–INdia DIABetes (ICMR-INDIAB) study. Diabetologia. 2011 Dec 1;54(12):3022-7.

Mohan V, Deepa M, Deepa R, Shanthirani CS, Farooq S, Ganesan A, et al. Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India-the Chennai Urban Rural Epidemiology Study (CURES-17). Diabetologia. 2006 Jun 1;49(6):1175-8.

Ofori SN, Unachukwu CN. Holistic approach to prevention and management of type 2 diabetes mellitus in a family setting. Diabe, Metab Synd Obesity: Targets Therapy. 2014;7:159.

Nathan DM. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabe Care, 2014;37(1):9-16.

Turner RC, Holman RR. Lessons from UK prospective diabetes study. Diabe Res Clin Pract. 1995 Jan 1;28:S151-7.

Temelkova-Kurktschiev TS, Koehler C, Henkel E, Leonhardt W, Fuecker KA, Hanefeld M. Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c level. Diabe Care. 2000 Dec 1;23(12):1830-4.

Suh S, Kim JH. Glycemic variability: how do we measure it and why is it important?. Diabe Metab J. 2015 Aug 1;39(4):273-82.

Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al., Consensus Statement by The American Association of Clinical Endocrinologists And American College Of Endocrinology On The Comprehensive Type 2 Diabetes Management Algorithm - 2019 Executive Summary. Endocr Pract. 2019;25(1):69-100.

Mitra A, Dewanjee D, Dey B. Mechanistic studies of lifestyle interventions in type 2 diabetes. World J Diabe. 2012 Dec 15;3(12):201.

Taylor PJ, Thompson CH, Brinkworth GD. Effectiveness and acceptability of continuous glucose monitoring for type 2 diabetes management: A narrative review. J Diabe Invest. 2018 Jul;9(4):713-25.

Hirsch IB, Battelino T, Peters AL. Role of Continuous Glucose Monitoring in Diabetes Treatment. American Diabetes Association; 2018:1-28.

Allen NA, Fain JA, Braun B, Chipkin SR. Continuous glucose monitoring counseling improves physical activity behaviors of individuals with type 2 diabetes: a randomized clinical trial. Diabe Res Clin Pract. 2008 Jun 1;80(3):371-9.

Yoo HJ, An HG, Park SY, Ryu OH, Kim HY, Seo JA, et al. Use of a real time continuous glucose monitoring system as a motivational device for poorly controlled type 2 diabetes. Diabe Res Clin Pract. 2008 Oct 1;82(1):73-9.

Allen N, Whittemore R, Melkus G. A continuous glucose monitoring and problem-solving intervention to change physical activity behavior in women with type 2 diabetes: a pilot study. Diabe Technol Therap. 2011 Nov 1;13(11):1091-9.

Cox DJ, Taylor AG, Singh H, Moncrief M, Diamond A, Yancy Jr WS, et al. Glycemic load, exercise, and monitoring blood glucose (GEM): a paradigm shift in the treatment of type 2 diabetes mellitus. Diabe Res Clin Pract. 2016 Jan 1;111:28-35.