RESUMO
Continuous glucose monitoring (CGM) was done in a 41 years-old female patient with type 2 diabetes mellitus (T2DM) to evaluate the glucose fluctuations, to achieve better glycemic control. The patient presented to the clinic with lethargy, on/off episodes of extreme weakness, sweating, and tingling sensation in the feet (B/L), with leg pains for the past 3 months. She did not have any history of hypertension and cardiovascular disease. On examination, her blood pressure was found to be 120/70 mm Hg. The fasting plasma glucose was 96 mg/dL, postprandial glucose was 160 mg/dL, and glycosylated hemoglobin was 6.8%. The patient was on metformin (500mg)- glimepiride (2mg) combination, once daily, before breakfast, and metformin (500mg) after dinner. Since the symptoms were related to glucose fluctuations and hypoglycemia, the patient was consequently recommended professional CGM to analyze the complete glycemic profile. The profile obtained from Ambulatory Glucose Profile (AGP) revealed glucose fluctuations observed as hypoglycaemia and hyperglycemic episodes. Consequently, the patient抯 treatment regimen was changed. The use of glimepiride was discontinued, and the patient was recommended with vildagliptin (50 mg) and metformin combination (1000 mg) bid with meals. This case study indicates that the use of CGM may help in improving our understanding of glycemic patterns and may have a beneficial effect on glycemic control.
RESUMO
The case report describes the potential role of real-time Ambulatory Glucose Profile (AGP) in identifying and managing a patient with hyperglycemia. This 55-years-old male patient with type 2 Diabetes Mellitus (T2DM) was presented to the clinic with weakness, increased urinary frequency, with constipation for the past 3 months. The patient was a known case of T2DM for 10 years, along with dyslipidemia, hypertension, and obesity. The profile obtained from AGP revealed glucose fluctuations with post-prandial excursions. Consequently, the patient抯 treatment regimen was changed. The use of glimepiride was discontinued, and the patient was recommended with voglibose 0.2 mg bid with two meals, metformin 100 mg + dapagliflozin 10 mg combination with morning meals, and metformin 1000 mg with evening meals. The treatment for hypertension and dyslipidemia was continued. This case study indicates that CGM can help improve our understanding of glycemic patterns and can have a beneficial effect on glycemic control.
RESUMO
This case report describes the management of a patient with mismatch/disparity between his Fasting Plasma Glucose (FPG)/ Postprandial Glucose (PPG) levels with that of Glycosylated Haemoglobin (HbA1c) levels. This 43-year-old male patient with Type 2 Diabetes Mellitus (T2DM) was presented with increased urination and tiredness, especially in the evening hours, along with a tingling sensation in bilateral feet on and off, with leg pain since past 4 months. The patient was obese with a family history of cardiovascular disease. In this patient, SGLT2 inhibitors were found to be effective in addressing glycaemic variability without triggering hypoglycaemic risk. Continuous glucose monitoring system aided in understanding the blood glucose fluctuations caused by the diet. This case study indicated that careful evaluation and appropriate management using Ambulatory Glucose profile would aid in preventing complications in such patients and improve the overall clinical outcomes.
RESUMO
A 60-year-old male patient with Type 2 Diabetes Mellitus (T2DM) since the last two years was presented in the clinic with repeated falls. He was on dietary treatment and was also taking metformin 500 mg twice daily, on and off. His Fasting Plasma Glucose (FPG) was 116 mg/dL, Postprandial Glucose (PPG) was 140 mg/dL and Glycosylated Haemoglobin (HbA1c) was 6.4%. The complete glycaemic profile obtained from the first Ambulatory Glucose Profile (AGP) revealed that the patient was not having hypoglycaemia and has very minimal glucose fluctuations without any post-prandial excursions. The visual cue obtained from Continuous Glucose Monitoring (CGM) / AGP enabled physicians to better inform the patient on the effects of medication and lifestyle on diabetes, thereby allowing the patient to make informed treatment and lifestyle modifications. This case study sheds light on the need to recommend AGP in such cases to provide insights on the glucose trends, thereby improve patient’s confidence in the therapy, with lifestyle modification.