MON-659 - CGM Monitoring in Internal Medicine Residency Clinic: Prospective Trial - 4 Months Data

This prospective study aimed to evaluate how continuous glucose monitoring (CGM) use affects Glycemic Management Indicator (GMI) levels, which reflect HbA1c (estimated HbA1c), average blood glucose, and time in range (TIR) in patients who require multiple insulin injections—primarily those with Type 2 diabetes—and includes one patient with Type 1 diabetes mellitus.

The main goal of the project was to assess the role that Internal Medicine Residents play in CGM management under an endocrinologist's supervision in a General Internal Medicine residency clinic. This approach has not been implemented in such residency clinics before and, if successful, could be expanded to other Internal Medicine residency programs across the USA and eventually integrated into the Internal Medicine residency curriculum, an innovation in residents’ education.

Patients were recruited from the Internal Medicine Residency Clinic. Eligibility criteria included an initial HbA1c level between 7% and 14%, self-monitoring of blood glucose (SMBG) four times daily, and qualification for use of a CGM device.

Additionally, the study includes patients with Diabetes Mellitus who use three to four daily insulin injections, with or without other diabetic medications. After appropriate education by a board-certified endocrinologist, internal medicine residents remotely monitor patients who transition from SMBG to CGM. Patients share their CGM data with the Internal Medicine Clinic. Participants are contacted every two weeks by their designated resident physician via telephone and seen bi-monthly in the clinic by members of the CGM team. All residents work under the supervision of a board-certified endocrinologist, who oversees the project and is also part of the clinic. The study is planned to last 24 months.

Currently, we have 4 months of data from 24 patients, providing insight into patient outcomes to date. The data show that after switching from SMBG to CGM at the four-month mark, the GMI decreased from 9.92% to 7.74%. The average blood glucose decreased from 275 mg/dl to 176 mg/dl, and the TIR increased from 30% to 57%. All three parameters improved significantly. The first 2 months after the switch to CGM were the most critical period.

In this first prospective study in an Internal Medicine residency clinic in the USA at 4 months, we concluded that CGM, compared with SMBG, can lead to significant improvements in GMI, average blood glucose, and TIR. This demonstrates the feasibility of implementing CGM not only in specialist endocrine clinics but also in an Internal Medicine residency clinic, in a project managed by Internal Medicine and transitional year residents under the supervision of an endocrinologist. This is a pioneering study highlighting the potential of CGM to enhance medical residents’ education and to be included in the Internal Medicine educational curriculum.

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