Author: Julia Vetsikas
A clinical practice guideline for inpatient hyperglycemia management from the Endocrine Society was published in The Journal of Clinical Endocrinology & Metabolism. The guideline focuses on hyperglycemia management in non-critically ill hospitalized patients and highlights the use of emerging diabetes technology, including real-time continuous glucose monitoring (RT-CGM), for glycemic management in the hospital. Based on available evidence, the guideline recommends use of RT-CGM with confirmatory point-of-care (POC) testing for insulin dosing decisions in adults with insulin-treated diabetes hospitalized for noncritical illness who are at high risk of hypoglycemia.
Korytkowski M, et al. Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2022;107(8):2101-2128.
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CME INFORMATION
Release Date: 9/15/2022
CE Expired
TARGET AUDIENCE
This activity is intended for primary care physicians and internal medicine physicians.
LEARNING OBJECTIVES
Upon completion of this activity, participants will:
- Have increased knowledge regarding the Data supporting use of rtCGM in practice
- Have greater competence related to Implementing practical strategies for
using rtCGM in practice
The US Food and Drug Administration (FDA) approved the Omni Pod 5 tubeless insulin pump technology for individuals aged 2 years and older with type 1 diabetes (T1D). Omnipod 5 is the first tubeless, wearable automated insulin delivery (AID) system that integrates with the Dexcom G6 real-time continuous glucose monitoring (RT-CGM) system and a compatible smartphone to automatically adjust insulin and help protect against both hyper- and hypoglycemia.
Learn MoreThe National Committee for Quality Assurance (NCQA) is revising its Healthcare Effectiveness Data and Information Set (HEDIS) standardized measures assessing plan performance for 2023. Notably, the 2023 dataset will include a new measure related to diabetes management: the risk-adjusted ratio of observed to expected emergency department visits for hypoglycemia among older adults (aged ≥67 years) with diabetes.
This measure reflects a key component of health plan quality pertaining to the management of diabetes, since older adults are more likely to experience severe hypoglycemia, potentially leading to several adverse outcomes: fall-related events and fractures, increased risk of cardiovascular events, and cognitive decline. Similarly, prevailing clinical practice guidelines for the treatment of older adults with diabetes emphasize the prevention of hypoglycemia as an important outcome. The new HEDIS measure provides an opportunity for health plans to identify older members with diabetes who are at highest risk of hypoglycemia and implement preventive interventions and more intensive management.
Learn MoreKey findings from the symposium at the Academy of Managed Care Pharmacy (AMCP) 2022 Annual Meeting.
Key Takeaways from Dr. Peek:
– rtCGM demonstrated a robust, sustained effect on glycemic control with fewer medications and no increase in insulin doses compared with
blood glucose monitoring (BGM) in the MOBILE RCT
– In the Kaiser analysis, rtCGM initiation reduced healthcare resource utilization for ER/admit due to hypoglycemia by 53%
– Expanded access to rtCGM is warranted based on these findings, particularly in underserved demographics disproportionately affected by
diabetes
Key Takeaways from Dr. Mistry:
– Pharmacy coverage of rtCGM for members with T1 and T2D can result in reduced resource utilization from improvements in clinical
management as well as cost savings for health plans via administrative efficiencies
-rtCGM offers an opportunity for improved outcomes
and proven PMPM savings when covered under the pharmacy benefit
Key Takeaways from Kelly Close:
– CGM represents the single most important tool for improving clinical outcomes and quality of life for people with diabetes
– The lives of people with diabetes have improved exponentially over the past several decades, but continued advancement is possible
with increased access to CGM and the application of more sophisticated measures such as TIR
Jointly provided by Impact Education, LLC, and Medical Education Resources.
This activity is supported by an independent educational grant from Dexcom, Inc.
In a retrospective claims analysis from Kaiser Permanente of Northern California, 149 patients with insulin-treated type 2 diabetes (T2D; baseline HbA1c <8%) who initiated real-time continuous glucose monitoring (RT-CGM) demonstrated durable glycemic benefit compared with 17,273 noninitiators serving as reference. RT-CGM initiation was associated with decreased HbA1c (-0.06%) while noninitiation was associated with increased HbA1c (+0.32%). A weighted adjusted difference-in-difference model of change in HbA1c yielded a net benefit of -0.30% (P=0.004) for RT-CGM. These findings highlight the notion that RT-CGM may be useful in preventing glycemic deterioration and offer a durable benefit in well-controlled patients with insulin-treated T2D.
Karter AJ, Parker MM, Moffet HH, Gilliam LK, Dlott R. Continuous Glucose Monitor Use Prevents Glycemic Deterioration in Insulin-Treated Patients with Type 2 Diabetes. Diabetes Technol Ther. 2022;24(5):332-337.
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