A misdiagnosis of type 2 diabetes mellitus: Using CGM to improve patient-centered care
The American Diabetes Association recommends HbA1c to be a gold standard method for diagnosis of diabetes. HbA1c levels of 6.5 % twice can be a confirmatory diagnosis for diabetes. Historically, maintaining lower HbA1c is associated with reduced risk of micro and macro vascular complications.
HbA1c is considered to be a very convenient test since it does not need an individual with DM to be fasting or is not influence by shor-term stress, modifications in diet and illness and renders clinicians the benefit of evaluating blood glucose levels of a span of 120 days.
Continuous Glucose Monitoring (CGM) helps in better management of blood glucose and thereby enhances therapy interventions. This case based article “A misdiagnosis of type 2 diabetes mellitus: Using continuous glucose monitoring to improve patient-centered care” has thereby been put forth by Christine Schumacher and the summary of the article has been given below.
Diagnosis:
A patient with HbA1c levels being > 10 % was put on metformin 500 mg and titrated to 1000 mg. Inspite of the treatment regimen, she was experiencing Hypoglycemia.
Her reports of HbA1c were very variable with different results observed in random blood glucose monitoring at office visits, laboratory reports and home blood glucose monitoring.
Her other laboratory parameters were within normal quantitative limits.
Treatment:
A serum fructosamine test was done along with the administration of a CGMS to detect variability without being on metformin. A misdiagnosis of Type-2 diabetes was reported.
Results:
Even though the HbA1c is a hallmark method for diagnosis of diabetes, it is imperative to interpret the findings in clinical scenario and thereby understand the limitations of its utility.
It thereby implies the significance of CGM technology to aid in better treatment of diabetes and avoid the potential risk of any adverse events.
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