Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 2

2 - AMBULATORY GLUCOSE PROFILING (AGP) HELPS BRIDGE THE GLYCAEMIC GAP BETWEEN CONVENTIONAL SUGARS AND HBA1C THUS FACILITATING BETTER CONTROL IN YOUNGER PATIENTS AND THOSE WITH UNPREDICTABLE LIFESTYLES.

Thursday, Apr 25
12:00 PM – 12:30 PM

Objective :

Often in  younger patients and patients on the move with erratic eating and exercise habits, while conventional sugar readings may be satisfactory, HbA1C can be off the mark. Titrating doses or tweaking treatment in such patients  is difficult and can be hazardous because in absence of the complete glycaemic profile, clinical evaluation may miss the highs and worsen the lows.A real-time glossary of sugar levels using AGP would help the clinician plan appropriate intervention 


 


Methods :

83 patients between the ages of 23 and 40 years with Type II diabetes and with HbA1c ranging from 7.5 to 9% (average 8.49) and FBS and PLBS  being near target, were included in the study.All these patints had no other significant comorbidities but only a history of unpredictable lifestyle Freestyle libre-bro sensor was applied to the patients after explaining and consenting them. They were called  for follow up on 5th, 10th and 14th day. Based on the daily readings and graphs obtained along with mean curve, diet and treatment changes were made on those visits.The sensor was removed after 14th day and patient was asked to follow up.


 


Results :

66 patients necessitated therapeutic intervention based on the daily variations and weekly summaries while the rest were subjected to diet and lifestyle modifications.The changes were instituted taking care to prevent hypos and surges to not affect quality of life. The mean HbA1c decreased in the fortnight from 8.49 to 8.09 as seen on the sensor.


Discussion :

 Using AGP, the glycaemic variability curves helped in recognising and treating asymptomatic hypoglycaemia, as well as unexpected surges in sugar at all times. In fact  the AGP helped to unfold the 24 hour sugar profile and bodily response of every patient.This  timely well-construed understanding helped punctuate the food/drug/ exercise routine of the patient, finally leading  to a better understanding and control of the metabolic profile.


Conclusion :

Systematic assimilation of AGP clearly scores over SMPG in patients with a volatile eating and exercise behaviour., The study also reiterates the fact that HbA1c alone, cannot be an appropriate indicator of glycaemic control.AGP detects those peaks and troughs which are often undetected in conventional measurements and  helps in achieving good glycaemic control especially in patients with challenging lifestyles.The need for clinicians to accept this therapeutic tool and extend it for  patients on nasogastric feeds,in psychiatric cases,those on antimalignancy or antiinfective therapy for a prolonged period of time, is important. In times to come with self readers, AGP would almost  certainly replace  SMPG in enligtened diabetics.

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Hemant Thacker

Consultant Physician and CardioMetabolic Speicialist
Breach Candy, Jaslok, Bhatia and H.N. Reliance Hospital
Mumbai, India

Dr. Hemant P. Thacker is an M.D. in Internal Medicine from Mumbai – attached to Breach Candy, Jaslok, Bhatia & Reliance H. N. hospitals. He is a Specialist in Cardio-Metabolic disorders and a Fellow of the American College of  Physicians  and Clinical Endocrinology.
  
Besides being a teacher for post graduate Medicine(DNB),  he has been the Principal Investigator for  numerous   International  and National Clinical trials and runs his own Research site which is audited and approved. He is a pioneer for antibiotic stewardship and under his guidance the first policy was designed in 2009 and released at Bhatia Hospital.
 
He is the founder member of the Preemptive Disease International Forum and the founding Chairman of the South Bombay Physician’s Club (academic body which has been active for over 12 years and MCI accredited).
 
He has presented cases and numerous posters at world conferences ( ADA, AACE, World Conference of Hypertension, etc) and has delivered orations and lectures in CardioMetabolics on diverse platforms for multiple organizations, across the globe.
He has innumerable publications in indexed journals  and has contributed  many chapters to the API textbook of post-graduate medicine. In 2014 he was awarded the Giants International award for his outstanding contribution in the field of medicine.

Rupal Shrimanker

Clinical Coordinator
Bhatia Hospital
Mumbai, India

Sr. Clinical Research Coordinator and Diabetic educator with Bhatia Hospital since 2004. She has worked has a coordinator in more than 30 trials for Diabetes, , Dyslipidemia, Heart failure, Cardiology and many more studies.