From the Guidelines
The patient's refusal to use continuous glucose monitoring (CGM) necessitates close monitoring of her diabetes management through regular blood glucose monitoring using traditional fingerstick methods, as emphasized by the importance of glucose monitoring in managing diabetes, particularly for patients on intensive insulin regimens 1. Given her current situation, where she is on the maximum dose of Mounjaro but previously required insulin therapy that was discontinued due to a rash, it is crucial to assess her current glycemic control. The rash that developed after increasing insulin dosage suggests a possible allergic reaction, which necessitates proper evaluation by her endocrinologist to determine appropriate alternative treatments 1. Key points to consider in her management include:
- The importance of glucose monitoring in diabetes management, especially for patients on intensive insulin regimens or those with a history of insulin use 1.
- The need for regular evaluation of her blood glucose levels, given her refusal to use CGM, to adjust her treatment plan as necessary and prevent complications such as hypoglycemia and hyperglycemia 1.
- The potential for Mounjaro at maximum dose to be insufficient alone if she previously required insulin therapy, highlighting the need for her endocrinologist to consider alternative insulin formulations or other injectable medications that might not trigger similar reactions 1.
- The importance of patient education on how to use blood glucose monitoring data to adjust food intake, exercise, and pharmacologic therapy, as well as the need for ongoing instruction and regular evaluation of technique, results, and ability to use data from self-monitoring of blood glucose to adjust therapy 1.
From the Research
Patient Information
- The patient is on the maximum dose of Monjoura and refuses to use Continuous Glucose Monitoring (CGM).
- The patient was previously on Insuline, but the dose was doubled, resulting in a rash, and the medication was discontinued.
- The patient was advised to schedule an appointment with an endocrinologist and was established prior to being seen at this clinic.
Relevant Studies
- A study published in 2016 2 discussed the limitations of Self-Monitoring of Blood Glucose (SMBG) and the benefits of Continuous Glucose Monitoring (CGM) in managing insulin-treated diabetes.
- A 2011 study 3 compared the effectiveness of CGM plus SMBG versus SMBG alone in managing diabetes and found moderate quality evidence that CGM + SMBG is not more effective than SMBG alone in reducing HbA1c or hypoglycemic events in patients with type 1 diabetes using insulin infusion pumps.
- A 2021 randomized clinical trial 4 found that CGM resulted in significantly lower HbA1c levels at 8 months compared to blood glucose meter monitoring in adults with poorly controlled type 2 diabetes treated with basal insulin without prandial insulin.
- A 2024 systematic review and meta-analysis 5 found that CGM use was associated with improvements in glycemic control in adults with type 2 diabetes, including a decrease in HbA1c and an increase in time in range.
CGM Benefits
- CGM provides real-time glucose readings, direction, and velocity of glucose change, and programmable alarms, offering a significant safety advantage over SMBG 2.
- CGM has been shown to be beneficial in detecting elevated ketone bodies in patients with type 1 diabetes 6.
- CGM use has been associated with improved glycemic control, including increased time in range and decreased time below range and above range 5.