Can Continuous Glucose Monitoring be Successful in Managing Diabetes Mellitus in the General Internal Medicine Residency Clinic

Objectives: This 4-year retrospective extension study aimed to determine whether continuous glucose monitoring (CGM) can be safely implemented in an Internal Medicine Residency Clinic, not just in a specialized Endocrine Clinic, for managing Diabetes Mellitus Type 1 and Type 2 in patients who used 3-4 insulin injections daily and self-monitored blood glucose (SMBG) four times a day. We extended the study by an additional year to increase the sample size and statistical power and to assess whether longer-term CGM use would result in a sustained reduction in HbA1c, which also serves as a glucose management indicator. This was applicable to the original 51 patients we followed for three years, and now the study has been extended for one more year. We added 40 more patients and followed them for an additional year. An additional parameter was the reduction of the glucose management indicator (GMI), which had been used interchangeably with HbA1c during the first four months after introducing CGM, compared to the final GMI reduction at four years. In total, we monitored 91 patients. Our internal medicine and transitional year residents transitioned patients from SMBG to CGM devices to monitor blood glucose levels due to uncontrolled diabetes. They performed these duties under the supervision of a board-certified endocrinologist who was part of the clinic. Patients were continuously monitored by sharing their 24-hour glucose data with our clinic. Each patient was assigned to specific resident, who our endocrinologist initially trained to interpret CGM data and adjust insulin treatment accordingly. The residents maintained contact with their assigned patients via phone every two weeks and made treatment adjustments as needed. Patients also visited the clinic every two months for follow-up with members of the CGM team. The CGM team consulted with the endocrinologist whenever necessary to ensure optimal management of patients’ diabetes.