Type 2 Diabetes Management in Primary Care: The Role of Retrospective, Professional Continuous Glucose Monitoring
- Maneesh Shrivastav1,
- William Gibson Jr.2,
- Rajendra Shrivastav3,
- Katie Elzea4,
- Cyrus Khambatta5,
- Rohan Sonawane1,
- Joseph A. Sierra1 and
- Robert Vigersky1
- 1Medtronic, Northridge, CA
- 2Diabetes Assessment and Management Center, Shreveport, LA
- 3Community Hospital of Staunton, Staunton, IL
- 4HealthEast Diabetes and Endocrinology, St. Paul, MN
- 5Mangoman Nutrition and Fitness, LLC, San Francisco, CA
- Corresponding author: Maneesh Shrivastav, maneesh.a.shrivastav{at}medtronic.com
Diabetes is a major worldwide epidemic with >415 million individuals living with the disease. This number is expected to grow to a staggering 642 million by 2040 (1). According to the American Diabetes Association, diabetes affects 29.1 million Americans, or 9.3% of the population. Diabetes management in the United States presents several challenges: 20% of individuals with diabetes remain undiagnosed, 1.4 million new cases are diagnosed annually, and one-third of adults with diabetes are not at the general recommended A1C goal of <7% (2).
In addition to the clinical burden of diabetes, the financial impact is also substantial. The cost of diagnosed diabetes was ∼$245 billion in 2013, representing a 41% increase over the previous 5 years. These costs include inpatient care, prescriptions and supplies for the management of the disease and its complications, doctor office visits, and nursing care and facility stays (3).
According to the Centers for Disease Control and Prevention, primary care visits accounted for 52.3% of all medical office visits in the United States in 2013. Diabetes was the fifth ranked primary diagnosis for such visits, accounting for ∼3% of primary diagnoses (4). At the heart of diabetes management is the challenge of adequately controlling glucose over the long term to prevent complications such as retinopathy, nephropathy, and neuropathy while avoiding potentially life-threatening hypoglycemia in the short term.
Continuous glucose monitoring (CGM) technology is one advancement that can improve overall glycemic control while minimizing hypoglycemia (5). CGM has been available since the late 1990s. However, its use is not widespread. Clinical inertia is often cited as major barriers to the use of CGM. The introduction of new technology into a clinic requires initiative, awareness of its benefit, and efforts to integrate its use into the routine clinic workflow. This article reviews the use of …
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