Applications of interstitial glucose monitoring of diabetes in clinical practice

  • Katherine A. A. Alington

Student thesis: Doctoral Thesis

Abstract

Background and Aims
Traditional monitoring of diabetes has been through HbA1c measurement and finger-prick self monitoring of blood glucose. More recently continuous glucose monitoring has been developed and utilised in clinical practice. This provides more detailed glucose metrics to examine glycaemic control and overcomes limitations associated with HbA1c and self-monitoring such as missed variability and collection bias.
Patients with Type 1 and Type 2 Diabetes may develop pancreatic exocrine insufficiency and treatment with pancreatic enzyme replacement may impact upon glycaemic control. There are limited data to substantiate this and no studies have employed continuous glucose monitoring. In Gestational Diabetes, tight glycaemic control is essential and optimum management relies on the availability of adequate glucose results. Continuous glucose monitoring is not routinely used in Gestational Diabetes, but may provide a useful tool for glycaemic monitoring. Studies were undertaken in these two scenarios to examine the utility of continuous glucose monitoring.

Methods
Study 1: Participants with diabetes and pancreatic exocrine insufficiency were recruited to this single-arm phase IV trial. Participants undertook 14-days of blinded continuous glucose monitoring with baseline symptom questionnaire, HbA1c and weight measurement. Following pancreatic enzyme replacement therapy for six weeks, repeat 14-day blinded continuous glucose monitoring, questionnaire, HbA1c and weight measurement were recorded. Primary outcome was glucose variability.
Study 2: Women with gestational diabetes were recruited to this randomised controlled trial at 28 weeks gestation. All participants undertook 14 days of baseline blinded continuous glucose monitoring before randomisation to either self-monitoring or real-time continuous glucose monitoring. Further blinded continuous glucose monitoring was repeated prior to delivery. Primary outcome was number of glucose tests performed by participants.

Results
Study 1: 19 participants were recruited. There was no significant difference in glucose variability pre and post pancreatic enzyme replacement therapy (p=0.354). There were no significant differences in any glucose metrics or HbA1c after pancreatic enzyme replacement therapy. However, there was a significant improvement in abdominal pain, diarrhoea and bloating symptoms.
Study 2: 40 women were recruited and randomised. There were significantly more glucose tests performed by women using continuous glucose monitoring than those using self-monitoring during pregnancy (p=0.001). There were no significant differences in glucose metrics or adverse maternal or foetal outcomes between the two arms. Women in the continuous glucose monitoring arm reported significantly higher satisfaction than those using self-monitoring in six out of nine categories questioned (all p=<0.05).

Conclusion
Continuous glucose monitoring can be valuable, providing a reliable insight into previously undetected glycaemic patterns and provides additional information beyond HbA1c and self-monitoring. It is a useful tool to promote glucose monitoring in gestational diabetes. Pancreatic enzyme replacement has been shown to significantly improve symptoms of pancreatic exocrine insufficiency in patients with diabetes, without adverse changes in glycaemic control following initiation.
These studies demonstrate the ease of use and transferrable application of continuous glucose monitoring with the potential to better examine glycaemic control, improve patient satisfaction and aid management.
Date of AwardOct 2021
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorMridula Chopra (Supervisor)

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